title: Experience of plastic surgery registrars in a European Working Time Directive compliant rota.
abstract: BACKGROUND
  Surgical training requires exposure to clinical decision-making and operative experience in a supervised environment. It is recognised that learning ability is compromised when fatigued. The European Working Time Directive requires a decrease in working hours, but compliance reduces trainees' clinical exposure, which has profound implications for plastic surgery training. The aim of this study was to evaluate plastic surgery registrars' experience of an EWTD-compliant rota, and to examine its impact on patient care, education, and logbook activity.
  
  
  METHODS
  An electronic survey was distributed to plastic surgery registrars in a university teaching hospital. Registrars were asked to rate 31 items on a five-point Likert scale, including statements on patient care, clinical and operative duties, training, and quality-of-life. Interquartile deviations explored consensus among responses. Operative caseload was objectively evaluated using eLogbook data to compare activity at equal time points before and after implementation of the EWTD rota.
  
  
  RESULTS
  Highest levels of consensus among respondents were found in positive statements addressing alertness and preparation for theatre, as well as time to read and study for exams. Registrars agreed that EWTD compliance improved their quality-of-life. However, it was felt that continuity of patient care was compromised by work hours restriction. Registrars were concerned about their operative experience. eLogbook data confirmed a fall-off in mean caseload of 31.8% compared to activity prior to EWTD rota implementation.
  
  
  CONCLUSIONS
  While EWTD compliant rotas promote trainee quality-of-life and satisfaction with training, attention needs to be paid to optimising operative opportunities.
authors.affiliation: a Department of Plastic Surgery , St James's Hospital Dublin, Trinity College Dublin , Ireland.
authors.forename: Catherine
authors.initials: C
authors.lastname: de Blacam
authors.affiliation: b Royal College of Surgeons in Ireland , Dublin , Ireland.
authors.forename: Sean
authors.initials: S
authors.lastname: Tierney
authors.affiliation: a Department of Plastic Surgery , St James's Hospital Dublin, Trinity College Dublin , Ireland.
authors.forename: Odhran
authors.initials: O
authors.lastname: Shelley
mesh_terms: D000328:Adult; D000066491:Clinical Decision-Making; D005060:Europe; D005260:Female; D019538:Health Care Surveys; D006785:Hospitals, University; D006801:Humans; D007396:Internship and Residency / Q000331:legislation & jurisprudence*; D008297:Male; D008505:Medical Staff, Hospital / Q000331:legislation & jurisprudence; D010561:Personnel Staffing and Scheduling / Q000331:legislation & jurisprudence*; D011788:Quality of Life; D013518:Surgery, Plastic / Q000193:education*; D011795:Surveys and Questionnaires; D014940:Work Schedule Tolerance; D016526:Workload
keywords: European working time directive; plastic surgery training; surgical training; work hours limitation