Shadowing by foundation doctors halves errors, pilot shows

Authors: Helen Jaques 

Publication date:  06 Jul 2012

The four day shadowing period being introduced for medical graduates starting foundation year 1 this summer could halve the number of mistakes made by new doctors, a pilot of the scheme in Bristol has indicated.

In March the Department of Health announced that all new foundation year 1 doctors will spend a minimum of four paid working days shadowing the job that they will be taking up in August.[1]

The pilot conducted at University Hospitals Bristol NHS Foundation Trust, the results of which have just been published by the health department, found that doctors who took part in shadowing and targeted training in 2009 made half as many mistakes in their first four months as doctors who started in 2008 and did not do any shadowing.

The August national start date for new doctors is associated with increased risk to patients, with emergency patients admitted on the first Wednesday of the month having a 6% higher mortality rate than people admitted on the previous Wednesday.[2] “This shadowing period could potentially save lives and will equip new junior doctors with the local knowledge and skills needed to provide safe, high quality patient care, from their first day as a doctor,” said Bruce Keogh, the NHS’s medical director.

From July 2009 new foundation year 1 doctors starting work at hospitals in Bristol undertook ward based shadowing or “supervised work”; informal teaching sessions with current junior doctors; formal teaching sessions on issues such as patient safety and handovers; and social events to develop a peer network. These doctors registered with the General Medical Council one week early and were provided with a free extra week of professional indemnity cover.

The new doctors who started in 2009 made 52% fewer mistakes than new doctors who started in summer 2008 and reported only one incident in their first four months of practice that led to permanent harm of a patient; in 2008 there were five such incidents.

Medical Education England’s steering group on shadowing has spelt out the details of the national shadowing programme, recommending that the four days of shadowing should include a timetabled block of continuous ward based shadowing lasting at least two days (at least 50% of the minimum four days) and a non‐ward based component that should be devised to maximise the safety of patients and a high quality service.[3] As part of the ward based component, new foundation doctors should be encouraged to take some clinical responsibility and have the opportunity to shadow a clinical handover and an out of hours shift.

Shadowing should be remunerated on the basis of a pro rata basic foundation year 1 salary, and doctors in the shadowing programme should be contracted to the employing trust through either an honorary contract or as an addendum to the existing foundation year 1 contract.


  1. Jaques H. Shadowing period to be introduced for new foundation year 1 doctors. BMJ Careers  16 Mar 2012. [Link] .
  2. Dr Foster Intelligence. New study shows fresh thinking required on week junior doctors start. 22 Sep 2009. [Link] .
  3. Outram C. MEE Shadowing Steering Group on national shadowing arrangements for appointees to the Foundation Programme. Agreed Recommendations. Medical Education England, 26 Jun 2012. [Link] .

Helen Jaques news reporter BMJ Careers

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