Firm foundation for senior house officers: Junior doctors should become progressively more enabled

doi:10.1136/bmj.329.7459.230-a

BMJ 2004;329:230 (24 July), doi:10.1136/bmj.329.7459.230-a

Letter

Firm foundation for senior house officers

Junior doctors should become progressively more enabled

The first 150 words of the full text of this article appear below.

EDITOR—Gallen and Peile discuss establishing a firm foundationfor senior house officers.¹ Concerns about trends in juniordoctor training are growing in acute medical specialties. Theproposed reforms may exacerbate a deteriorating situation.

In the past decade the competencies of junior grade doctorshave collapsed. Previously junior house officers would rapidlyacquire emergency medicine skills by being supervised participantsin on-call ward cover and acute takes, consolidating these skillsand acquiring considerable responsibilities as senior houseofficers.

Thus on-site medical competency has become extremely thin onthe ground out of hours and in emergencies. Worse, prospectiveregistrars are ill equipped to deal with emergencies owing tolack of exposure as senior house officers. Intensive care out-reach,increased tertiary or subspecialty referrals, and the appointmentof acute medicine consultants may absorb some of this experiencedeficit, but it still represents a worrying threat to patients'safety in the face . . . [Full text of this article]

Chris M Laing, specialist registrar nephrology and general and internal medicine

Hammersmith Hospital, London W12 0HS claing@mac.com