Nigerian Surgical Trainees’ Work Schedule: It is Time for a Change!

Abstract

Background Unregulated work schedules have deleterious effects on trainees’ productivity and patients’ safety. For these reasons, duty hours have been capped in many developed countries. Such regulations, however, appear to be lacking in many parts of Africa, and the effects of unregulated work hours in this part of the world have only been scantily documented. This study evaluated the work schedule of Nigerian surgical trainees, and its impact on their wellbeing, as well as assessed the perception of trainees towards capped duty hours. Methods A cross‐sectional survey of 650 Nigerian Resident Doctors in surgical specialties was conducted in November 2020. Enquiries were made about their work schedules using a purpose‐designed questionnaire, developed using Google Forms®. The data were analysed using the IBM SPSS version 23. Results The mean weekly work hours of surgical residents was 122.72 ± 34.17 h. Majority (228, 40.4%) of the residents had cumulative call hours of ≥ 72 h per week. One‐half (283, 50.1%) of them worked continuously for up to 48–72 h during calls, with mean daily sleep hours of 3.53 ± 1.42 h during calls. The majority (558, 98.8%) of respondents had post‐call clinical responsibilities. Seventy‐five percent of the respondents reported hazards from prolonged work hours, and an overwhelming majority (530, 93.8%) desire official limits on work hours. Conclusion Prolonged, unregulated work schedules appear to be the norm among Nigerian surgical trainees. This trend calls for urgent measures, to avoid potentially catastrophic consequences on both physicians and patients.

Health, well-being, and burnout amongst Early Career Doctors in Nigeria

“…The male ECDs in our study reported longer routine work and on-calls hours. Given that 65% of the respondents in our study were RDs, a preponderance of males in the surgical specialties, which are characterised by longer work hours, with little sleep, compared to the non-surgical specialties [ 6 ], may explain the longer routine work and on-call hours reported by the male ECDs. The higher physical demand, including long theatre hours of surgical specialties make these specialties less attractive to females [ 25 ].…”

“…Amongst the psychosocial problems is burnout. Burnout rates of as high as 51.9% have been reported amongst Nigerian ECDs, and this was found to be significantly associated with long work hours [ 5 , 6 ]. Work hours of Nigerian doctors are currently not regulated, with RDs bearing the brunt of these long unregulated work hours [ 7 ].…”

Knowledge, Attitude and Uptake of Pap Smear among Female Healthcare Professionals in a Nigerian Teaching Hospital

“…This may not be unconnected with Nigerian healthcare personnel's long, unregulated work hours. This has been aggravated by the massive emigration of health workers, worsening the already poor doctor-to-patient ratio and the nurse-to-patient ratio of 4:10,000 and 15:10,000, respectively, [25,26] with the attendant consequence of long queues and prolonged waiting times in clinics and outpatient departments. In this study, more of the FHPs who had shorter working hours (physiotherapists and medical social workers) had done a Pap smear than those who longer hours (nurses, medical doctors, pharmacists, and medical laboratory scientists).…”

We Asked the Experts: The Tropical Surgeon: Everywhere in Chains But Not Imprisoned

“…Poor staffing is a perennial problem, resulting in surgical residents working for prolonged hours. Cumulative work hours of up to 123 h/week have been reported [2]. It is normal to have one house officer, one surgery registrar, and one specialist registrar on-call every day of the week in many surgical units in the tropics.…”

“…It is normal to have one house officer, one surgery registrar, and one specialist registrar on-call every day of the week in many surgical units in the tropics. These long work hours correlate with high rates of burnout, reduced quality of life, morbidity, and, in extreme cases, mortality, amongst surgical residents [2].…”