The European Working Time Directive: quo vadis?A well-planned and organized assassination of surgery

In this issue of the European Journal of Cardio-thoracic Surgery, Lim and Tsui [1] on behalf of the Registrars and Consultant Cardiac Surgeons of Papworth Hospital refer to the impact of the European Working Time Directive (EWTD) on exposure to operative cardiac surgical training. They have performed a cohort study to determine the factors that influenced operative surgical training. In summary, out of 3312 cardiac surgical operations that were performed over a 2-year period, the proportion of cases performed by trainees was 39% and 40% in each of the 2 years before and after the EWTD was introduced. Using logistic regression analysis, which is a tool that our beloved Papworth colleagues know very well, they reach the conclusion that with a successful institution specific training module and a commitment to training, exposure to operative surgical training can be sustained despite shortening of working hours. This is an institutional experience that is very well presented by the authors. The question is: Will this be a good example for everybody? It is difficult to say. There are too many differences among public and private institutions, including the case load, and also among accredited teaching institutions and those with no teaching programme. There are also too many differences among European countries. The interest of this paper is that it addresses a very important point for our immediate future as a Specialty and also for Medicine and Surgery in general. Is Cardiothoracic and Vascular Surgery endangered? As rightly stated by the authors in their introduction, it is true that there is considerable disquiet among trainers and trainees. The authors have come with an elegant paper that, however, does not address all the problems and all the doubts. Let’s have a look at it. Number one and a big problem. A full-shift pattern was introduced for registrars at their Institution. It was introduced by the administration of the Hospital but the authors do not confirm to us if there was a previous discussion with the surgeons or if, simply, the senior surgeons or the Head of the Department had to agree without discussion. To conclude, first, the Hospital administration does not care about teaching or learning, it does not even care about what happens to the trainees as long as there is no noise and everybody agrees. Good for Europe or, at least, for the UK! It is strongly recommended to carefully read the ‘Compendium of solutions to implementing the