Practice

The Competent Novice

Practising safely in the foundation years

BMJ 2009; 338 doi: 10.1136/bmj.b1046 (Published 3 April 2009)
Cite this as: BMJ 2009;338:b1046

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  1. Susannah Long, clinical research fellow and specialist registrar in geriatric and general medicine,
  2. Graham Neale, visiting professor,
  3. Charles Vincent, professor of clinical safety research
  1. 1Clinical Safety Research Unit, Imperial College, St Mary’s Hospital, London W2 1NY
  1. Correspondence to: S Long, s.long{at}imperial.ac.uk

    Junior doctors are vital to promoting quality of care and safety for patients. This article outlines strategies to reduce errors and subsequent harm

    Learning points

    • Adverse events are common, particularly in vulnerable patients such as older people

    • Junior doctors are at the front line of patient care and therefore play a crucial role in reducing harm to patients

    • If a junior doctor is at all worried about a patient, it is their responsibility to seek help

    • Junior doctors should discuss and report adverse events, with the aim of learning from them

    • It is vital that a full apology and explanation be given to the patient when an adverse event occurs

    Many junior doctors may not be aware that about one in 10 acute hospital admissions in the United Kingdom is associated with at least one adverse event, occasions on which patients are harmed by their medical management rather than the illness itself.1 2 About half of these adverse events are thought to be preventable, and a third are associated with serious disability or death. More commonly, less serious incidents cause inconvenience and discomfort for the patient and can lead to a longer stay in hospital—see the first scenario box about Mrs Jones (case scenario: part1). Junior doctors are at the front line of patient care and therefore play a crucial role in reducing harm to patients. This is why patient safety is an integral part of the Foundation Curriculum (www.foundationprogramme.nhs.uk).

    Why do things go wrong?

    Studies of errors in health care and other industries have led to a much broader understanding of their cause, with less focus on the individual who makes the error and more on the wider system and organisational factors.3 An action or omission may be easily identified as the immediate cause of an incident, but closer analysis usually reveals a series …

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