Preregistration house officers in eight English regions: survey of quality of training

OBJECTIVE

To assess the quality of preregistration house officer training in eight English regions.

DESIGN

Postal questionnaire.

SETTING

Thames, East Anglian, Mersey, Northern, and Wessex regions.

PARTICIPANTS

1670 preregistration house officers.

MAIN OUTCOME MEASURES

Education, hours of work, workload, conditions of work, and attitudes to job and medicine as a career.

RESULTS

Response rate was 69% (1146 replies). Most house officers had attended induction courses (1036/1129 (92%)); 74% (757/1024) found them satisfactory. The proportions who had never received adequate guidance on how to break bad news and how to control pain were 59% (670/1135) and 56% (634/1136) respectively. There was much variation between regions. Overall, 65% (736/1138) reported confidence in performing cardiopulmonary resuscitation. Most respondents (95% (1089/1142)) worked an on call rota, 3% (36) a partial shift, and 0.6% (seven) a full shift; 19% (202) were on duty for average weekly hours that exceeded the targets for 1 April 1993. House officers had a median of 20 patients under their care and clerked a median of 10 emergency cases, six routine cases, and two day cases a week. Over half (690/1128 (61%)) could not obtain hot food after 8 pm, 20% (223/1095) did not always have clean sheets available in their on call room, and 45% (462/1036) did not consider the protection of staff against violence to be adequate at their hospital. The most important problems with the preregistration year were inappropriate or non-medical tasks (ranked first by 360 respondents), hours of work (359), and pay for out of hours work (167). Overall 57% (646/1125) would encourage a friend to apply for their post, but only 24% (266/1112) would encourage a friend to take up medicine and 44% (494/1112) would discourage the idea.

CONCLUSIONS

House officers' training is deficient in important respects, with inappropriate tasks and heavy clinical workloads impeding the provision of proper education.

Preregistration house officers in the Thames regions: changes in quality of training after four years

OBJECTIVE

To measure changes in the training and workload of preregistration house officers over four years.

DESIGN

Postal questionnaire.

SETTING

The Thames health regions.

PARTICIPANTS

1049 preregistration house officers.

RESULTS

Response rate was 69% (725 replies). The proportion of house officers officially on duty > 83 hours a week fell from at least 42% to 21%, and the proportion officially on duty < or = 72 hours rose from no more than 9% to 40%. Adequate guidance in breaking bad news increased from 25% to 46% (p < 0.0001; 95% confidence interval for difference, 16.2% to 25.8%) and guidance in pain control increased from 36% to 46% (p < 0.01; 5.0% to 15.0%). The number of house officers attending an induction course increased from 61% to 94% (p < 0.001; 28.9% to 37.1%). There was no change in the proportion unable to attend formal educational sessions because of clinical commitments or in levels of satisfaction with consultants' educational supervision. The median number of inpatients under house officers' care fell from 20 to 17, but the numbers of patients clerked in an average week showed little change. House officers were less satisfied with the clinical experience their post provided (proportion dissatisfied rose from 30% to 39%; p < 0.01; 4.2% to 13.8%) and less enthusiastic about recommending their post to a friend (proportion neutral or not recommending rose from 30% to 42%, p < 0.0001; 7.9% to 16.9%).

CONCLUSION

Despite progress in reducing hours of duty and providing induction courses, the training that hospitals and consultants provide for house officers is still unsatisfactory and inconsistent with the General Medical Council's recommendations.

CPR and the RCP (2). Training of students and doctors in UK medical schools

We asked British medical schools and teaching hospitals about the training they offer to medical students and hospital doctors in cardiopulmonary resuscitation. The response rate was 96%. Training that is practical and consistent with guidelines is offered to nearly all students and house officers, often by consultants. Training for other junior doctors and consultants is much less common. The organisation of training is haphazard, and many hospitals have no resuscitation training officers. As a result, few doctors receive the frequent retraining needed to maintain competence in managing cardiopulmonary arrest.

Preregistration house officers in the four Thames regions: II. Comparison of education and workload in teaching and non-teaching hospitals

OBJECTIVE

To detect differences in the education and workload of preregistration house officers working in teaching and non-teaching hospitals.

DESIGN

A postal questionnaire.

SETTING

Teaching and non-teaching hospitals in the four Thames regions.

PARTICIPANTS

1064 Preregistration house officers.

RESULTS

Response rate was 61% for teaching hospitals and 73% for non-teaching hospitals. House officers in teaching hospitals had significantly fewer inpatients under their care (house physicians 16.9 v 22.9, house surgeons 17.9 v 20.3) and admitted fewer emergency patients per week (house physicians 7.7 v 12.7, house surgeons 6.5 v 9.8). More house officers in teaching hospitals reported that they had too few patients to provide adequate clinical experience. More of their time was consumed by administrative activities devoid of educational value.

CONCLUSION

Preregistration house officer posts at teaching hospitals provide less clinical activity and are perceived as less educationally satisfactory by their holders than those elsewhere.

Preregistration house officers in the four Thames regions: I. Survey of education and workload

OBJECTIVE

To assess the education and workload of preregistration house officers in the four Thames regions.

DESIGN

Postal questionnaire.

SETTING

Teaching and non-teaching hospitals in the four Thames regions.

PARTICIPANTS

1064 Preregistration house officers.

RESULTS

Response rate was 70% (740 replies). Nine per cent of house officers (66/729) worked a rota of one in two. The average house officer had 20.4 inpatients under his or her care and admitted 23.2 patients per week. Sixty two per cent of house officers (459/740) felt that they spent an excessive amount of time on non-medical tasks of no educational merit; 75% (546/725) had never received adequate guidance on breaking bad news and 64% (467/729) had never received adequate guidance on pain control; 34% (249/731) did not feel confident that they could perform cardiopulmonary resuscitation unsupervised. House officers would tend to recommend their post to a friend.

CONCLUSIONS

There are deficiencies in preregistration training in the four Thames regions. The General Medical Council's requirements are not being heeded.

Anatomical validation of middle cerebral artery position as identified by transcranial pulsed Doppler ultrasound

The basal cerebral arteries were insonated using transcranial pulsed Doppler ultrasound (TPDU) at 2 MHz. The Doppler sample volume (SV) depths at which signals were obtained which could be attributed to the middle, anterior and posterior cerebral arteries (MCA, ACA and PCA) were compared with measurements in adult cadavers and with B-scan ultrasound studies in infants. The depth of the internal carotid artery (ICA) terminal division into ACA and MCA was closely correlated for both groups. In adults, it was found at 5.6 +/- 1.0 cm using TPDU while in cadavers it was found at 5.3 +/- 0.5 cm from the temporal bone. In infants, it was found at 3.2 +/- 0.3 cm for the right side, and 3.2 +/- 0.2 cm for the left side using TPDU, and at 3.4 +/- 0.4 cm and 3.4 +/- 0.5 cm for right and left sides respectively using B-scan ultrasound. The mean depth of the MCA mid-point in infants as defined by TPDU and B-scan was also closely correlated, with values of 2.8 +/- 0.3 cm and 2.7 +/- 0.3 cm for right and left sides respectively using TPDU and of 2.8 +/- 0.4 cm and 2.7 +/- 0.4 cm for right and left sides respectively using B-scan ultrasound. Values for the most lateral part of the MCA did not correlate. In adults, signals from the ACA and PCA were obtained at greater SV depth than the MCA, thus preventing confusion.