Intended for healthcare professionals

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Rate of undesirable events at beginning of academic year: retrospective cohort study

BMJ 2009; 339 doi: (Published 14 October 2009) Cite this as: BMJ 2009;339:b3974

Real risk or a result of revolving rotations?

Reading this study, I fear there is a danger that it may give a false
impression of the level of patient study within UK hospitals to lay people
and the media. The study highlights several limitations but another that
has not been noted is that certainly within a UK setting junior trainees
would not be responsible for anaesthetising patients and certainly many
Foundation Trainees undertake anaesthetic rotations in a supernumerary
position with limited responsibility. The study is also perhaps a poor
proxy of the “status quo” as anaesthetics and intensive care tend to
handle patients who are sicker than other post operative patients, and
also operate in a high risk area of medicine compared to day to day ward
work where far more junior trainees are in operation. The lack of detail
on patient demographics, the nature of the complications and patient harm
sustained and the evens leading up to the adverse event also limit the
studies applicability to every day life. The fact that the study is also
reflecting a healthcare system quite removed from the NHS system also has
to be borne in mind.

However, another interesting concept to consider is that under the
current format of UK training, foundation trainees rotate every 4 months
and Specialist trainees every 6 months. In many areas this may involved
not only changing department but also hospital site which brings with it
the necessity to familiarise oneself with a new working environment,
protocol etc….

Surely if nothing else this study reinforces the calls by clinicians
that induction should focus far more on the working of the department and
less on how to access your e-mail, where to find the canteen and what day
the fire drill is operated? Without this then trainees will be unsure of
their working environment which may compromise patient care.

Competing interests:
None declared

Competing interests: No competing interests

26 October 2009
David G Samuel
F2 Breast and General Surgery
Prince Charles Hospital, Merthyr Tydfil CF47 9TD