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BMJ No 7123 Volume 315 Paper Saturday 20/27 December Christmas 1997 issue Do you know your chocolates? Recognition survey among medical staff of various grades Fiona Cooke, Rhian Morse Gifts of chocolates are common on hospital wards. Preregistration house officers have a massive exposure to a wide range and quantity of chocolates - one of the many early and challenging experiences for the new doctor. Chocolate contains caffeine, a methyl xanthine whose primary biological effect is antagonism of the adenosine receptor, producing a stimulant effect. It is not surprising that chocolates are keenly sought after, particularly by the tired and weary. We set out to test the ability of doctors and nurses to recognise popular chocolates and determine the association with years post qualification. Methods, subjects, and results A random selection of 76 doctors and nurses at the Royal United Hospital, Bath, and the University Hospital of Wales, Cardiff, took part. The volunteers consisted of 16 new (day 1) preregistration house officers, 11 post-registration house officers (just completed preregistration year), 5 senior house officers, 15 registrars (junior and senior), 12 consultants, and 17 qualified nurses. Each volunteer was shown a grid containing 12 popular chocolates and asked to identify both the flavour and the make of each chocolate (maximum score 24) (figure). Do you know your chocolates? Answers are at the end of the article. Prodding, smelling, and tasting were not allowed. The table shows mean recognition scores for make and flavour for each grade of volunteer. All grades except for consultants were better at recognising the make of chocolates than the flavour. Consultants performed equally badly at both tasks. One way analysis of variance showed significant between grade differences for total chocolate scores (F=8.3, P<0.01, df=4). Post hoc analyses (the Newman Keuls procedure) showed that scores for the post-registration house officers were significantly better than scores for the preregistration house officers, registrars, and consultants. In addition, a significant inverse correlation existed between years post registration and total scores for chocolate recognition (Pearson's r=-0.47, P<0.01). The nurses performed as well as the post-registration house officers. The "coffee creme" chocolate was recognised by most subjects at all grades. Recognition of make and flavour of chocolates among 76 doctors and nurses at two hospitals. Values are mean recognition scores unless stated otherwise Grade Make Flavour Total score Coffee creme recognition (%) Preregistration house officer (n=16) 4.9 2 6.9 81 Post-registration house officer (n=11) 6.9 4.8 11.7 100 Senior house officer (n=5) 6.2 3.2 9.4 80 Registrar (n=15) 5.5 2.5 8 87 Consultant (n=12) 2 2.2 4.2 67 Nurse (n=17) 7.2 5.1 12.3 88 Maximum score of 12 each for make and flavour, 24 for total score. Comment There seems to be a steep learning curve for chocolate recognition during the preregistration house officer year. This is true for many other medical skills and is likely to be related to exposure time. It is difficult to deduce whether the learning process for chocolate recognition is an active or passive one, but it is obviously important to the house officer. It is unlikely to be acquired from, or taught by, more senior colleagues because our study suggests that this skill deteriorates with increasing seniority. This apparent "fall out" of information regarding chocolates has been shown for other more orthodox aspects of medical knowledge - for example, management of hypertension.(1) Despite the poor performances of senior staff, however, this group certainly knew which chocolates they liked and which they did not, despite being unable to specifically recognise them. Terms such as "yucky one" or "yummy one" and "nice one" were commonly used by the senior registrars and consultants interviewed. Perhaps an analogy can be drawn with the acquisition of a more instinctive approach to medical problems as clinicians become more senior. Many consultants have been heard to say, "I don't know what's wrong with this patient, but he's definitely sick!" The other major finding was the almost universal recognition (and dislike) of the coffee creme. The reason for this is unclear, but in our experience this skill probably extends beyond the medical profession. Finally, consultants beware, managers have already expressed an interest in the chocolate recognition score as a surrogate measure of time spent on the wards. Other members of the CPS Group were A M Nybo Andersen, M Andersen, P K Andersen, K Begtrup, B Hogh, H Jensen, K Molbak, N M Nielsen, L L Winther Nielsen, S Olsen, and J B Pedersen. Funding: None. Conflict of interest: None. Answers to chocolate quiz: A: brazilnut caramel (Roses); B: strawberry delight (Black Magic); C: coconut eclair (Quality Street); D: nougat (Milk Tray); E: wafer sandwich (Dairy Box); F: coffee creme (Roses); G: truffle shell (Milk Tray); H: toffee penny (Quality Street); I: truffle and nougat (Black Magic); J: caramel cup (Dairy Box); K: orange cream (Black Magic); L: fudge (Quality Street). Royal Brompton Hospital, London SW3 6NP Fiona Cooke, senior house officer Department of Integrated Medicine, University Hospital of Wales, Heath Park, Cardiff CF4 4XW Rhian Morse, consultant physician Correspondence to: Dr Morse References 1 Sackett D L, Haynes R B, Guyatt G H, Tugwell P. Clinical epidemiology: a basic science for clinical medicine. 2nd ed. Little, Brown, 1991:305-7. Home | Current issue | Past issues | Classified ads | Career Focus | Feedback Collections | About this site | About the BMJ | BMA | Medline