New systems being trialled for assessing and reviewing patients may have a negative effect on junior doctor training, according to a new study of acute care at the Royal Liverpool University Hospital.
The findings, published in Clinical Medicine, show that while NHS targets are being met, trainees’ learning opportunities have suffered. Waiting times in A&E and time to assessment by a consultant in acute settings improved after reforms in the hospital, according to the study. However, the restriction of hours prevented junior doctors from being present when the patients they admitted to the wards were reviewed by a consultant. At this stage around half of all diagnoses are changed and the current system has no mechanism for feedback to the initial assessing team. The authors note that the patterns of work and systems employed at the Royal Liverpool are likely to be found in other hospitals struggling to balance Government targets for waiting times with the new target for reducing junior doctors’ working hours. Commenting on behalf of the research team, Dr Solomon Almond, said: “The results of our audit highlight the benefits for patients of being seen by consultants soon after admission. However, the restriction of junior doctors’ hours means there is less time for consultants to discuss their decisions with the doctors in training. “Ideally all emergency admissions would be seen straight away by consultants accompanied by the junior doctors. This would re-establish the link between hands-on clinical medicine, training and experience that was for many years the foundation of post graduate medical education in this country.” Dr Andrew Goddard, director of workforce planning at the Royal College of Physicians, said: “This study shows that increasing the input of consultants into the care of medical patients admitted to hospital changes the way doctors are trained. The short term benefits to the patient of seeing a consultant first may be offset by loss of training opportunities for the consultants of the future.”
