Training in trauma surgery

Excessive volume of trauma workload out of hours: is it really true?

To determine whether an excessive out of hours workload might contribute to the current lack of interest in trauma orthopaedics as a sub-specialty in the United Kingdom we reviewed data collected prospectively on 467 multiple trauma patients (ISS > 15) presenting to a teaching hospital over a 5 year period (January 1996-January 2001). Almost half of the patients (48.6%) presented between the hours of 18:00 and 08:00 with the trauma team called more frequently out of normal working hours. Two hundred and eleven (45.2%) patients underwent an operative procedure during their admission with an orthopaedic surgeon involved in the procedure in the majority of cases. Nearly half (41.5%) of these cases started between 18:00 and 08:00 with a larger portion (49.6%) finishing between these hours. A Consultant was the primary surgeon in 123 (82.0%) cases and involved in the majority of out of hours operating. Intensive care was required for 151 (32.3%) patients. The median hospital stay was 9 days (1-93). The out of hours workload for Orthopaedic consultants working in a busy teaching hospital is considerable. Planning issues need to be addressed to ensure that a career in trauma surgery is made attractive to current and future orthopaedic trainees.