4 Jul, 12 | by BMJ Group
It’s coming up to that time of year once again, where—for newly qualified doctors across the country—the jubilation associated with passing finals gives way to the incipient dread of the first day in a new job, and the knowledge that very soon patients’ lives really will be in their hands.
It’s well known that if you want to avoid those taking their first professional steps on the wards you should avoid becoming unwell in the first week of August. Type “junior doctors” into a search engine and it will helpfully suggest you might be looking for “changeover dates.” Surely it is at least slightly surprising that after five or six years of full-time training the public still don’t have a great deal of faith in our ability to do our job?
Public perceptions stem from personal experience but also from the media to which they are exposed. It is not difficult to find articles decrying junior doctors and the training they receive. If the national broadsheet media were to be believed, there exists a breed of “Incompetent junior doctors putting patient’s lives at risk” in what was, just last week, coined the “NHS killing season.” Is it any wonder, then, that patients have little faith in newly qualified doctors?
Such doubt may be misplaced, however, according to a study published by van der Leeuw et al in BMC Medicine this week. In a systematic review of the literature from 2004-2011, the study seeks to identify correlations between aspects of residency training and patient outcomes. It is also mindful that the responsibility for providing day-to-day patient care lies predominantly with those still in training. The article itself refers to residents, who are foundation and core or specialist trainee equivalents in the USA, however the literature searched was international and limited only to English language publications by a lack of availability of such articles in other languages.
The study lists a number of findings, many of which are largely unsurprising. For example, evidence suggests residents become more efficient in practical procedures as their training progresses, those towards the end of their training tend to score more highly on patient satisfaction and have better patient outcomes than those just starting out, and trainees appear to benefit from having more, as opposed to less, structured training. Interestingly, teaching hospitals had better patient outcomes than non-teaching hospitals, particularly in surgical cases.
The conclusions reached should reassure all concerned that the care they receive from doctors still in training is not only safe, but comparable with care provided by their more senior counterparts. This reassurance comes with a few necessary conditions, however. Junior doctors must be provided with the required supervision and appropriate additional time to achieve the same level of outcome as their more experienced seniors.
This message needs to be heard, as the headlines casting their competency in doubt are damaging not only to the doctor-patient relationship, but to the prospects of these junior doctors in terms of training opportunities and building experience.
Everyone naturally wants the best care for their friends, their family, and for themselves, and it is only logical to assume that doctors with greater experience would be best placed to provide this. However, this review article highlights a number of studies, a majority of which find doctors still in training are capable of providing an equivalent standard of care. I can only hope that in the interests of fair reporting the media see fit to disseminate the findings of this study. Although “junior doctors most often perfectly competent” may not have quite the same sensationalist ring to it, with the first week in August fast approaching, it is vital that those unfortunate enough to fall ill and require hospital care during this time have confidence in the ability of those charged with providing their care.
Emma Rourke is a BMJ Clegg scholar and an intercalating medical student at Newcastle University.