Junior doctors are being left to run hospital departments unsupervised, GMC warns

Authors: Gareth Iacobucci 

Publication date:  27 十一月 2017


Junior doctors in some hospitals are being forced to work beyond their capabilities and to run busy departments unsupervised, putting patients at risk, the General Medical Council has warned.

In its UK-wide report on training environments in 2017 the GMC describes examples of trainees being left to deal with “situations beyond their competence” because of an absence of senior supervising doctors.[1] This was being driven by recruitment difficulties, the regulator said.

The report was based on the GMC’s annual survey, which is answered by 53 000 junior doctors and 24 000 trainers.

More than a sixth (8256) junior doctors surveyed said that they felt forced to cope with clinical problems beyond their competence or experience on at least a monthly basis, while 6% (3327) said they felt exposed to this on at least a weekly basis. This was most common among trainees at the beginning of their postgraduate careers.

The GMC’s chief executive, Charlie Massey, said that in one hospital a group of doctors in foundation training were required to work on an overnight rotation in an emergency department without undergoing an induction or any assessment of their skills. In another emergency department a foundation doctor on duty in a resuscitation unit reported calling three times for support from senior colleagues without receiving assistance.

Massey told the Guardian newspaper, “There was a very real risk that they could be working beyond their competence because they were on a night shift with limited supervision, therefore they might have had to undertake tasks for which they weren’t qualified.”[2]

Massey added, “In some cases trainees are being left to fend for themselves when they clearly don’t have the competence to make the decisions about patients’ treatment that are being asked of them. That’s a real concern. A significant proportion of trainees, especially those early in their careers, feel very exposed in terms of what they are being asked to do.” he added.

The GMC’s report said that education and training relied too heavily on the goodwill and sacrifices made by senior colleagues who acted as trainers. Almost half of the trainers surveyed (11 616) said that they worked beyond their rostered hours each week, and nearly a third (7031) said that this happened daily.

For the first time this year’s survey also asked trainers about their workload. Nearly three quarters (17 186) said that their daytime workload was “heavy” or “very heavy.” A lower proportion of trainees (41%, or 21 675) reported their daytime workload as being “heavy” or “very heavy.”

But while three quarters of trainees (40 567) rated their training as “good” or “very good,” 22% (11 880) said that they regularly felt short of sleep while they were on duty. And more than half (28 425) said that they worked beyond their rostered hours either daily or weekly.

The report said, “A worrying number of doctors in training continue to raise concerns about heavy workloads and shortness of sleep while on duty, with some missing educational opportunities because of these pressures.”

In response to new questions focusing on rota gaps, trainees and trainers—particularly those working in acute care specialties—said that poorly designed or incomplete rotas were having a negative effect on education.

References

  1. General Medical Council. Training environments 2017: key findings from the national training surveys. [Link] .
  2. Campbell D. Safety fears as junior doctors left to run A&Es and other hospital units. Guardian 26 Nov 2017. [Link] .

Gareth Iacobucci The BMJ

Cite this as BMJ Careers ; doi: