Trainee satisfaction before and after the Calman reforms of specialist training: questionnaire survey

Changes in United Kingdom oral and maxillofacial surgical specialty trainees since 1995 - numbers, gender, first degrees, and nations of origin

Training in UK surgery has changed dramatically since 1995, from a relative lack of structure to time-limited and highly documented programmes. Training in oral and maxillofacial surgery (OMFS) has shared these changes and included some significant changes of its own. Minutes from the OMFS Specialty Advisory Committee (SAC) were reviewed over the last 25 years to record the number and location of newly approved posts. The General Medicine Council's (GMC) OMFS specialist list in 2019 was combined with the records of OMFS specialists' dental qualifications held by the General Dental Council (GDC) and augmented from a database of OMFS trainees and consultants in the UK. Data on demographics, location, and nature of the first medical or dental degree were noted for analysis. A total of 691 OMFS specialists and trainees were identified from GMC, OMFS SAC and consultant databases. Of these, 12 consultants held only dental qualification/registration. First degree data could not be obtained for 12 specialists (all male). A further 20 OMFS specialists, whose training was outside the UK, were also excluded from further analysis. In 1995 there were 95 national training posts, by 2013 there were 150. Over the last quarter of a century, there has been an increase in medicine first trainees, an increase in female trainees and specialists, and a relative decrease in OMFS trainees from the Indian subcontinent. The varied origins of the OMFS workforce has contributed to greater diversity and inclusion within the specialty. In the UK, OMFS appears to have produced the correct number of specialists whilst maintaining a high standard of training. The next change in OMFS training programmes is to deliver The Postgraduate Medical Education and Training Board's (PMETB) recommendations. As we move to achieve this it is imperative that as new doors open, we do not close others.

Family medicine vocational training and career satisfaction in Hong Kong

BACKGROUND

Postgraduate vocational training in family medicine (FM) is essential for physicians to build capacity and develop quality primary care. Inadequate standards in training and curriculum development can contribute to poor recruitment and retention of doctors in primary care. This study aimed to investigate: 1) the satisfaction level of doctors regarding vocational training in family medicine and associated demographics; and 2) the satisfaction level of doctors regarding their family medicine career and associated factors.

METHOD

This is a cross sectional study of all family medicine physicians across all government-funded primary care clinics (GOPCs). The study questionnaire consisted of items from a standardized and validated physician survey named the Physician Worklife Survey (PWS) (Konrad et al., Med Care, 1999). We selected three scales (7 items) relating to global job satisfaction, global career satisfaction and global specialty (family medicine) satisfaction with additional items on training and demographics. All significant variables in bivariate analyses were further examined using stepwise logistic regression.

RESULTS

Out of 424 eligible family medicine physicians, 368 physicians successfully completed the questionnaire. The response rate was 86.8%. Most participants were male (52.6%), were aged between 35 and 44 years (55.5%), were FM specialists (42.4%), graduated locally (86.2%), and had postgraduate qualifications. Eighty-two percent (82%) of participants were satisfied with their training. Having autonomy and protected time for training were associated with satisfaction with FM training. Satisfaction with family medicine as a career was correlated with physicians' satisfaction with their current job. Doctors who did not enroll in training (p < 0.001) and physicians who were older (p = 0.023) were significantly less satisfied. Stepwise multivariate regression showed that doctors who subjectively believed their training as "broad and in depth' had higher career satisfaction (p < 0.001).

CONCLUSION

Overall, the satisfaction level of physicians on current family medicine training in Hong Kong was high. Having autonomy and protected time for training is associated with higher training satisfaction levels. Perceiving FM training as "broad and in-depth" is associated with higher family medicine career satisfaction.

Psychiatric training revisited – better, worse or the same?

AIMS AND METHOD

To evaluate psychiatric training in one deanery following a programme of site visits, interviews with trainers and trainees, reports, and recommendations. To assess the findings in the context of NHS training requirements. Information was collected by semi-structured interviews and questionnaire surveys.

