Trainee surgeons warn of dangers of emergency cross cover rotas

Trainee surgeons have warned that care of patients is being compromised by specialty trainees being made to provide emergency cross cover in specialties different from their own.

Cross cover occurs when doctors who are training in one specialty provide emergency care, usually out of hours or when on call, for another specialty. Some pairs of surgical specialties where cross cover is common are general surgery and urology; ear, nose, and throat (ENT) and maxillofacial surgery; and orthopaedics and plastic surgery.

A snapshot survey conducted by the Association of Surgeons in Training found that treatment of acute scrotum problems varied considerably depending on whether it was carried out by trainees in urological surgery or by trainees in general surgery who were providing cross cover.

The survey reported wide variation in trainees’ confidence and competence in assessing and managing acute scrotum in the emergency setting. In some cases, general surgery trainees were being expected to operate in cases of acute scrotum with little or no experience or training in the condition.

Specialties that usually have a resident on-call rota system, such as general surgery, can be seen as an easy target for provision of emergency cross cover, the association said. The organisation has highlighted the issues of dentists providing cross cover for plastic surgery units and non-ENT trainees providing emergency resident ENT cover as other areas of concern.

The General Medical Council’s core guidance for doctors, Good Medical Practice, specifies that doctors must recognise and work within the limits of their competence, the association pointed out.

The association recommends that trainees should not be expected to provide emergency cross cover for any specialty or condition that is not included in their curriculum.

Trainees who are asked to provide cross cover in an area where they believe that they have not received enough training or in which they don’t have competence must bring this to the attention of the on-call specialty consultant and should document having done so.

The association suggests that, in areas where there is potential for emergency cross cover between specialties, the respective curriculums should be reviewed and aligned to ensure that trainees show similar competence at similar grades.

However, wherever possible, care of patients should be provided by those doctors trained or training in the specialty in question, thus avoiding the need for cross cover provision, it concludes.

• Read ASiT’s full statement online at: http://www.asit.org/resources/articles/emergency_cross-cover.