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LETTERS: S G Ninan Team based doctors produce better ward care BMJ 2007; 334: 170-b [Full text]

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The extinction of informal training?

1. Mark Fox, 2. Jenny Watt, Specialist Registrar in Geriatric Medicine, Chorley and South Ribble District General Hospital, Preston Road, Chorley, PR7 1PP   (17 February 2007)

The value of Ward Rounds

Mr Shankar Thiagarajah   (28 February 2007)

The extinction of informal training? 17 February 2007
1. Mark Fox, Clinical Fellow in Gastroenterology Fairfield General Hospital, Rochdale Old Road, Bury, Lancashire, BL9 7TD, 2. Jenny Watt, Specialist Registrar in Geriatric Medicine, Chorley and South Ribble District General Hospital, Preston Road, Chorley, PR7 1PP Send response to journal: Re: The extinction of informal training?	Throughout our short careers informal teaching by seniors has arguably consistently provided the most valuable learning experiences. This is especially true for the assessment of critically ill patients, gaining competency in practical procedures and consolidating communication skills. Hospital medicine has undergone a great deal of change in recent years and with the advent of Modernising Medical Careers will undoubtedly continue to evolve. Fundamental to this is the reduction of working hours of doctors in training as a result of the impact of the European Working Time Directive(1) which has led to the introduction of shift working and the fragmentation of the junior team and consequently poor continuity of care for patients and a loss of learning opportunities for trainees. Ninan highlights the multiple benefits of a team over a ward-based system for both patients and healthcare professionals yet the latter is increasingly preponderant in hospitals today.(2) There has been an inexorable rise in the number of emergency admissions without a corresponding increase in nursing and medical staff that consequently, can be overwhelmed by the workload at times. Not only does this compromise safe practice but also undermines junior training. The nature of post take rounds has changed dramatically with an apparent focus on service provision. Often, in our trusts, one member of the team accompanies the consultant while the others continue to clerk - a stark contrast to the bygone days when presentation skills were tested and cases dissected for training purposes. Informal ‘on the job’ training by seniors is crucial for the development of junior doctors in training. Efforts should be made to ensure this resource does not remain underused or indeed become extinct. References: (1) Council Directive No 93/104/EC of 23 November 1993 concerning certain aspects of the organisation of working time; (2) Ninan SG, Team based doctors produce better ward care. BMJ 2007; 334: 170. (27 January). Competing interests: None declared
The value of Ward Rounds 28 February 2007
Mr Shankar Thiagarajah, SHO Plastic Surgery Royal Preston Hospital, PR2 9HT Send response to journal: Re: The value of Ward Rounds	As we enter the new ‘improved’ age of postgraduate medicine aided and abetted by the infamous mmc, mtas, etc, unfortunately the age old system of team-based medicine seems to be destined to the memories. And it’s to the losses of medical staff and patients alike. As a fresh-faced pre-registration house officer, my learning curve was undoubtedly the steepest during my first post. A huge part of this learning process was partaking in regular ward rounds, whether as part of the entire team or with my SHO alone. From this I learnt many skills that I still use to this day. Namely, the ability to lead a ward round, to make concise and accurate entries to patient notes, communication skills towards patients and other members of the team, and organisational skills. And though at times nerve-shattering and humiliating, ward rounds are to this day arguably the best teaching forum available. Unfortunately, to no fault of the current FY1 doctors, I’m increasingly finding that these ‘ward doctors’ are as the name suggests merely ward doctors. Gone are the days where the house officer would be the link between the patients and SHO and the registrar. Gone are the days where the house officer would perform ward rounds and make clinical decisions. I have witnessed direct how the function of the ward based house officer is limited to the ‘jobs to do list’ manufactured by the nurses. And despite all the new paperwork and bureaucracy, there is no replacing team based medicine. Competing interests: None declared