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

Abstract

The 'new deal' on junior doctors' hours of work has led to the widespread introduction of working patterns such as full shifts and partial shifts in the United Kingdom. The impact of these changes on the training of medical staff is unclear. The subjects of the current study were 36 pre-registration medical house officers working shift rotas and on-call rotas at a teaching hospital in the north of England. They were studied over a 12-month period using a self-report questionnaire seeking their views on the quality of their training experience and their satisfaction with the in-service training they received. Nursing staff, consultant and medical student opinion was also sought. Partial-shift and full-shift systems led to reduced hours of work when compared to on-call rotas (mean hours: partial shift 65.0; full shift 59.8; on-call 72.7), but they were associated with significantly lower training experience and training satisfaction scores for the house officers than were on-call systems (P < 0.01). Shift systems were unpopular among consultants and medical students but not nursing staff. Despite reducing excessive hours of work, shifts may be detrimental to the training of medical house officers. The further imposition of shift working should be suspended until such time as the impact of new working patterns on the training of medical staff has been determined.

The modernisation of the surgical house officer

“…Studies have suggested that it is possible to implement the shift system successfully with improved quality of life for doctors, 4 better education, 5 and more opportunities for flexible training. The detrimental effect on training is, however, well documented [6][7][8] with some of the studies reporting increased job dissatisfaction 8 and a reduction in quality of life. 9 Little is reported on the effects of cross-specialty cover on patient care and training.…”

Wat draagt het doen van diensten bij aan de opleiding tot internist?

“…Ook daar blijkt dat het doen van diensten, die gecompenseerd worden in vrije tijd, nadelig is voor de opleiding. 16 Een moratorium op de invoering van compensatie in vrije tijd, zoals door sommigen wordt bepleit, is echter in Nederland alleen al op wettelijke gronden een gepasseerd station.…”

Clinical and education implications of shift work

“…Kapur & House (1998) found that shifts were unpopular with medical and nursing staff and, despite reducing excessive hours of work, full and partial shifts may be detrimental to the PRHO's training and education (Gillard et al, 2000;Paice, 2000).…”