Senior house officers in medicine: postal survey of training and work experience

P J Baldwin, Baldwin PJ, R W Newton, Newton RW, Buckley G, G Buckley, M A Roberts, Roberts MA, M Dodd, Dodd M
BMJ (Clinical research ed.) · 1997 · vol. 314(7082) , pp. 740–3 · doi:10.1136/bmj.314.7082.740 · PMID:9116556 · PMC2126148
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This survey of Scottish senior house officers found that excessive work hours, partial shifts reducing patient continuity, and limited consultant supervision detrimentally affect clinical training quality in general medicine.

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This postal survey evaluated the working conditions and training experiences of 252 senior house officers in medicine across Scotland. The results indicated that doctors frequently worked beyond their contracted hours, with those on rotas exceeding their limits by an average of 7.4 hours per week compared to 3.7 hours for partial shift workers. Significant variations in workload continuity and intensity were observed between different specialty groups, while consultants' teaching styles were found to correlate with trainees' attitudes toward work. The authors concluded that training quality is compromised by insufficient supervision and feedback, urging improvements in consultant-trainee relationships. The paper does not explicitly discuss endometriosis or adenomyosis; it was included in the corpus via a keyword match in the upstream search index.

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Abstract

OBJECTIVES: To describe working conditions for senior house officers in medicine in Scotland and to relate these to the quality of clinical training they receive. DESIGN: Postal questionnaire survey. SUBJECTS: All senior house officers in medicine and related specialties in post in Scotland in October 1995 (n = 437); 252 (58%) respondents. MAIN OUTCOME MEASURES: Questionnaires covered hours, working patterns, measures of workload, an attitudes to work scale, and experience of education and training. RESULTS: In the week before the questionnaire, doctors on rotas had worked a mean of 7.4 (95% confidence interval 5.8 to 9.0) hours in excess of their contracts, compared with 3.7 (2.0 to 5.5) hours for those on partial shifts. The most common reason for this was "the needs of the patients or the service." Those on partial shifts reported significantly less continuity of care with patients than those on rotas (Mann-Whitney U test, z = -4.2, P < 0.0001) or full shifts (z = -2.08, P = 0.03). Doctors in general medicine reported significantly higher measures of workload (number of acute admissions, number of times called out, and fewest hours' uninterrupted sleep) than those in subspecialties. Consultants' clinical teaching and style of conducting a ward round were significantly related to factors extracted from the attitudes to work scale. CONCLUSIONS: The quality of senior house officers' training is detrimentally affected by a variety of conditions, especially the need for closer support and supervision, the need for greater feedback, and the lack of time that consultants have to dedicate to clinical training. Efforts should be made to improve these conditions and to reinforce a close working relationship between trainee and supervising consultant.
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Abstract OBJECTIVES: To describe working conditions for senior house officers in medicine in Scotland and to relate these to the quality of clinical training they receive. DESIGN: Postal questionnaire survey. SUBJECTS: All senior house officers in medicine and related specialties in post in Scotland in October 1995 (n = 437); 252 (58%) respondents. MAIN OUTCOME MEASURES: Questionnaires covered hours, working patterns, measures of workload, an attitudes to work scale, and experience of education and training. RESULTS: In the week before the questionnaire, doctors on rotas had worked a mean of 7.4 (95% confidence interval 5.8 to 9.0) hours in excess of their contracts, compared with 3.7 (2.0 to 5.5) hours for those on partial shifts. The most common reason for this was "the needs of the patients or the service." Those on partial shifts reported significantly less continuity of care with patients than those on rotas (Mann-Whitney U test, z = -4.2, P < 0.0001) or full shifts (z = -2.08, P = 0.03). Doctors in general medicine reported significantly higher measures of workload (number of acute admissions, number of times called out, and fewest hours' uninterrupted sleep) than those in subspecialties. Consultants' clinical teaching and style of conducting a ward round were significantly related to factors extracted from the attitudes to work scale. CONCLUSIONS: The quality of senior house officers' training is detrimentally affected by a variety of conditions, especially the need for closer support and supervision, the need for greater feedback, and the lack of time that consultants have to dedicate to clinical training. Efforts should be made to improve these conditions and to reinforce a close working relationship between trainee and supervising consultant. Full Text The Full Text of this article is available as a PDF (352.6 KB).

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MeSH descriptors

Medical Staff, Hospital Medical Staff, Hospital Adaptation, Psychological Clinical Competence Humans Inservice Training Job Satisfaction Personnel Staffing and Scheduling Practice Patterns, Physicians' Scotland Teaching Workload

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