Senior house officer training: is it getting better? A questionnaire survey

Introduction

A survey of senior house officer posts in north east thames region uncovered problems with workload, supervision, and education1 2 similar to those described by others.3 during the following years two important stages in the implementation of the “new deal” on junior doctors' hours4 were achieved. after two years we revisited the hospitals surveyed to discover what progress had been made and whether shorter working hours had affected training.

Methods and results

The first survey (1992-3 to 1993-4) was carried out by the associate dean, who visited all 19 acute hospitals and three specialist hospitals in North East Thames region and interviewed as many senior house officers as available. Before the interview trainees completed a structured questionnaire. Postal questionnaires were distributed to those doctors unavailable on the day. In 1994-5 we repeated the survey, using the same method, in all 11 hospitals visited during 1992-3. These included nine district general hospitals, one psychiatric hospital, and one large multisite university teaching hospital. The survey was not extended to hospitals visited in 1993-4 because many New Deal changes were taking place during this year.

In 1992-3 we surveyed 270 senior house officers, 216 (80%) by questionnaire and interview, 54 (20%) by postal questionnaire. In 1994-5 we surveyed 361, 249 (69%) by questionnaire and interview, 112 (31%) by postal questionnaire. The larger number in the second survey reflected a better response to the postal questionnaires and an increase in the total number of senior house officers. The response rate based on the total number of posts was 270/519 (52%) for the first round and 361/582 (62%) for the second. However, at any time at least 15% of the doctors were on leave and at least 15% of posts were vacant. We excluded locums or trainees less than two weeks in post. Corrected for 30% unavailability, response rates were respectively 270/363 (74%) and 361/407 (89%). The proportion of respondents from each specialty was similar on each occasion, apart from paediatrics and obstetrics and gynaecology, where new posts were created between the surveys. The proportion of non-British graduates rose from 32% to 44%.

Table 1) shows an improvement in senior house officers' rating of their posts between the two periods. the specialties showing most improvement were paediatrics and obstetrics and gynaecology, the worst rated specialties in the first survey, where new posts had enabled more partial shift working. the only specialty with lower ratings in the second survey than in the first was accident and emergency, where senior house officers were less likely to recommend their post. non-british graduates were less likely to feel forced to cope beyond their competence, but did not differ otherwise from british graduates in their responses.5 both interview and postal respondents showed improvement between the two surveys.

Comment

The reasons for the improvement are speculative. The implementation of the New Deal may have contributed, particularly over intensity of work. In September 1992 over 60% of senior house officers in these 11 hospitals were contracted for over 72 hours for on call rotas or 56 hours for full shifts. By February 1995 the figure had dropped to under 1%. Over £870 000 was spent by the New Deal task force in these hospitals to reduce non-medical duties for junior doctors, fund 15 new consultant posts, and upgrade accommodation. Approval was given for 66 extra senior house officer posts (a 12.5% increase). Other factors include greater pressure from colleges, part funding of posts by the postgraduate dean, and setting of regional training standards for senior house officers.2 The surveys themselves may have raised consultants' awareness of the problems and of their responsibilities as educational supervisors.