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PAPERS: Elisabeth Paice, Maryanne Aitken, George Cowan, and Shelley Heard Trainee satisfaction before and after the Calman reforms of specialist training: questionnaire survey BMJ 2000; 320: 832-836 [Abstract] [Full text]

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Trainee satisfaction with Calman reforms

Adrian Thuraisingam   (31 March 2000)

Trainee satisfaction and the New Deal

E Paice   (1 April 2000)

Trainee satisfaction with Calman reforms 31 March 2000
Adrian Thuraisingam Send response to journal: Re: Trainee satisfaction with Calman reforms	EDITOR- Paice et al report increased overall job satisfaction amongst specialist registrars following the introduction of the Calman reforms.1 They also demonstrate similar increased satisfaction amongst pre- registration house officers and senior house officers over the same time period, despite the Calman reforms largely effecting higher specialist training, this would perhaps indicate an alternative reason or reasons for this improvement. It is possible that this increased satisfaction is just as likely to be due to the New Deal which eventually came into force at the end of December 1996, that is to say immediately after the first questionnaire. The New Deal or at least its stated aims were all those that should have improved working conditions and hence job satisfaction i.e. decreased working hours, increased rest periods and the increased use of support services. Additionally their questionnaire did not address a very important aspect of job satisfaction- career progression or doctors' perception of it. Obtaining a national training number is increasingly difficult since the numbers of junior trainees do not necessarily match the numbers of specialist registrar in some specialities.2 In addition national training numbers are likely to be reduced.3 Even once completion of specialist training has been reached there is no guarantee of a consultant post at the end with insufficient vacancies being available in some specialities such as obstetrics and gynaecology.4 The Calman reforms have doubtless improved many aspects of higher specialist training but they are no panacea. Adrian Thuraisingam trust grade (desperately seeking NTN) North Manchester General Hospital, Manchester, M8 5RL 1 Paice E, Aitken M, Cowan G, Heard S. Trainee satisfaction before and after the Calman reforms of specialist training: questionnaire survey. BMJ 2000;320:832-6 2 Galasko CS, Smith K. Ratio of basic surgical trainees to type 1 specialist registrar programmes 1999/2000/2001/2002. Annals Royal College Surgeons England 81(3 Suppl):124-8, 1999. 3 Wilson C. Reduction in SpR numbers leads to service fears. Hospital Doctor 2 Dec1999 1. 4 Ryde K. Planning the medical workforce. BMJ 1999;319:2
Trainee satisfaction and the New Deal 1 April 2000
E Paice, Dean Director TPMDE Send response to journal: Re: Trainee satisfaction and the New Deal	Dr Thuraisingam raises an important question, and one we asked ourselves. While most of the changes resulting from the New Deal on junior doctors' hours in North Thames took place between 1993 and 1996, there were further improvements in on-call rotas between our two surveys. In 1996/7 most SpRs were on 1:4 or 1:5 and in 1998/9 most were on 1:5 or 1:6. However, we found little correlation between the frequency of on call and overall satisfaction with the post. There was a correlation between overall satisfaction and hours of continuous uninterrupted rest during a night on call. This appeared to get worse between the two surveys ie the SpRs were on call less often but working harder when on. However, we were not confident that we were comparing like with like as there were many variations in patterns of work. We concluded that, at least at SpR level, the improvements in trainee satisfaction could not be explained simply by the New Deal, which in any event was unlikely to have affected educational objective-setting, induction, use of log books or consultants' feedback, all of which were strongly associated with overall satisfaction. As to the question of career progression, I can only say that we did not address this in the study.