Sir, a number of countries have implemented restrictions in the number of hours staff are permitted to work. The European Union Working Time Directive (EWTD), fully implemented in the UK in 2009, set a limit on maximum hours of duty for doctors at 48 hours per week.1 The Accreditation Council for Graduate Medical Education in the US implemented the duty hours policy, a similar restriction on maximum hours worked, set at 80 per week, which took effect in 2003.2 We aimed to establish the extent of research on the impact of work time restrictions (WTRs) in the oral and maxillofacial surgery literature.

We performed an electronic search of the British Journal of Oral and Maxillofacial Surgery (BJOMS), the Journal of Cranio-Maxillofacial Surgery ( JCMFS), the Journal of Oral and Maxillofacial Surgery (JOMS ) and the International Journal of Oral and Maxillofacial Surgery (IJOMS). Journal websites were searched for all publications containing the terms 'working time directive' or 'duty hours policy' in the abstract, title or keywords from inception to February 2014.

Of the 42,788 articles archived in BJOMS, JCMFS, JOMS and IJOMS, only 10 (0.02%) addressed WTRs. The earliest article was published in 2006. Between 2006 and 2009, 0.19 articles/month were published on the topic. The highest rate of publication occurred in 2009 with 0.33 articles/month published (Fig. 1). Since 2009 there has only been one article published (in 2011) on the topic.

Figure 1
figure 1

Rate of article publication in four journals combined between 2006 and 2013

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In light of the considerable impact WTRs have on surgical practice and postgraduate training,3 only a very small proportion (0.02%) of articles in general OMFS journals have discussed this issue. There is therefore a need for more original research exploring the impact of WTRs on OMFS training and practice. A large US study found a significant decrease in operative experience of general surgery trainees after the implementation of WTRs when compared to before its implementation.3 Concerns have also been raised in the UK about the effect of WTRs on exposure to teaching4 and on the need for surgical cross-cover to meet on-call requirements.5

The debate on WTRs has largely centred on general surgery; however, the effects on OMFS should be studied in greater depth. Subsequent studies would inform the specialty ensuring surgical training, alongside the time restrictions, maximises trainee development without compromising patient safety.