Saturday, 26 May 2012


Orthopaedic surgeon & trainee

I know I said "Au revoir" but I could not let this go uncommented on. A paper by orthopaedic dinosaurs consultants in Nottingham purports to show that trainees training in orthopaedics has suffered since the implementation of the working time directive. Actually it doesn't show any such thing.

Firstly they point out that the total  number of operations performed by trainees dropped by 13% after the introduction of the WTD. Well that falls into the category of the bleedin’ fuckin’ obvious for a start. If they are doing less hours they are bound to do less work. It is highly likely that this statistic illustrates nothing more than possible overwork in these people before the WTD. And when you overwork people, quality suffers. Simply doing operations does not constitute training any more than driving a long way unsupervised constitutes a driving lesson, and, like driving, doing a lot of work can simply allow the entrenchment of bad habits.

Secondly the figures are claimed to show a reduction in the number of operations performed independently. Well, since the total operations in this category were unchanged that must surely mean that the number of supervised operations increased. Yes? Isn’t that what’s known as training? The equivalent of a driving lesson?

This paper is a prime example of Bad Science, to coin Ben Goldacre’s phrase. It in no way provides any evidence whatsoever of the quality of surgery, but is a crude, and inappropriately interpreted estimate of bare meaningless numbers. Quantity does not equate to quality! It is perfectly possible that the quality of surgery improved after the WTD.

The authors are not just dinosaurs, they’re fuckwits as well.

Now, back to my distraction.

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