RESULTS

Forty-three sites were visited, training is generally of a high standard and most trainees are satisfied with their posts. There are significant problems in delivering sufficient community experience to general practice trainees and deficits in availability of multi-professional training programmes.

CLINICAL IMPLICATIONS

College tutors should work to ensure that trainees have access to shared learning occasions with non-medical health professionals to meet the NHS training agenda.

In-Training Assessment for Specialist Registrars: Views of Trainees and Trainers in the Mersey Deanery

Annual review of specialist registrars and production of a record of in-training assessment (RITA) is a mandatory component of training that has attracted criticism. Mersey Deanery has established a system of review that includes wider evaluation of the trainee's needs and of training requirements. We conducted a survey to ascertain whether this broadened review process was thought beneficial. In one year 1093 questionnaires were distributed to trainees and trainers.

605 (81%) of 744 trainees and 309 (89%) of 349 trainers responded. At least 89% of both groups said that the procedure had been effective in reviewing the previous year and the most recent post and in identifying training requirements. More than 90% rated the overall process positively. Trainees particularly appreciated the advice on future training, on careers and on research.

This form of review is expensive in consultant time but was valued by both trainees and trainers.

Cascading training the trainers in ophthalmology across Eastern, Central and Southern Africa

Background

The Royal College of Ophthalmologists (RCOphth) and the College of Ophthalmology of Eastern Central and Southern Africa (COECSA) are collaborating to cascade a Training the Trainers (TTT) Programme across the COECSA Region. Within the VISION 2020 Links Programme, it aims to develop a skilled motivated workforce who can deliver high quality eye care. It will train a lead, faculty member and facilitator in 8 countries, who can cascade the programme to local trainers.

Methods

In phase 1 (2013/14) two 3-day courses were run for 16/17 selected delegates, by 3 UK Faculty. In phase 2 (2015/16) 1 UK Faculty Member ran 3 shorter courses, associated with COECSA events (Congress and Examination).

A COECSA Lead was appointed after the first course, and selected delegates were promoted as Facilitators then Faculty Members on successive courses. They were given appropriate materials, preparation, training and mentoring.

Results

In 4 years the programme has trained 87 delegates, including 1 COECSA Lead, 4 Faculty Members and 7 Facilitators. Delegate feedback on the course was very good and Faculty were impressed with the progress made by delegates.

A questionnaire completed by delegates after 6–42 months demonstrated how successfully they were implementing new skills in teaching and supervision.

The impact was assessed using the number of eye-care workers that delegates had trained, and the number of patients seen by those workers each year. The figures suggested that approaching 1 million patients per year were treated by eye-care workers who had benefited from training delivered by those who had been on the courses.

Development of the Programme in Africa initially followed the UK model, but the need to address more extensive challenges overseas, stimulated new ideas for the UK courses.

Conclusions

The Programme has developed a pyramid of trainers capable of cascading knowledge, skills and teaching in training with RCOphth support. The third phase will extend the number of facilitators and faculty, develop on-line preparatory and teaching materials, and design training processes and tools for its assessment. The final phase will see local cascade of the TTT Programme in all 8 countries, and sustainability as UK support is withdrawn.

Does after-hours in-house senior physician cover improve standard of care and outcomes in high-risk preterm neonates? A retrospective cohort study

AIM

To compare the standard of care and outcomes to discharge for inborn high-risk preterm (gestation <32 weeks) neonates admitted to the neonatal intensive care unit (NICU) before and after adopting an after-hours in-house senior physician cover roster (ISPCR). The ISPCR involved the presence of a consultant neonatologist or neonatal fellow in the NICU until 11 pm.

METHODS

This was a retrospective analysis of prospectively collected data for 12 months before (1 February 2002 to 31 January 2003, epoch 1) and after (1 April 2003 to 31 March 2004, epoch 2) adopting the ISPCR. Short-term neonatal outcomes, including mortality and morbidity such as intraventricular haemorrhage, retinopathy of prematurity, necrotising enterocolitis and chronic lung disease, were examined. The standard of acute care, including admission temperature, correct positioning of tubes and lines, and preventable ventilatory complications in the first 8 h following admission, was also compared.

