Education and the working patterns of junior doctors in the UK: a review of the literature

Scallan, Samantha

doi:10.1046/j.1365-2923.2003.01631.x

Cited by 41 publications

(36 citation statements)

References 47 publications

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“…It is important that trainers are familiar with the role of feedback in learning and appropriately trained in delivering it. Time constraints and assessments performed in less suitable environments had a negative impact on feedback highlighting the value of undertaking CBDs in a planned manner and how important it is to make optimal use of contact with trainers when the opportunity does arise (Scallen 2003). The choice of case played an important role, with challenging cases resulting in more beneficial feedback.…”

Section: Discussionmentioning

confidence: 99%

“…Although feedback is generally described as being more useful when it is specific, trainees valued this general feedback (van de Ridder 2008). This perhaps reflects the important all forms of feedback particularly as opportunities for regular feedback in the clinical setting have diminished with reduced working hours and contact with trainers (Scallen 2003).…”

Section: Discussionmentioning

confidence: 99%

“…There has been a reduction in working hours in the United Kingdom with the implementation of the European Working Time Directive and the New Deal document and a change in the structure of training with Modernising Medical Careers (Department of Health 1991, 2003. Reduced training time and contact with trainers has lead to a reported deterioration in the quality of training and less opportunity for reflection and feedback (Scallen 2003). The introduction of mandatory assessment tools, such as case-based discussions (CBDs), in specialist training (ST) programmes, may have a role in compensating for this effect (Carr 2006).…”

Section: Introductionmentioning

confidence: 99%

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Do trainees value feedback in case-based discussion assessments?

2012

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Background: Feedback is important in learning, including in workplace-based assessments. Aim: To explore trainee's perceptions of the educational value of case-based discussions (CBDs) specifically focusing on feedback. Methods: An online questionnaire and interviews obtaining detailed descriptions of paediatric trainees at UK specialist training levels 1 and 2 views and experiences were used. Qualitative data were analysed using a thematic framework analysis. Results: Trainees viewed CBDs as educationally valuable, aiding reflective learning, improving decision making skills and effecting a change in practice. Opinions varied regarding how useful they found the feedback. Feedback was perceived as more valuable from assessors who had a positive attitude towards CBDs, understood the process and had experience in leading them. Time constraints and assessments performed in less suitable environments had a negative impact on feedback. Trainees felt the choice of case played an important role, with challenging cases resulting in more beneficial feedback. Conclusions: CBD assessments provide a new opportunity for good quality learning and feedback, providing there is a commitment to the educational aspects of the process by both trainer and trainee. Trainers being aware of the qualities of the discussions that result in successful feedback, could significantly improve their educational value.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Do trainees value feedback in case-based discussion assessments?

2012

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“…By looking at several cohorts of F2 doctors we have been able to enlarge the scope of enquiry of postgraduate medical education compared with studies considering only a single specialty or work pattern; this was called for in the review by Scallan. 101 In addition, we have developed a simple, self-report measure to assess perceived confidence and competence during training, called for by Miller and Archer. 102 …”

Section: Postgraduate Medical Training: the Theory And The Realitymentioning

confidence: 99%

An evaluation of foundation doctor training: a mixed-methods study of the impact on workforce well-being and patient care [the Evaluating the Impact of Doctors in Training (EDiT) study]

Mason

O’Keeffe

Carter

et al. 2013

Health Services and Delivery Research

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BackgroundA major reform of junior doctor training was undertaken in 2004–5, with the introduction of foundation training (FT) to address perceived problems with work structure, conditions and training opportunities for postgraduate doctors. The well-being and motivation of junior doctors within the context of this change to training (and other changes such as restrictions in working hours of junior doctors and increasing demand for health care) and the consequent impact upon the quality of care provided is not well understood.ObjectivesThis study aimed to evaluate the well-being of foundation year 2 (F2) doctors in training. Phase 1 describes the aims of delivering foundation training with a focus on the role of training in supporting the well-being of F2 doctors and assesses how FT is implemented on a regional basis, particularly in emergency medicine (EM). Phase 2 identifies how F2 doctor well-being and motivation are influenced over F2 and specifically in relation to EM placements and quality of care provided to patients.MethodsPhase 1 used semistructured interviews and focus groups with postgraduate deanery leads, training leads (TLs) and F2 doctors to explore the strategic aims and implementation of FT, focusing on the specialty of EM. Phase 2 was a 12-month online longitudinal study of F2 doctors measuring levels of and changes in well-being and motivation. In a range of specialties, one of which was EM, data from measures of well-being, motivation, intention to quit, confidence and competence and job-related characteristics (e.g. work demands, task feedback, role clarity) were collected at four time points. In addition, we examined F2 doctor well-being in relation to quality of care by reviewing clinical records (criterion-based and holistic reviews) during the emergency department (ED) placement relating to head injury and chronic obstructive pulmonary disease (COPD).ResultsPhase 1 of the study found that variation exists in how successfully FT is implemented locally; F2 lacks a clearly defined end point; there is a minimal focus on the well-being of F2 doctors (only on the few already shown to be ‘in difficulty’); the ED presented a challenging but worthwhile learning environment requiring a significant amount of support from senior ED staff; and disagreement existed about the performance and confidence levels of F2 doctors. A total of 30 EDs in nine postgraduate medical deaneries participated in phase 2 with 217 foundation doctors completing the longitudinal study. F2 doctors reported significantly increased confidence in managing common acute conditions and undertaking practical procedures over their second foundation year, with the biggest increase in confidence and competence associated with their ED placement. F2 doctors had levels of job satisfaction and anxiety/depression that were comparable to or better than those of other NHS workers, and adequate quality and safety of care are being provided for head injury and COPD.ConclusionsThere are ongoing challenges in delivering high-quality FT at the local level, especially in time-pressured specialties such as EM. There are also challenges in how FT detects and manages doctors who are struggling with their work. The survey was the first to document the well-being of foundation doctors over the course of their second year, and average scores compared well with those of other doctors and health-care workers. F2 doctors are benefiting from the training provided as we found improvements in perceived confidence and competence over the year, with the ED placement being of most value to F2 doctors in this respect. Although adequate quality of care was demonstrated, we found no significant relationships between well-being of foundation doctors and the quality of care they provided to patients, suggesting the need for further work in this area.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…The full shift system is best suited where the work intensity is high and evenly distributed over the 24-hour period, for example, in Intensive Care. It is not universally popular, but the evidence is contradictory [23]; criticisms include the lack of continuity of care, decreased operative experience [24], and disrupted education and social life.…”

Section: Changing the Working Patterns Of Doctorsmentioning

confidence: 99%

Tomorrow's surgeon—who cares for the patient? The impact of the European working time directive

Lloyd

2005

Journal of Pediatric Surgery

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Education and the working patterns of junior doctors in the UK: a review of the literature

Abstract: The literature review has helped to identify the popular wisdom surrounding the debate on junior doctors' hours, the progress of the UK when compared to that of other countries and gaps in research. Further research is needed to refine understanding of this area.

Cited by 41 publications

References 47 publications

Do trainees value feedback in case-based discussion assessments?

Do trainees value feedback in case-based discussion assessments?

An evaluation of foundation doctor training: a mixed-methods study of the impact on workforce well-being and patient care [the Evaluating the Impact of Doctors in Training (EDiT) study]

Tomorrow's surgeon—who cares for the patient? The impact of the European working time directive

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