Campbell and Spencer have enumerated the challenges that the European Working Time Directive (EWTD) presents.1 The basis of the problem appears to be that doctors in training will have to be grouped together in larger cells with a minimum of 10 on each rota. The rationale behind this assertion is that exposure to useful training time in clinics and non‐acute work will be eroded with smaller numbers on a rota.2 This may well be the case in the context of a large hospital with many sub‐specialist clinics and day time training opportunities, but it does not recognise the importance of learning to assess and manage the acutely ill child.
Our experience is that 62% of admissions from the emergency department occur outside of the normal working day. These unwell children are a precious training resource which is only of value at the time when they are assessed and managed in the acute situation. If these admissions are to provide useful training opportunities, trainees must have access to appropriate supervision out of hours.
The corollary of increasing numbers on a rota is that more doctors are present during the normal working day. With 10 in a cell there will be an average of six doctors present during the normal working day. This is more than is needed in a smaller district general hospital.
We have maintained a 2009 EWTD compliant middle grade rota over the last year with seven doctors. The educational value of the training posts has been affirmed by both the College and the Deanery and this has been achieved by ensuring an appropriate level of out of hours consultant supervision. We believe that this model should be considered when facing the challenges of the EWTD, particularly in the context of more remote district general hospitals.