RESULTS

The numbers (235 in epoch 1, 245 in epoch 2), demographic characteristics and severity of illness (CRIB score) of neonates admitted to the NICU was comparable between epochs. Overall neonatal outcomes did not show significant improvement after adopting an ISPCR, nor were they improved for after-hours admissions in the presence of senior in-house physicians. The standard of acute care was also not significantly different. Minor improvements, such as earlier administration of surfactant, were noted in epoch 2.

CONCLUSIONS

Adoption of an ISPCR was not associated with any significant change in the standard of acute care and short-term outcomes for inborn neonates <32 weeks' gestation.

Training tomorrow's military surgeons: lessons from the past and challenges for the future

The nature of conflict is evolving, with current warfare being associated with an initial "shock and awe" phase followed by protracted periods ofcounter-insurgency and peace support missions. As conflict has changed, so have the munitions deployed and the resulting patterns of injury. Improvised Explosive Devices have become the preferred weapon of the insurgent and the resultant explosive and fragmentation injuries are the hallmark of modern military wounding. These injuries pose a significant challenge to deployed medical forces, requiring a well-defined, seamless approach from injury to rehabilitation. Traditionally, military medical services demonstrate a poor 'institutional memory' in the maintenance of combat surgical skills. Numerous publications detail the re-learning of key tenets of war surgery by generations of surgeons deploying onto the field of battle. While the maintenance of military surgical capability in trained surgeons may be addressed through combat surgical courses, concern exists as to the generic competency of those currently in training and their ability to deal with the burden of injury associated with modern conflict. The training of junior doctors in the United Kingdom and further afield is in a state of flux. New curriculum development, streamlined and run-through training programmes have combined with the legal requirements of the European Working Time Directive to produce a training landscape almost unrecognisable with that of previous years. This article investigates the development of current military wounding patterns and modern surgical training programmes. It describes processes already in place to address the unique training needs of military surgeons and proposes a framework for enabling appropriate training opportunities in the future.

Impact of Calman system and recent reforms on surgical training in gynaecology

Specialist training in the UK has been affected by changes in recent years aimed at a reduction in junior doctors' working hours to comply with employment regulations and the introduction of structured training with specified duration. The Calman reforms implemented in 1996 introduced a focussed system with defined competencies and a shorter training period. The previous system was based on experience gained in an apprentice-type setting with no defined duration of training. The European Working Time Directive (EWTD) regulates the number of working hours for junior doctors and aims for a 48-h working week by 2009. In the surgical disciplines a reduction in working hours and shorter duration of training could adversely affect the acquisition of operative skills. The concern among trainees and their trainers was that surgical exposure has been reduced and therefore trainees have limited surgical experience by the time they complete training. We conducted this study in a teaching district hospital to determine the effect of recent changes on gynaecological surgical training. We found that there was a 27% reduction in surgical activity between 1995 and 2005 from 3,789 to 2,781, whereas the number of trainees had increased by 67% from 6 to 10. The proportion of operative procedures performed by trainees decreased from 55% (2,078/3,789) in 1995 to 34% (951/2,781) in 2005 (p < 0.001). The average number of procedures performed by each trainee in 2005 was 95 compared with 346 in 1995, a 73% reduction (p < 0.001). Innovative approaches to surgical training in gynaecology are required to produce a competent surgeon in a shorter time, or the risk of future consultants having limited surgical experience will increase.

Paediatric specialist registrars' views of educational supervision and how it can be improved: a questionnaire study

OBJECTIVES

To determine what paediatric specialist registrars think of the educational supervision they have received and what advice they would give to a consultant who wanted to be a more effective educational supervisor.

DESIGN

A questionnaire study.

SETTING

The North Thames Deanery, UK.

