Improving education for senior house officers

BMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7259.511/a (Published 19 August 2000) Cite this as: BMJ 2000;321:511
  1. Mark Rickenbach, lecturer,
  2. Joan Dunleavey, Wessex Research Network co-ordinator
  1. School of Medicine, Portsmouth University, Portsmouth PO3 6AD
  2. Primary Medical Care, Aldermoor Health Centre, Southampton SO16 5ST

    EDITOR—Paice has shown an improvement in specialist registrar training after the Calman reforms, and Catto asks what are we doing to help senior house officers. 1 2 At Portsmouth, since 1994, we have studied the problems faced by senior house officers during their training. 3 4

    We have standardised, six monthly, questionnaire data that compare posts with each other and examine changes in posts over time. With these data and structured interviews with and feedback from senior house officers, consultants, and educationalists we have looked both at interventions to improve senior house officers' education and at blocks to improvements.

    The main issues we identified include a need for consistency and clarity over what is required for senior house officer training and also a need for local feedback to demonstrate that improvements have occurred. The Early Years goes some way to address the issue of what is required, but it has not reached the daily working interface of senior house officers and consultants.5 The Calman reforms achieved uniformity and consistency of aims and were associated with increased monitoring of their implementation.

    We believe that this is one reason why they have been successful. Questionnaire surveys demonstrate the problems, but the issue faced by consultants is how to introduce educational improvements within limited resources.

    We conclude that there are four steps to introducing educational initiatives. The first, and most often missed, is the coordination and organisation of meetings such as appraisals, inductions, or periods of ward based teaching. The second is to ensure regular input from senior experienced staff for the meetings. The third is to address the quality of that input. The fourth step is to have a system of internal monitoring within the post that checks the first three steps are in place.

    Specific tasking for each of these stages and explicit setting aside of time has achieved change at Portsmouth with limited additional resources in time or funding. A department that has organised, regular, high quality, educational initiatives, which it audits internally, does well, and this has been associated with increased the satisfaction of its senior house officers.


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