Introduction of a partial shift system for house officers in a teaching hospital.

Abstract

Abstractscheme could be developed to incorporate three Objectives-(1) To introduce a partial shift system separate surgical firms. A pilot partial shift system was to reduce the hours of work of preregistration house introduced for all house officers in general surgery at St surgeons to an average of 64 a week to comply with Bartholomew's Hospital on 1 November 1991, shortly the New Deal for junior doctors; (2) to test linking after the New Deal was published. The problems the partial shift concept to an existing structure of exposed by the pilot study resulted in many modifica-"on call" firms.tions, and a much improved partial shift system was Design-Formal assessment after three months of introduced on 1 February 1992. This paper describes a pilot partial shift system for eight house surgeons the workings of the system up to 31 July 1992. on three firms instituted on 1 November 1991, followed by questionnaire and interview evaluation Subjects and methods at three and six months of a revised system implemented on 1 February 1992.Throughout the study there were roughly 80 general Setting-Department of general surgery at St surgical patients daily at St Bartholomew's Hospital, Bartholomew's Hospital, London. mainly accommodated in 50 beds on two adult wards. Subjects-24 house surgeons attached to three The remaining patients were in the five day ward, the surgical firms.day surgery unit, the intensive care unit, the children's Results-In eight weeks each house surgeon ward, the renal transplant unit, and the amputee worked one week (five shifts) of night duty, one week rehabilitation unit. There were three surgical firms, of "cover" (afternoon and evening) duty, and six identified by colour codes as Yellow, Green, and Dark weeks of normal daytime hours. Each weekday a Blue. Each firm had a specialist interest, but all house surgeon from the firm on call worked an covered emergency general surgery. The firms worked extended daytime on call shift until 10 pm. Weekend a one in three on call rota. Each firm had two duties were split between two house surgeons from consultants, one senior registrar, and a senior house the firm on call. A computer generated graphical officer. There were eight preregistration house display of the rota was used to facilitate leave surgeons (three on the Blue firm, three on the Green planning. Average working hours were reduced to firm, and two on the Yellow firm). The posts were below 64 per week, including prospective cover, Of three months' duration. The other three months without detriment to patient care and educational were spent in orthopaedics, urology, or otolaryngology, standards. Within the shift system individual house where the house surgeons were on conventional on surgeons could be on call with their own firm by day call rotas. The general surgical house officers also and at weekends. Opinions were equally divided cared for 20 radiotherapy inpatients and any radioamong junior staffas to their preference for either on therapy emergency admissions. call or partial shift sys...

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

“…Recent studies 4–10 of the hours worked by junior doctors indicate a downward trend in line with the requirements of the New Deal 1–3 and the EWTD. However, whilst hours are falling, some juniors are still working in excess of the set targets: 48% of junior doctors exceeded the New Deal limits in their working practices in 2001, and of these doctors pre‐registration house officers (PRHOs) were the worst off: over 60% of posts were non‐compliant 11 .…”

“…The shift system of working has typically been adopted by hard‐pressed specialties due to the intensity of the workload that continues into out‐of‐hours periods 13,19 . A number of studies have described the successful implementation of shift systems to meet the terms of the New Deal 9,10 , 20–24 and positively acknowledge their effects in terms of junior doctors' welfare, 22,25 education 22,26 and increased opportunity for flexible, part‐time and family friendly working arrangements. The evidence for the success of shift working is, however, in dispute: the findings of other studies 14,16 , 17,27–32 suggest that this way of working leads to increased job dissatisfaction and 14,30 , 33 −35 disruption to quality of life, 28,31 , 34,36 compromises training 29,37 and that it may not necessarily improve the welfare of doctors 14,30 , 32,35 , 38 .…”

Working patterns and the quality of training of medical house officers: evaluating the effect of the `new deal'

“…Preliminary reports on shift systems were encouraging and suggested hours of work could be reduced, while maintaining or even improving the quality of the junior doctors' training experience (Finn & Speidel 1988, Naysmyth et al 1991Vassallo et al 1992, Spence-Jones & Crawford 1994. In a postal survey of over 300 senior house of®cers, Paice et al (1997) reported that training had improved markedly since the introduction of the new deal.…”

Enhancing the educational content of SHO posts.

“…'3 One study found that nearly two thirds of patients had had their incontinence for over two years before they first sought professional advice.8 More than 90°/ of incontinent people, however, considered that their general practitioner would be sympathetic or helpful to their problem' 4; almost half would welcome some form of treatment. 9 What form should treatment take? Most incontinent women have either genuine stress incontinence or detrusor instability, or both, yet distinguishing between these two on the basis of symptoms is impossible in a quarter of patients.…”