Producing a regional guide to house jobsBMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7104.2 (Published 09 August 1997) Cite this as: BMJ 1997;315:S2-7104
- 1West Yorkshire Junior Doctors Committee
- 2BMA Yorkshire Office, Gladstone House, Redvers Close, Lawnswood Business park, Leeds LS16 6SS.
For the last four years medical students in West Yorkshire have had the advantage of a guide to help inform their applications for house jobs. As Cynthia Cummings and Andrew Smith make clear, it's not only an antidote to the rumours that are apt to fly - but a stimulus for change in house officers' working conditions
The idea of drawing up a guide to house jobs developed from discussions at the west Yorkshire junior doctors' executive meetings towards the end of 1992. Both juniors and BMA staff shared increasing concern about the quality of junior doctor jobs in the region, both in terms of lack of provision of teaching and training, as well as poor accommodation and canteen facilities. The New Deal was still new and its targets for hours presented a considerable problem. In units where the hours targets were being met, it was also becoming increasingly apparent that intensity of work would be the next problem, as the numbers of junior doctors on call at any one time reduced in order to meet the hours targets. It was agreed that we would take a survey of junior doctors in the region to identify both areas of concern and of good practice, with a view to disseminating what we learned and, hopefully, bringing about change for the better.
Focus on house officers
It was agreed, that whilst it would be impracticable, due to weight of numbers, to survey all junior doctors, it would be possible to undertake the exercise in respect of house jobs only. Because of this, and the fact that house officers are the newest and most vulnerable group of junior doctors, it was agreed that we would target them, with a view to publishing the information we collected in the form of a guide to the house jobs in the region.
The BMA office obtains details of doctors in post from most units on a regular basis and therefore identification was not a problem. We have to rely on distribution of the surveys through the hospital mailing systems, but, again, this has caused no difficulties. The survey involves contacting approximately 220 doctors twice each year.
Increasing response rate
To ensure a good rate of return the BMA staff at mess meetings and the place of work accredited representatives actively encourage the house officers to return the surveys. We promise that their anonymity will be preserved and there is no requirement to put their name or details on the returned form. The BMA office also funds a £35 store voucher for the first identifiable document selected at random by the chairman of the juniors' committee at one of their regular monthly meetings. We find that Yorkshire graduates who had the benefit of the guide as students are willing to share information about the jobs with us in order to assist those following them.
The survey document was drawn up to take account of all the difficulties which had been mentioned around the region, in order to establish which hospitals were subject to which problems and over the four years which the publication has been in print, it has been reviewed and improved. Further amendments are to be made before the fifth set of survey forms are distributed about the end of September 1997 and during March 1998. The next guide will be published to coincide the house officer appointments scheme, run by the postgraduate dean's office in May 1998.
The aim of the guide is to assist the students to make a more rational choice between the 21 hospitals in the region when they apply for their jobs. Most students have only seen the two main teaching hospitals in the region, although they might have had occasional attachments at some of the district hospitals.This tends to cause some of them to worry about the quality of the jobs in other units. The guide provides the students with information on each of the medical and surgical house officer posts in Yorkshire, with details on hospital facilities and accommodation. As our initial intention was to inform the students, it came as something of a surprise that trust managements took such an interest in the first edition of the guide: they were averse to the printing of adverse information.
Guide shapes negotiations
We saw in this an opportunity to forge improvements right across the region. As time has elapsed and subsequent copies of the guide have been printed, our relationships with Trusts in this respect have improved. It should, however, be noted that the existence of this guide can often be used as part of a negotiating stance when junior doctor issues are being discussed.
In the early stages there was some criticism regarding the accuracy of some of our statements, and for this reason we started sending advance copies of the appropriate insertion to the appropriate trust so that they might check the accuracy of the factual information. We reserved the right to publish the opinions of doctors despite Trust comments: for example, on one occasion we were told that the food in a particular hospital canteen was not very good. The Trust insisted that it was, but the comment about the poor quality of food stayed in the guide.
All aspects evaluated
In an attempt to improve on the previous editions of the guide, this year we obtained and reported on the same details for each hospital. We examined medicine and surgery separately and then we looked at hospital facilities.
We asked about sequence of rota or partial shift, class of additional duty hours paid, number of hours worked, prospective cover, difficulties in arranging annual leave, details of work intensity on call, and the inclusion of any inappropriate tasks such as routine phlebotomy or ECGs. We also asked them to rate the level of stress they considered the job carried on a 1-5 scale. We investigated the hospital's bleep policy and whether, if one did exist, it actually had the required effect; details of how much consultant teaching was given; the availability and possible accessibility of educational meetings; and a rating of overall clinical supervision. We asked whether the post could be recommended to a friend of colleague.
We asked questions about standards about hospital facilities and accommodation, the mess, the on call rooms and the accommodation, including safety and security details. We wanted to know about the standard of food in the canteen and the hours of availability. Finally, we asked about the hospital library and obtained a rating on the standard of the hospital induction day.
For each of the areas questioned, the returns from the survey were analysed, using a check list form drawn up for that purpose. The narrative for each insertion in the guide was drawn up from that analysis checklist. We also included quotations from the questionnaires.
The aim of this standardised format was to enable a direct comparison of hospitals and their house officer posts. The feedback we have already received on this edition would support this approach. The reporting of the same points also ensures that both positive and negative aspects of each post are shown, making the analysis fair to each hospital. This also allows for areas requiring improvement to be highlighted bringing them to the attention of each trust. Reports from the past and present guides also have the effect of adding pressure for efforts to improve the posts and facilities offered in the posts. Some examples of this are Bradford who reported the implementation of a bleep policy, Dewsbury where a night catering service has been introduced, and St James University Hospital in Leeds where efforts are being made to improve security on the site.
The analysis of the returned surveys and the writing of the narrative takes place with a very tight timescale. The contents must be checked by the BMA legal department and trusts are sent an advance copy of their own insertion for comment. We send out advance copies uunder embargo to BMA press secretaries, place of work accredited representatives and work closely with the BMA press office in order to gain maximum publicity for the document. In the crucial week in April, several of the BMA staff and the representatives of the West Yorkshire JDC find themselves working day and night to ensure that the production is completed on time.
Whilst there are still difficulties in some areas, we are pleased to observe that the quality of jobs does appear to be improving across the region. We have good relationships with the staff in the postgraduate dean's office and those on the task force and we believe that our combined efforts will continue to benefit our junior doctors. The main problem now seems to be the intensity of work during on call periods. This is also reflected by the number of posts which currently attract Class 2 ADH payments for out of hours work. Efforts are, we are pleased to note, on-going in most hospitals to address this issue and return the jobs to a true rota pattern of work. All concerned continue to strive towards this.
Promoting BMA membership
The guide is a service to students who are already BMA members and we hope that our efforts pay dividends not only in encouraging students to join the Association, but to take an interest in junior doctors matters and attend the West Yorkshire JDC meetings. It also raises awareness of the role of the BMA and the local office. The guide is launched at an annual lecture from one of us (CC), which gives a very basic introduction to contracts of employment in the NHS; around 90% of the fourth year turn out to listen to the talk and collect their copy. It is interesting to note that at this stage many of them do not even know what an additional duty hour is.
We know that our guide proves to be useful to fourth year medical students but we hope that it will also be used by trust mangements and other medical colleagues across Yorkshire. By the end of September work will be in hand in the local BMA office to begin distribution of the survey forms to the 1997/98 house officers for the next edition, when we would like to continue the trend of improvement, not only in the document itself, but, more importantly, in the quality of our house officer posts.