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Tomorrow’s Doctors Key to Protecting The Future
Increasing pressure in NHS hospitals could be causing junior doctors to miss essential training, states the General Medical Council1. In its most recent training survey featuring the views of more than 55,000 junior doctors, it found that junior doctors are regularly missing essential safety training, cautioning that it could lead to patient safety issues in the future.
In a letter sent to all hospital trusts, GMC Chief Executive Charlie Massey reiterated the importance of medical training, describing it as a “bellwether for the quality and safety of patient care”2.
The GMC isn’t alone in its concern about how effective junior doctors are. In its Being a junior doctor report, the Royal College of Physicians (RCP) collected the first-hand views and experiences of almost 500 junior doctors, claiming that, while 96% felt valued by their patients, 41% felt that the excessive burden of excessive administration poses a serious risk to patient safety3.
Junior doctors play an essential role on the front-line in the fight against infection, but their training seems increasingly pressurised and abbreviated. Just what can be done to support them?
State of play
When making the transition from the classroom to the ward, a 2010 study claimed that fewer than 50% of junior doctors felt that their medical school had prepared them well enough. As a result, the RCP is clear about the importance of professional training and development – as well as strong mentorship - on the ward.
Led by Professor David Greenaway, the RCP’s Shape of Training review of postgraduate medical education sets out a clear vision for the training of junior doctors4. The review was borne from the GMC’s belief that there was – and still is – a tension between the needs of the service and the demands of training.
Leading from the front
Embarking on their clinical journey, it’s likely that junior doctors will make mistakes – it’s how they are dealt with that’s important believes junior doctor Sinead Millwood. Embarking on their clinical journey, research has shown that it is common for junior doctors to make mistakes5. In a recent study led by Millwood, 100% of first year junior doctors admitted to making mistakes that could have impacted patient safety – but not all of them would disclose these mistakes, particularly not to senior colleagues6.
In a recently published paper, Millwood describes how she created her own programme to change the culture of patient safety within Yeovil Hospital. Every month the junior doctors attended a ‘Near misses’ section where a senior colleague discussed how to deal with the problem, and how to avoid making the same mistake again.
Junior doctors can play an active role in patient safety, but this capacity is currently under-utilised7. The study asserted that junior doctors are more likely to "embrace new ideas and recognise the importance of transparency and integration of technology into healthcare systems.”
While not suggesting junior doctors go it alone, the paper encourages hospitals to embrace a more collaborative approach to patient safety, a view held by professional organisations including The Health Foundation who conducted a comprehensive review of literature into the positive contribution junior doctors can make to quality improvement8.
Lead by example
The RCP report paints a picture of junior doctors under stress, under resourced and even under-fed – with 56% claiming in the last month they went through at least one shift without eating.
The reality is, junior doctors aren’t alone in finding the NHS a stressful place to work, with the Royal College of Physicians in 2015 finding that 38% of NHS staff had suffered from workplace stress in the previous year (2014)9. The report makes clear the links between staff mental health and wellbeing and patient outcomes, including claiming that hospital acquired infections can be reduced.
Acknowledging the need to shoulder the burden, the GMC’s Shape of Training review suggests the relationship between junior doctors and more senior colleagues should embody an apprenticeship approach, where knowledge is shared.
The approach should encompass not only core medical skills, but also the practice of the profession and importantly the culture. A detailed analysis of leadership and management studies by the Faculty of Medical Leadership and Management sets out a manifesto for developing an ‘engaged audience’ of junior doctors inspired by their colleagues, and their organisations10.
By working together, clinicians of all grades and specialities can take the fight to infection.
1 National training survey 2016. (2016) General Medical Council. http://www.gmc-uk.org/National_training_survey_2016___key_findings_68462...
3 Being a junior doctor (2016) Royal College of Physicians. (https://www.rcplondon.ac.uk/guidelines-policy/being-junior-doctor)
4 Securing the future of excellent patient care (2016) Shape of Training.
5 Lewis, P.J. et al. (2014) Exploring the causes of junior doctors’ prescribing mistakes: a qualitative study. British journal of clinical pharmacology. doi: 10.1111/bcp.12332. https://www.ncbi.nlm.nih.gov/pubmed/24517271
6 Millwood, S. (2014) Developing a platform for learning from mistakes: changing the culture of patient safety among junior doctors. BMJ Quality Improvement. doi:10.1136/bmjquality.u203658.w2114 http://qir.bmj.com/content/3/1/u203658.w2114.full
7 Joseph Elias Ibrahim, Shelley Jeffcott, Marie‐Claire Davis, Liam Chadwick, (2013) "Recognizing junior doctors' potential contribution to patient safety and health care quality improvement", Journal of Health Organization and Management, Vol. 27 Iss: 2, pp.273 – 286 http://dx.doi.org/10.1108/14777261311321824
8 Involving Junior doctors in quality improvement (2011). The Health Foundation. http://www.health.org.uk/sites/health/files/InvolvingJuniorDoctorsInQual...
9 Work and wellbeing in the NHS: why staff health matters to patient care (2015) Royal College of Physicians. https://www.rcpsych.ac.uk/pdf/RCP-%20WorkWellbeingNHS.pdf
10 Wathes, R. and Spurgeon, P. (2016) Junior doctor engagement: Investing in the future. Faculty of Medical Leadership and Management. (https://www.fmlm.ac.uk/resources/junior-doctor-engagement-–-investing-in-the-future)
PP-GEP-GBR-0595. Date of Preparation: April 2017.