PARTICIPANTS

129 year 3, 4 or 5 paediatric specialist registrars in the North Thames Deanery.

MAIN OUTCOME MEASURES

Reported value of educational supervision on a Likert scale; what elements of educational supervision were reported to be most useful; what elements of educational supervision were reported to be done poorly; what advice would specialist registrars give to a consultant who wanted to be a more effective educational supervisor.

RESULTS

86/129 specialist registrars responded (67%). The mean score on the Likert scale (0-a complete waste of time; 100-excellent) was 57 with 37% of respondents giving a score of less than 50. The most valued aspects of educational supervision were: feedback on performance--cited by 50 respondents (56% of respondents); career advice--cited by 43 (48%); objective setting--cited by 36 (40%); pastoral support--cited by 25 (28%). Aspects of educational supervision that were reported to be often not done well were: commitment to educational supervision--cited by 44 respondents (49% of respondents); ensuring sessions are bleep-free-cited by 43 (48%); listening rather than talking--cited by 23 (26%); being encouraging--cited by 18 (20%). Advice to consultants about how to improve educational supervision included: listen rather than talk; be encouraging; treat the trainee as an individual with individual needs.

CONCLUSIONS

We can find no other study of trainees' views about how educational supervision can be improved. Although some trainees found educational supervision very valuable, many did not. Educational supervision should only be carried out by consultants who are committed to the task. An educational supervisor should listen carefully in order to understand the trainee's individual ambitions and needs, should provide specific feedback on performance and should be encouraging.

Paediatric specialist registrars' views of educational supervision and how it can be improved: a questionnaire study

OBJECTIVES

To determine what paediatric specialist registrars think of the educational supervision they have received and what advice they would give to a consultant who wanted to be a more effective educational supervisor.

DESIGN

A questionnaire study.

SETTING

The North Thames Deanery, UK.

PARTICIPANTS

129 year 3, 4 or 5 paediatric specialist registrars in the North Thames Deanery.

MAIN OUTCOME MEASURES

Reported value of educational supervision on a Likert scale; what elements of educational supervision were reported to be most useful; what elements of educational supervision were reported to be done poorly; what advice would specialist registrars give to a consultant who wanted to be a more effective educational supervisor.

RESULTS

86/129 specialist registrars responded (67%). The mean score on the Likert scale (0-a complete waste of time; 100-excellent) was 57 with 37% of respondents giving a score of less than 50. The most valued aspects of educational supervision were: feedback on performance--cited by 50 respondents (56% of respondents); career advice--cited by 43 (48%); objective setting--cited by 36 (40%); pastoral support--cited by 25 (28%). Aspects of educational supervision that were reported to be often not done well were: commitment to educational supervision--cited by 44 respondents (49% of respondents); ensuring sessions are bleep-free-cited by 43 (48%); listening rather than talking--cited by 23 (26%); being encouraging--cited by 18 (20%). Advice to consultants about how to improve educational supervision included: listen rather than talk; be encouraging; treat the trainee as an individual with individual needs.

CONCLUSIONS

We can find no other study of trainees' views about how educational supervision can be improved. Although some trainees found educational supervision very valuable, many did not. Educational supervision should only be carried out by consultants who are committed to the task. An educational supervisor should listen carefully in order to understand the trainee's individual ambitions and needs, should provide specific feedback on performance and should be encouraging.

The role of research training during higher medical education in the promotion of academic medicine in the UK

OBJECTIVES

To examine the research activities and perceived barriers to research among higher specialist trainees in geriatric medicine and to show how trainees active in research might have a role in assisting their peers in getting started in research.

DESIGN

Cross-sectional questionnaire survey on research activities, attitudes to doing research and perceived difficulties in doing research.

SETTING AND PARTICIPANTS

Trainee members of the British Geriatrics Society (BGS) in the UK.

