European Working Time Directive - Overview


The European Working Time Directive and Surgical Training


The European Working Time Directive (EWTD) 2003/88/EC is a Union Directive laying down minimum safety and health requirements for the organisation of working time. Originally primarily intended as labour law, its progressive introduction up to full implementation in August 2009 has substantially reduced duty-hours and caused widespread concern in surgery. Detrimental effects on the continuity of patient care, reduced availability of medical staff with associated rota difficulties, and the reduction in time for training junior doctors have been widely reported. Craft-specialties such as surgery and those providing an acute service have faced particular challenges.

ASiT has been concerned about the adverse effects of the European Working Time Directive (EWTD) on patient safety and surgical training since its introduction. In recent years the association has undertaken numerous projects and published several documents in relation to this. Follow the links below to access these:

ASiT Work on the EWTD:

EWTD: A practical review for surgical trainees (journal paper)

ASiT Position Statement on the EWTD

Post-EWTD Implementation Survey 

EWTD has a negative impact on surgical training in the UK (journal letter)

EWTD resources page

EWTD Taskforce Submission

Related international publications on working hours:

O'Grady G, Harper S, Loveday B, Adams B, Civil ID, Peters M. Appropriate working hours for surgical training according to Australasian trainees. ANZ J Surg. 2012;82(4):225-9.

Benes V. The European Working Time Directive and the effects on training of surgical specialists (doctors in training): a position paper of the surgical disciplines of the countries of the EU. Acta Neurochir (Wien). 2006;148(11):1227-33.

UK (ASiT paper)
Fitzgerald JEF, Caesar BC. The European Working Time Directive: A practical review for surgical trainees. International Journal of Surgery 2012; 10:399-403.

Report of the ACGME Work Group on Resident Duty Hours . Chicago, Ill: Accreditation Council for Graduate Medical Education; 2002.




Added on: 3rd February 2013

This page was last updated on 03-02-2013
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