Intended for healthcare professionals


End “Black Wednesday” by starting specialty posts a month after foundation programme, royal colleges say

BMJ 2014; 348 doi: (Published 17 April 2014) Cite this as: BMJ 2014;348:g2846
  1. Abi Rimmer
  1. 1BMJ Careers

Specialty training should begin in September, a month after the start of the foundation programme, the Academy of Medical Royal Colleges has said.

The move is designed to bring an end to the handover challenges seen when medical trainees across the UK move to a new hospital post on the first Wednesday in August. This has traditionally been accompanied by a spike in death rates and has become known as “Black Wednesday.” The change would also improve patient safety and the quality of care and reduce stress on doctors in training, the academy said.

Proposals for the change were made by the academy’s Staggered Trainee Changeover Working Group, which explored the need for variation in the current system for trainee doctor handover dates.1 The group’s report said, “There is a clear need for change in the process of trainee doctor changeover (the time when junior doctors rotate their position). The beginning of August brings an apparent increase in patient morbidity and evidence suggesting increased mortality. It is a time that trainee doctors find stressful and difficult.”

The group proposed that all foundation year 1 posts begin on the first Wednesday in August and that specialty training posts should begin in September. “These changes would ensure that new junior doctors in training would be supported by senior trainee doctors, who would have already been in post for five to 11 months,” the report said.

The proposals would create a one month gap for trainees, between foundation training and specialty training, which the group said would provide “a natural break after an intense two year foundation programme.” This gap may even help to reduce the number of trainees delaying entry into specialty training to go abroad, the report said.

To cover the shortfall in the first year of the new system’s introduction, the group proposed that doctors in specialty training would be contracted to work for 13 months at that level “so as not to compromise patient safety.”

Responding to the proposal, Andrew Collier, co-chairman of the BMA’s Junior Doctors Committee, said that the association was concerned about proposed changes to rotation arrangements that would lead to an enforced break in employment, as this could affect employment rights and benefits, such as redundancy entitlements and pension arrangements.

“To avoid a break in service, as well as a gap in doctors’ training and income, the BMA has suggested that, if a staggered changeover is implemented, outgoing doctors should remain in post for an extra month to help with the induction of new trainees or avail of training and development opportunities. This would benefit both patient care and doctors’ training experience,” he said. “Ultimately, we want employers and the government to take action to make the changeover period less chaotic, addressing workload pressures on doctors and consider increasing staffing levels during the changeover.”

A spokesman for Health Education England said, “We have received the academy’s report and thank them for their work in this important area. The most appropriate way forward is to consider the recommendations as part of the wider work around the Shape of Training report.”