RESULTS

A total of 122 responses (30% response rate) were received after a single mailing and a follow-up questionnaire to trainees attending the BGS national conference. Although 64% (67/104) of respondents would like to undertake a period of research, many perceived barriers preventing them from planning, funding and executing a research project. Among those who had not undertaken research, the majority (70%, 42/60) indicated that they have no clear idea of a topic to research, 64% (39/61) did not know how to develop an idea and 62% (38/61) indicated that they did not know how to get funding. Trainees motivated to do research were faced with particular difficulties with regards to funding and selection of a project topic.

CONCLUSIONS

One useful method would be systematically to provide basic information to trainees on how to enter into the early stages of research. This would help to overcome some of the unnecessary uncertainty that many trainees keen to do research seem to have.

Perceptions of the learning environment in higher specialist training of doctors: implications for recruitment and retention

INTRODUCTION

Career choice, sense of professional identity and career behaviour are influenced, subject to change and capable of development through interaction with the learning environment. In this paper workplace learning discourses are used to frame ongoing concerns associated with higher specialist training. Data from the first stage of a multimethods investigation into recruitment into and retention in specialties in the West Midlands is used to consider some possible effects of the specialist learning environment on recruitment and retention.

METHODS

The aim of the study was to identify issues, through interviews with 6 consultants and questionnaires completed by specialist registrars from specialties representing a range of recruitment levels. These would inform subsequent study of attributes and dispositions relevant to specialist practice and recruitment. The data were analysed using NVivo software for qualitative data management.

RESULTS

Participants' perceptions are presented as bipolar dimensions, associated with: curriculum structure, learning relationships, assessment of learning, and learning climate. They demonstrate ongoing struggle between different models of workplace learning.

CONCLUSION

Changes in the postgraduate education of doctors seem set to continue well into the future. How these are reflected in the balance between workplace learning models, and how they influence doctors' sense of identity as specialists suggests a useful basis for examination of career satisfaction and recruitment to specialties.

Progression of junior doctors into higher specialist training

OBJECTIVES

To report on the transition of junior doctors into higher specialist training in the UK, following the Calman reforms and recent initiatives to promote training in general practice. Design and setting Postal questionnaire survey carried out in the UK.

PARTICIPANTS

All graduates of 1996 from UK medical schools were surveyed in 2002.

MAIN OUTCOME MEASURES

Outcome measures were considered to be details of applications, outcomes of applications, intentions to apply for specialist training, and career plans with regard to such issues as flexible training and work.

RESULTS

Of 2312 responders, 39% had applied for specialist registrar (SpR) training and 35% for general practice (GP) training. Of applicants for SpR training, 68% were successful; 24% failed, almost all of whom intended to reapply, many after gaining research experience; 4% awaited a decision, and 4% had had another outcome (e.g. they withdrew their application). A sixth of responders intended to apply but had not yet done so. Of applicants for GP training, 95% had been successful. A further 2% intended to apply but had not yet done so. Responders viewed flexible and part-time training and work opportunities, and information about available posts, as being more widely available in general practice than in hospital practice. Half of the responders did not agree that their postgraduate training had been of a high standard.

CONCLUSIONS

Progression into GP training seemed to have been a smoother and less protracted process than that into SpR training. Delayed applications for SpR training were common, and many of those who had applied had not been accepted. The use of research experience to strengthen a re-application was common.

The transition from learner to provider/teacher: the learning needs of new orthopaedic consultants

BACKGROUND

Given the relatively sudden change from learner to teacher-provider that new consultants experience and the likely clinical and managerial challenges this may pose, there is a relative dearth of research into the problems they may have in relation to their new roles, or how supported they feel by senior colleagues acting in a mentoring role. This research sought to determine new consultants views on the quality and relevance of their training, its relationship to their confidence in clinical and managerial skills and their views on mentorship by senior colleagues.

METHODS

Detailed postal questionnaire to new consultants using open and closed questions. Open questionnaire to established consultants to validate new consultant responses.

