Comments on: Fiona Pathiraja: Putting a price on safety

By: Anna

Anna — Thu, 08 Sep 2011 11:29:56 +0000

My medical school made final years undertake 10 weeks of 1-1 F1-shadowing. On top of this when I started work a few weeks ago (South Thames Foundation School), I had a week-long paid induction period involving tours of the hospitals within the trust, talks from pharmacy and microbiology, IT training, an ALERT course, and further F1 shadowing. Despite all of this preparation my first few weeks as a doctor have at times been terrifying. I wouldn't say I'm undersupported, but at the moment I'm the only member of my team on the ward. All it takes is an SHO to be on leave, a registrar to be sick, and a consultant on holiday and suddenly you're flying solo, albeit with friendly back-up from doctors on other teams. I have numerous F1 friends (not just in my trust) who have experienced this – some in their first week. Adapting hospital rotas to ensure F1s are always supported/supervised by a more senior doctor during their fist few weeks would have an bigger impact on patient safety than a week's worth of induction training.

By: Bernard

Bernard — Mon, 15 Aug 2011 22:51:53 +0000

UK medical schools (and I went to a leading London school) do not provide a proper apprenticeship for their students. Student numbers have been so inflated in the past decade that you have 4-6 students attached to each firm. No expectation to learn drug doses, how to dose warfarin etc, or in any way get stuck in on the shop floor. Time is taken up with tedious and banal form filling-in and box-ticking of competences and disingenuous "workbased assessments". (This is continued into the foundation years and beyond - take one look at the nausea inducing NHS ePortfolio).

Compare with American medical schools were students work parallel to interns (1:1 ratio) and work full days with almost identical responsibility for their patients, with an entirely different educational ethic and ambition. In this country until relatively recently, final year students could do House Officer locums, presumably dropped for medicolegal reasons.

So, regarding the annual August "black Wednesday", it is the effete educationalists' wrecking job of UK medical schools which we should be examining, not NHS employers. Virtually all F1s attend shadowing, paid or unpaid, out of professional commitment to achieve the best for their patients when they start. Trouble is, by then, it is sadly too late to truly prepare for the new working lives as doctors.

By: Dr Fiona Pathiraja

Dr Fiona Pathiraja — Mon, 08 Aug 2011 15:08:56 +0000

Thanks for the comment. Preparation for practice is being addressed around the country as med schools realise that their final years are not always ready for practice on the wards. Corporate induction is not supposed to compensate for knowledge. However, the NHS is missing a trick by not engaging these keen, enthusiastic new docs through a high quality induction programme in their first jobs.

By: Dr Fiona Pathiraja

Dr Fiona Pathiraja — Mon, 08 Aug 2011 15:05:53 +0000

Thanks Peter for the ref – will definitely look it up! F

By: John

John — Mon, 08 Aug 2011 13:51:33 +0000

This should be handled further upstream. I know practicing f1s that have never clerked patients by themselves and have graduated from medical school with merits and distinctions. I agree with Peter, but the system change needs more proximal input – from medical schools.

By: Aias

Aias — Sun, 07 Aug 2011 00:22:42 +0000

Νοone has addressed the real issue which is: has preparation for being a medical doctor deteriorated over the years and is so why? No corporate induction can ever compensate for lack of basic medical knowledge. Human beings are not Tesco products to follow protocols with

By: Peter Lachman

Peter Lachman — Fri, 05 Aug 2011 22:48:50 +0000

This is a classic problem of trying to mend
a broken system. The design is the problem - the archaic way we use trainees
to provide service. One would never design the process in this way if one
started over.

We need have a radical rethink (read
Clayton Christensen on this) and provide training and service in different
ways. Patients should not be exposed to inexperienced trainees who are not
supervised whenever they see patients.

This will require reconfiguration and closure
of units and the development of centres which provide real supervised training and
centres which only provide service.

By: Dr Fiona Pathiraja

Dr Fiona Pathiraja — Fri, 05 Aug 2011 15:55:16 +0000

There are areas of notable practice for paid F1 shadowing and induction in England (South West and East of England). They do this well but yet to be adopted across the country due to cost pressure and NHS Employer contract details for F1 docs. F

By: Muir Gray

Muir Gray — Fri, 05 Aug 2011 11:58:19 +0000

there must be somebody, somewhere who has made this a littlebit less bad ? is there any one on The Network whp knows

By: Dr Fiona Pathiraja

Dr Fiona Pathiraja — Fri, 05 Aug 2011 01:28:23 +0000

C, sounds like Northern Ireland are ahead of the game then! There are sites of best best practice in England (East of England, South West) but long way to go before a uniform system. Also needs enthusiastic people like you to lead the schemes on the front line. Fi

By: Phil Anderson

Phil Anderson — Thu, 04 Aug 2011 21:36:19 +0000

I think the F1 docs sometimes unfairly get landed with the whole blame for this, and we forget that on the same day F1s become F2s with a sudden increase in responsibility. As one of my fellow exF1 said to me "we're now on a rota with people who know stuff"

As well as this, there is the unfamiliarity of a new hospital for everyone from F2 to SpRs, things get missed because the protocols are different, what was normally done by a Reg in one hospital may be done by an SHO in another etc.

By: DrGandalf

DrGandalf — Thu, 04 Aug 2011 18:45:38 +0000

Completely agree that handover needs to happen, not just a few minutes but a few days of acclimatisation on the wards and in the hospital. Great article and significantly better than my rant on Black Wednesday at - http://egplearning.co.uk/blog/…. Though we do have the same reference lol

By: Colin Weir

Colin Weir — Thu, 04 Aug 2011 17:46:05 +0000

We do a salaried induction for our FY1s-I think we are unique in this deanery at least in doing that. They start week before on a Wed doing ALERT, Thurs is ILS, Fri is a trust induction on infection control, safe IV cannulation, MEWS, right patient right blood and so on. Following this on Monday a Deanery induction and Tues is a day with the outgoing FY1s.

On top of this we have an online resource of competencies for FY1s to complete including safe prescribing, death certification, and many other subjects which is checked by a completion online MCQ.

If thats not enough they complete a 4 week apprenticeship in final year in the hospital in which they will take up first appointment.

I don't know if this is best practice but patent safety is the premium here and if we value our young doctors and the care of the patients who need them then paying for attendance at induction must be right.