Training within the European Working Time Directive

Now that 1 August has passed, all trusts should have implemented the hours and rest requirements stipulated in the European Working Time Directive (EWTD). This has been a challenge, and solutions have had to be creative; in psychiatry, many Trusts are attempting to reduce senior house officers (SHOs)’ night commitments, rather than implementing a shift system akin to other specialties.

In order to reduce the night workload, responsibility for assessing and managing patients in accident and emergency (A&E) departments has shifted from the SHO, and is now more frequently done by nurse-led emergency teams. While a multidisciplinary approach is to be applauded, too often the SHO is not part of the process for fear of contravening the EWTD.

Assessing patients in A&E when on-call is invaluable for developing many of the skills that make a good psychiatrist, particularly risk assessment. Patients are seen when acutely unwell and sometimes it will be their first presentation. The patients in A&E often represent the more complex cases, with social problems and substance misuse as well as mental illness. Practice in dealing with these patients is crucial to developing psychiatric skills during the training period.

I feel if SHOs’ exposure to patients in A&E is reduced in the name of EWTD compliance, training will suffer. To echo Sir William Osler, to train without reading books is to go to sea without any charts, to train without seeing patients is to not go to sea at all. I think that psychiatric trainees are in danger of missing the boat.