RESULTS

Respondents felt their clinical training was good and were generally confident in most clinical skills although some perceived deficiencies in more complex procedures and specialist areas. Most lacked confidence in many managerial skills. These perceptions were verified by established consultants. Although no relationship was found between total training time or quality of training with confidence, extra training in specific sub-specialities improved confidence in these areas. While most established consultants thought that mentorship would be useful for new consultants, only 52% of them shared this view.

CONCLUSION

Training and experience in management should be given greater emphasis. There may be a need for specific, targeted training in complex procedures for doctors who experience lack of confidence in these areas. Mentorship should be offered to new consultants and recognised in the job-plan of the new consultant contract.

Safety in training and learning in the intensive care unit

Resident and subspecialty fellow trainees in the intensive care unit (ICU) present risks for patient safety because of their inexperience yet offer opportunities to promote safe patient care because of their around-the-clock presence and their involvement in frontline processes of care. Most trainees approach their ICU experiences without previous education in performance improvement or patient safety. This article reviews the barriers that are faced by residents in providing safe patient care and outlines the nature of a patient safety curriculum that could tap the opportunities that are presented by trainees to promote safer patient care.

Special features topic: the effects of limited work hours on surgical training in otolaryngology-head and neck surgery

PURPOSE OF REVIEW

This paper reviews the historic events that culminated in the development of duty hour regulations, and then discusses many of the problems being encountered as the regulations are implemented.

RECENT FINDINGS

On July 3, 2003, the Accreditation Council for Graduate Medical Education (ACGME) instituted duty hour requirements for residency training programs in the United States. Although these regulations should have come as no surprise to graduate medical education programs, many were nevertheless unprepared for their implementation. In comparison to duty hour restrictions currently in place in European countries, those being implemented in this country are much more lenient. Both the fiscal and the educational impact of these requirements on graduate medical education are substantial. Recent accreditation actions taken against a training program at Johns Hopkins University clearly demonstrates that the ACGME is prepared to strictly enforce these standards.

SUMMARY

The impact of the new duty-hour requirements on residency training and education will be a matter of great interest as they are implemented throughout the graduate education system in the United States.

Curriculum and assessment in higher specialist training

Higher Specialist Training (HST) has been radically reformed in the last decade, and specialties have been urged to conduct further reform. This paper reports on an explorative investigation into curriculum provision and assessment within four specialties in the West Midlands. Methods include analysis of curriculum documents; observation of the RITA process; and interviews with consultants (4), specialist registrars (5) and members of the regional higher specialist training management team (3). Three major themes identified within the interviews are discussed: the content and use of the curriculum; the impact of service-based learning; and issues around assessment.

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

OBJECTIVE

To identify and review UK research relating to the effects of patterns of work on the education of junior doctors, describe the trends in the research, contextualise the progress of the UK in reducing the number of hours worked by junior doctors alongside that of other countries and identify areas for future research.

METHOD

A total of 77 research studies, mostly written after 1995, were identified as relevant from approximately 900 references generated by searching Medline and using a 'snowball' technique. The articles identified were qualitatively reviewed to identify their key research conclusions and/or the main points of argument. These were collated and presented in a qualitative review.

RESULTS

Research in the UK is contradictory regarding the effects of working patterns and the views of doctors towards them. Further research is needed to examine in depth the differences in the effects of working patterns on education between hard-pressed and non hard-pressed specialties, hospitals and regions. When viewed in an international context, the UK ranks among a number of countries with similar medical systems that are moving towards reducing the hours worked by doctors in training, all of which are at different points in the process.

CONCLUSION

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.

