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EWTD: Incompatible with subspecialty training?
  1. R Hansen1,
  2. E Giles2,
  3. A R Barclay3,
  4. A Burtt4,
  5. P B Sullivan5,
  6. R M Beattie6
  1. 1Child Health, University of Aberdeen, Aberdeen, UK
  2. 2Paediatric Gastroenterology, Royal London Hospital, London, UK
  3. 3Paediatric Gastroenterology, Royal Hospital for Sick Children, Glasgow, UK
  4. 4Paediatric Gastroenterology, Chelsea and Westminster Hospital, London, UK
  5. 5Paediatric Gastroenterology, John Radcliffe Hospital, Oxford, UK
  6. 6Paediatric Gastroenterology, Southampton University Hospitals, Southampton, UK


Aims Historically, the RCPCH College Specialty Advisory Committee (CSAC) recommends that trainees in Paediatric Gastroenterology, Hepatology and Nutrition (PGHAN) spend at least 70% of working hours in that subspecialty. Since changes due to the European Working Time Directive (EWTD), there has been an increasing perception from both trainees and trainers that there is insufficient time within the subspecialty. Our aim was to quantify the proportion of PGHAN trainees fulfilling RCPCH recommendations of time spent in subspecialty and to assess the impact of the EWTD on this.

Methods The 13 trainees working on the national grid in PGHAN between January and June 2010 were surveyed. As a comparator, 14 consultants who completed training in PGHAN 2006–2009 were also emailed with an adjusted survey regarding their final year of training.

Results 12/13 trainees and 7/14 new consultants responded. Three trainees were still working on rotas >48 h per week. All consultants stated having worked 54–60 h per week. Only four trainees replied they were spending >70% of contracted hours on subspecialty training, and 1 replied ‘40–49%’. 6/7 consultants stated they had spent >70% of time in their subspecialty (p<0.05 compared with current trainees, Rank Sum, Sigma Stat 3.5). 9/13 trainee respondents stated >70% of hours at work were between 9 am–5pm. When asked whether they felt it necessary to work out of contracted hours for training, there were nine trainee responses. Of these, one was ‘never’, four ‘occasionally’ and four ‘often’.

Conclusion The majority of trainees are no longer receiving the subspecialty training hours recommended by RCPCH, significantly different to a few years ago. Given that most PGHAN trainees seem to be working >70% 9:00–17:00, it seems many trainees are working outside of subspecialty within normal working hours. The majority are training outside of contracted hours, presumably on restricted access training opportunities such as endoscopy. These results are subject to substantial bias but demonstrate a challenge in training paediatric gastroenterologists. Inadequacy of subspecialty training may jeopardise a centre's status as an accredited training unit and a trainee's ability to obtain CCT. While this is a survey of PGHAN, these challenges face all paediatric subspecialties.

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