The Impact of the European Working Time Regulations and Modernising Medical Careers on Out-of-hours ENT Cover

Abstract

The implementation of the European Working Time Regulations (EWTR), coupled with the ongoing impact of Modernising Medical Careers (MMC), has necessitated a significant redevelopment of out-of-hours cover for surgical specialties in the UK. A review of the literature related to the provision of out-of-hours ENT cover gives an insight into the impact of these changes on a comparatively small surgical specialty. A 2008 survey revealed that three-quarters of junior doctors providing ENT out-of-hours care were crosscovering specialties other than ENT – a figure up from just over half of junior doctors in 2005, prior to stricter EWTR rules. Of all 'first-on-call' doctors for ENT, only 19–32% have prior ENT experience. Consequently, ENT services are provided frequently by inexperienced, non-enT doctors covering multiple other specialties, often as part of a 'hospital-at-night' team.

The ENT boot camp: an effective training method for ENT induction

“…Out of hours there could be no specialist senior support on‐site, and so it is crucial that junior medical staff understand the basics of patient assessment and management. Unfortunately, these doctors often lack ENT experience, knowledge and confidence, particularly on taking up a new post . Some institutions no doubt have rigorous induction training in place, but often teaching is sporadic, and may come part way through a new post.…”

“…Unfortunately, these doctors often lack ENT experience, knowledge and confidence, particularly on taking up a new post. 7 Some institutions no doubt have rigorous induction training in place, but often teaching is sporadic, and may come part way through a new post. The regular rotation of small numbers of staff at each hospital can also make training labour intensive, with simulation of emergency scenarios not a practical option.…”

A randomized controlled trial of simulation‐based training for ear, nose, and throat emergencies

“…These situations often initially present to junior doctors working in the emergency department and on the wards, rather than an experienced specialist. Work over the last few years has shown that junior doctors have a poor knowledge of ENT emergencies, and little or no experience or training in their initial management . The problem stems from a lack of teaching at medical school and as a junior doctor, and this may give rise to patient safety issues when it comes to ward and emergency cover.…”