Senior house officer training in oral and maxillofacial surgery: a national survey

Service commitments have often taken priority over training for many senior house officers. There have been changes, with more planned to make this truly a training grade. We conducted a national postal survey of senior house officers (SHO) in oral and maxillofacial surgery (OMFS) in 2001/2002. A total of 229 replies were received with an estimated response rate around 70%. Almost 60% of these respondents (57.2%) had been a SHO in OMFS for over 3 years. Only 39% had a weekly bleep-free teaching session. Forty-eight per cent did not think undergraduate BDS training was adequate for their job. This 48% of SHOs were significantly less likely to have out patient clinic sessions with a designated trainer undertaking teaching (chi 2 = 6.127, P = 0.013) or have a bleep-free teaching session (chi 2 = 6.896, P = 0.009). Sixty-four per cent had received formal training in medical examination of patients. Twenty-nine per cent had not been appraised during their present post. Forty-two per cent of SHOs in OMFS are in band 3 posts. Improvements have been made, but there is a case for further change.

Education and training in the paediatric senior house officer grade: analysis of RCPCH hospital/child health visits reports, 1997-2001

AIMS

To review the process and outcome of education and training visits to paediatric departments by the RCPCH.

METHODS

Retrospective audit of visits reports (1997-2001) against the RCPCH criteria for general professional training. Hospital and/or community child health departments who were responsible for training paediatric senior house officers were visited to assess whether RCPCH criteria of education were being met. Follow up visits were undertaken where limited education and training approval was given. Reports were received from 214 of 242 (88%) hospital and/or community based departments in England, Wales, and Northern Ireland.

RESULTS

Satisfactory achievement of the 12 training criteria by departments varied widely: 39-95% (median 66%) achieved. Follow up visits reported significant improvements in most departments. Criteria which departments struggled to achieve reasonable standards were: (1) ensuring SHOs were performing educationally appropriate duties (39% achieved); and (2) satisfactory outpatient experience (41% achieved). Twenty four per cent of hospital based departments did not have a paediatrician with 12 months or more experience of paediatrics resident on call.

CONCLUSIONS

The visiting process highlighted areas of good practice, encouraged change to meet the criteria, and recommended increased resources and staffing where necessary to improve training and hence the service. The need for continuing approval for education and training in these departments encouraged significant efforts on the part of trainers and managers to meet the requirements, and consequently the quality of service to children has been enhanced.

Specialist registrar training: what still needs to be improved?

It is 6 years since specialist training in the UK was radically reformed. Is educational quality still improving or have early improvements slipped as the novelty has worn off? What further improvements are needed to ensure the production of specialists who are properly prepared to be the consultants of the future? The authors address these questions from the perspective of one postgraduate deanery.

Views of junior doctors on the specialist registrar (SpR) training scheme: qualitative study of UK medical graduates

OBJECTIVE

To report junior doctors' views on specialist registrar (SpR) training.

DESIGN

In 1999, as part of ongoing studies of doctors' careers, we surveyed all doctors who had qualified from UK medical schools in 1993. Structured questions about recipients' careers were accompanied by a form inviting free text comments. Comments about the SpR scheme were extracted for analysis.

RESULTS

Doctors commented that there were insufficient national training numbers (NTNs) for those who wanted them, and that more than the minimum entry requirements seemed necessary for shortlisting. Strengthening curricula vitae through research and published work could prolong the duration of training and did not guarantee success. Specialist registrar training was considered by some respondents to be narrow and inflexible, with service work taking priority over training needs. As a result, some respondents feared they would not be competent to practise as consultants. There was a perceived shortage of consultant vacancies and 6 months was considered insufficient time for obtaining a suitable post.

DISCUSSION

It is inevitable that doctors may not necessarily be able to pursue their initially chosen career paths. Trainers need to provide realistic advice about career opportunities. Provision of information about NTN availability and formal career counselling could help to prevent delays in career progression. The shortened and more structured programme of training has reduced its flexibility in some doctors' experience. Improvements in educational content will need greater input from consultants, which may require an increase in consultant posts. Time will tell whether concerns about competence to practise as consultants and consultant post availability will be justified.

