Preregistration house officers in the Thames regions: changes in quality of training after four years.

OBJECTIVE--To measure changes in the training and workload of preregistration house officers over four years. DESIGN--Postal questionnaire. SETTING--The Thames health regions. PARTICIPANTS--1049 preregistration house officers. RESULTS--Response rate was 69% (725 replies). The proportion of house officers officially on duty > 83 hours a week fell from at least 42% to 21%, and the proportion officially on duty < or = 72 hours rose from no more than 9% to 40%. Adequate guidance in breaking bad news increased from 25% to 46% (p < 0.0001; 95% confidence interval for difference, 16.2% to 25.8%) and guidance in pain control increased from 36% to 46% (p < 0.01; 5.0% to 15.0%). The number of house officers attending an induction course increased from 61% to 94% (p < 0.001; 28.9% to 37.1%). There was no change in the proportion unable to attend formal educational sessions because of clinical commitments or in levels of satisfaction with consultants' educational supervision. The median number of inpatients under house officers' care fell from 20 to 17, but the numbers of patients clerked in an average week showed little change. House officers were less satisfied with the clinical experience their post provided (proportion dissatisfied rose from 30% to 39%; p < 0.01; 4.2% to 13.8%) and less enthusiastic about recommending their post to a friend (proportion neutral or not recommending rose from 30% to 42%, p < 0.0001; 7.9% to 16.9%). CONCLUSION--Despite progress in reducing hours of duty and providing induction courses, the training that hospitals and consultants provide for house officers is still unsatisfactory and inconsistent with the General Medical Council's recommendations.

[1]  J. Wadsworth,et al.  The National Childhood Encephalopathy study: a 10-year follow-up. A report on the medical, social, behavioural and educational outcomes after serious, acute, neurological illness in early childhood. , 1993, Developmental medicine and child neurology. Supplement.

[2]  P. Fine,et al.  Confounding in studies of adverse reactions to vaccines. , 1992, American journal of epidemiology.

[3]  R. Gale,et al.  How to run an induction meeting for house officers. , 1992, BMJ.

[4]  K. Wentz,et al.  Diphtheria-tetanus-pertussis vaccine and serious neurologic illness: an updated review of the epidemiologic evidence. , 1991, Pediatrics.

[5]  K. Calman,et al.  The pre‐registration house officer year: a critical incident study , 1991, Medical education.

[6]  K. Wentz,et al.  The NCES reconsidered: summary of a 1989 workshop. National Childhood Encephalopathy Study. , 1990, Vaccine.

[7]  G. Stewart.  Safety of pertussis vaccine , 1990, The Lancet.

[8]  W. Kaye,et al.  Resuscitation: experience without feedback increases confidence but not skill. , 1990, BMJ.

[9]  J H Gillard,et al.  Preregistration house officers in the four Thames regions: I. Survey of education and workload. , 1990, BMJ.

[10]  C. Bowie.  Lessons from the pertussis vaccine court trial , 1990, The Lancet.

[11]  P. Garrud,et al.  Counselling needs and experience of junior hospital doctors. , 1990, BMJ.

[12]  D. C. Miller,et al.  Pertussis vaccine and severe acute neurological illnesses. Response to a recent review by members of the NCES team. , 1989, Vaccine.

[13]  A. Griffith.  Permanent brain damage and pertussis vaccination: is the end of the saga in sight? , 1989, Vaccine.

[14]  J. Wadsworth,et al.  Severe neurological illness: further analyses of the British National Childhood Encephalopathy Study. , 1988, The Tokai journal of experimental and clinical medicine.

[15]  J. Wadsworth,et al.  A developmental test based on the STYCAR sequences used in the National Childhood Encephalopathy Study. , 1985, Child: care, health and development.

[16]  D. Miller,et al.  INFANTILE SPASMS AND PERTUSSIS IMMUNISATION , 1983, The Lancet.

[17]  D. Miller,et al.  Whooping cough and whooping cough vaccine: the risks and benefits debate. , 1982, Epidemiologic reviews.

[18]  G. Stewart.  VACCINATION AGAINST WHOOPING-COUGH Efficacy versus Risks , 1977, The Lancet.

[19]  J. Wilson,et al.  Neurological complications of pertussis inoculation , 1974, Archives of disease in childhood.

[20]  O. Miettinen.  Estimation of relative risk from individually matched series. , 1970, Biometrics.

[21]  M. Rutter.  A children's behaviour questionnaire for completion by teachers: preliminary findings. , 1967, Journal of child psychology and psychiatry, and allied disciplines.