Thorne L, Burn S, Shaw S, Arvin B, Bradford R
Royal Free Hospital, Pond Street, London, NW3 2QG, UK.
Br J Neurosurg. 2006 Feb;20(1):31-5. doi: 10.1080/02688690600600905.
To compare operative experience before and after implementation of the New Deal to reduce junior doctors working hours, operative data was audited over a 6-month period. The three registrars with national training numbers in our unit were placed on two virtual working patterns to determine what their operative experience would have been over that 6-month period. Comparison with a 1980s trainee over a similar period was also made. Trainees on a 1:3 rota would have performed more emergency operations [32 (28 - 38)], than those on a partial shift [1:6 with following day off, 16 (13 - 23)]. Particular examples include trauma craniotomies 13 (9 - 15) versus 6 (3 - 11) and CSF diversion, 9 (2 - 13) versus 4 (2 - 7). Although trainees on a 1:3 on call rota would have had more emergency operative experience over the same period of time, less common procedures, such as lumber decompression for cauda equina syndrome, were equally distributed between both groups. Trainees doing the partial shift would have lost 18 (12 - 24) elective cases over the same period as a result of enforced absence following periods of duty. These included posterior fossa, complex spinal, benign and rare cranial procedures. The increasingly common option of employing juniors on a full shift rota would have an even greater impact on training. Trainees are unavailable for elective training on night shift and then for a compensatory period afterwards, doubling the time spent away from formal surgical training. Indiscriminate reduction in working hours by enforced absence for compensatory rest has a potentially deleterious impact on elective training. By reducing the out of hours commitment trainees have a reduced, but possibly acceptable, exposure to emergency neurosurgery without impact on elective training.
为比较实施减少低年资医生工作时间的新政前后的手术经验，我们在6个月的时间里对手术数据进行了审核。我们科室的三名拥有国家培训编号的住院医生被安排了两种虚拟工作模式，以确定他们在这6个月期间的手术经验会是怎样的。同时还与20世纪80年代同期的一名实习生进行了比较。实行1:3排班制的实习生进行的急诊手术[32例（28 - 38例）]比实行部分轮班制[1:6且次日休息，16例（13 - 23例）]的实习生更多。具体例子包括创伤性开颅手术，分别为13例（9 - 15例）对6例（3 - 11例），以及脑脊液分流手术，分别为9例（2 - 13例）对4例（2 - 7例）。尽管实行1:3随叫随到排班制的实习生在同一时期会有更多的急诊手术经验，但一些不太常见的手术，如马尾综合征的腰椎减压术，在两组间的分布是相同的。实行部分轮班制的实习生在同一时期由于值班后强制缺勤会损失18例（12 - 24例）择期手术病例。这些病例包括后颅窝、复杂脊柱、良性和罕见的颅脑手术。越来越普遍的让低年资医生实行全时轮班制的做法对培训的影响会更大。实习生在夜班期间无法进行择期培训，之后还有一个补偿期，这使得他们远离正规外科培训的时间增加了一倍。通过强制缺勤进行补偿性休息来不加区分地减少工作时间，对择期培训有潜在的有害影响。通过减少非工作时间的任务，实习生接触急诊神经外科手术的机会减少了，但可能是可以接受的，且不会影响择期培训。