In-training assessment for specialist registrars: views of trainees and trainers in the Mersey Deanery

Annual review of specialist registrars and production of a record of in-training assessment (RITA) is a mandatory component of training that has attracted criticism. Mersey Deanery has established a system of review that includes wider evaluation of the trainee's needs and of training requirements. We conducted a survey to ascertain whether this broadened review process was thought beneficial. In one year 1093 questionnaires were distributed to trainees and trainers. 605 (81%) of 744 trainees and 309 (89%) of 349 trainers responded. At least 89% of both groups said that the procedure had been effective in reviewing the previous year and the most recent post and in identifying training requirements. More than 90% rated the overall process positively. Trainees particularly appreciated the advice on future training, on careers and on research. This form of review is expensive in consultant time but was valued by both trainees and trainers.

Flexible training under threat

As the number of women in medicine and the general demand for a better work-life balance rises, flexible training is an increasingly important mechanism for maintaining the medical workforce. The new pay deal, together with entrenched cultural attitudes, are potential threats. Ways forward include more substantive part-time posts, more part-time opportunities at consultant level, and using positive experiences as a way of tackling attitudes in the less accepting specialties.

Induction for overseas qualified doctors

This study describes a strategy for the integration of overseas doctors with different professional and cultural backgrounds. A central induction course, complementing local trust-based induction programmes, was developed and evaluated by the London Deanery. Most participants found the course helpful, and their comments were used to further improve it.

Stress in doctors and dentists who teach

OBJECTIVE

To explore the relationship between a teaching role and stress in doctors and dentists who teach.

METHODS

Medline, PubMed, BIDS database for social sciences literature, and the ERIC database for educational literature were searched using the key words 'stress' or 'burnout' with the terms doctor, physician, dentist, teacher, lecturer, academic staff, and university staff. Other books and journals known to the authors were also used.

RESULTS

Many studies have shown high levels of stress in doctors, dentists, teachers, and lecturers. A large number of factors are implicated, including low autonomy, work overload, and lack of congruence between power and responsibility. Doctors and dentists who take on a teaching role in addition to their clinical role may increase their levels of stress, but there is also evidence that this dual role may reduce job-related stress.

CONCLUSIONS

Working as a doctor or dentist may entail higher levels of stress than are experienced by the general population. In some situations adding in the role of teacher reduces this stress, but more research is needed to explain this finding.

Specialist Registrars in Otolaryngology: their training programme and career aspirations

The Calman reforms were introduced to Otorhinolaryngology in July 1996 and we are half-way through its first cycle. Further changes may become necessary with expansion of our specialty and because of the need to incorporate super-specialization into current training programmes. We felt that it was an appropriate to evaluate these reforms through the eyes of the Specialist Registrars and at the same time to take the opportunity to investigate their career aspirations. In August 1999 a postal questionnaire was sent to all 184 Specialist Registrars in otorhinolaryngology in England and Wales, of which 123 (66.85%) responded. The results are presented in this paper.

Use of ultrasound to improve the safety of postgraduate training in obstetrics and gynaecology

Supervised clinical work is perhaps the most valuable component of postgraduate training and has a long-term impact. Senior clinicians not only take the responsibility of teaching and supervising junior doctors but also most of them take the consequences of any clinical failures or mistakes associated with the training. Despite the introduction of simulators and computer-assisted learning, practice on real patients is still required to learn many skills in obstetrics and gynaecology. Training must be safe, because trainees or trainers must not put our patients at risk as part of the process of learning to heal others. Ultrasound can be used to demonstrate and guide several procedures that have been performed 'blindly' in the past. This technology can reduce the risks associated with training and supervision of junior doctors.

Postgraduate specialist training and continuing professional development

Specialist education and continuing professional development are likely to change considerably over the next 20 years. This will reflect the context within which medicine is practised. This will include changes in disease patterns, population structure, medical advances, information technology and, perhaps most powerfully, public involvement. In speciality education there will be a need to define more clearly both the role of the specialist, and the competences to be achieved. CPD is the longest period of education and, as such, it is the phase during which there is likely to be greatest change in clinical practice. There is a need to develop mechanisms to assure the public that doctors continue to practice up-to-date medicine, and that there is confidence and trust in the process.