The allocation of pre-registration house officer posts in the four Thames regions: a survey of house officer opinion

The satisfaction of pre-registration house officers with the operation of, and outcome of participation in, their medical school's allocation scheme for house officer posts was investigated by postal questionnaire. Satisfaction with outcome was generally high. Significant differences are reported between medical schools in participation rates in allocation schemes and in satisfaction with the operation of the schemes. The operation of the ranking schemes used at Guy's and St Bartholomew's Hospitals is shown to be significantly less satisfactory. Reasons for these findings are examined.     

Allocation of junior hospital doctors to pre-registration posts: does Britain need a national matching scheme?

The attitudes of British postgraduate deans and senior medical students to the introduction of a national pre-registration house officer allocation scheme were investigated by postal questionnaire. Several postgraduate deans expressed interest, but most were not in favour of the proposal. Students held similar views. The advantages and disadvantages of a national scheme are discussed.     

Perceptions of how well graduates are prepared for the role of pre-registration house officer: a comparison of outcomes from a traditional and an integrated PBL curriculum

INTRODUCTION: Most medical schools in the UK have been engaged in major curriculum reform based on their premises of what might improve undergraduate medical education. In 1994 the course at the medical school of the University of Manchester changed to an integrated course using problem-based learning throughout and with increased emphasis on community-based medical education. This study explores whether the new curriculum has produced any differences in perceptions of how well graduates are prepared for the role of pre-registration house officer. METHODS: A postal questionnaire was used to survey 1998 Manchester graduates (traditional course) and 1999 Manchester graduates (new course), three months into their first pre-registration house officer placement. A similar questionnaire was sent to the educational supervisors who were supervising the graduates. The questionnaire was designed to measure perceptions of levels of preparedness for the role of pre-registration house officer, using a list of broad areas of competence and specific skills listed in the General Medical Council's 'The New Doctor'. RESULTS: Graduates rated the new course significantly more effective for 12 of the 19 broad competences and eight of the 13 specific skills that were listed. The 'new' graduates rated their understanding of disease processes lower than the 'traditional' graduates, but there was no difference in the ratings given by the educational supervisors for this. Overall the educational supervisors rated the new course as better preparing graduates in five of the competences. CONCLUSIONS: Overall, the evaluation shows that a major change in curriculum approach has changed the profile of the perceived preparedness of graduates for entering professional practice.     

The West Midlands Matching Scheme 2000: a survey of participant satisfaction and outcomes

CONTEXT: The West Midlands Matching Scheme has been in operation since 1999 and is one of a number of schemes used for the allocation of pre-registration house officer positions in the UK. METHOD AND RESULTS: A questionnaire was distributed amongst candidates applying to the scheme in 2000. A response rate of 73.7% was obtained (160 replies from a sample population of 217). Half the responders reported to be dissatisfied with the explanation of the matching scheme given. A total of 66.6% were satisfied with the scheme being run via the Internet and E-mail. For 6-month positions in medicine, 85% of the candidates were happy with the job they had received. The figures for surgical jobs were similar and for rotations even higher. However, 23.8% of the sample was missing one or two jobs at the end of the matching process. This figure was still high when non-responders were taken into account. This group was not happy with the way in which the remaining jobs were distributed to them (71% dissatisfied). CONCLUSION: Although the matching scheme matched a high proportion of responders to jobs they were satisfied with, there was a significant group without jobs who were unhappy with the scheme. Some of those with jobs were also dissatisfied with the jobs they had received. Both problems should be addressed in future schemes. Further work in this area should examine the characteristics of the group without jobs and look at the success of other schemes in order to determine the optimal way in which to allocate PRHO jobs.     

Meeting the challenge of prescribing and administering medicines safely: structured teaching and assessment for final year medical students

OBJECTIVES: To promote safe prescribing and administration of medicines in the pre-registration house officer (PRHO) year through a programme of structured teaching and assessment for final year medical students. DESIGN: Forty final year medical students from two medical schools were randomly allocated either to participate in a pharmacist facilitated teaching session or to receive no additional teaching. Teaching comprised five practical exercises covering seven skills through which students rotated in small groups. One month later, a random sample of 16 taught and 16 non-taught students participated in a nine-station objective structured clinical examination (OSCE) to assess the impact of the teaching. SETTING: Manchester School of Medicine (MSM), and Kings College School of Medicine and Dentistry (KCSMD). PARTICIPANTS: Final year medical student volunteers. MAIN OUTCOME MEASURES: The need for teaching as indicated by student prior experience; questionnaire rating of student acceptability of teaching and assessment; self-rating of student confidence post-assessment, and student performance assessed by OSCE. RESULTS: The study demonstrated that the taught group achieved higher scores in eight OSCE stations. Four of these were statistically significant (P < or= 0.005). Taught students felt more confident performing the skills on five stations. From 0 to 47.5% students had prior experience of the skills taught. The post-teaching questionnaire evaluated exercises positively on several criteria, including provision of new information and relevance to future work. CONCLUSIONS: Structured teaching provided an effective and acceptable method of teaching the medicines management skills needed in the PRHO year. The structured approach complemented variable precourse clinical experience.     

The first house officer year: views of graduate and non-graduate entrants to medical school

Objective  To determine whether graduate and non-graduate entrants to medical school differ in their views on the first year spent in medical practice as a pre-registration house officer.
Methods  We carried out postal questionnaire surveys of medical qualifiers of 1999, 2000 and 2002 from all UK medical schools, 1 year after qualification. The timing of the study slightly pre-dates the recent major expansion in graduate entry fast-track courses.
Results  Differences between graduate and non-graduate entrants were few and, even when statistically significant, were small in scale. Graduate entrants viewed their working hours, pay and living conditions at work, such as hospital accommodation and food, a little less favourably than did non-graduate entrants. Graduate entrants were also less satisfied than non-graduates with time available for family, social and recreational activities. However, graduate entrants were more likely than non-graduate entrants to feel positive about their future career prospects. There were no differences between graduate and non-graduate entrants in whether they felt they had been well prepared by their medical schools for the jobs they undertook as house officers. Levels of job satisfaction expressed by graduate and non-graduate entrants were similar, as were their responses to most other statements about attitudes to clinical work.
Conclusions  'Quality of life' issues, a sense of being fairly rewarded, and expectations about one's physical working environment seem a little more important to graduate than to non-graduate entrants. Apart from these, the findings suggest that graduate status, at entry to medical school, has no appreciable influence on attitudes to the work of a junior hospital doctor.     

Doctors' views about their first postgraduate year in UK medical practice: House officers in 2003

Aim To report house officers' views in 2003 of their first postgraduate year, and to compare their responses with those of house officers 2 and 3 years previously. Methods Postal questionnaires to all house officers in 2003 who graduated from UK medical schools in 2002. Results The response rate was 65.3% (2778/4257). The house officers of 2003 enjoyed the year more than those of 2000–1. A total of 78% of respondents in 2003 scored 7–10 in reply to the question ‘How much have you enjoyed the house officer year overall?’, scored from 0 (no enjoyment) to 10 (enjoyed it greatly), compared with 70% of 2000–1 house officers. They were more satisfied with leisure time available to them (51% scoring 6–10 in 2003; 35% in 2000–1). There were significant improvements in almost every aspect of doctors' experience. Hospital medical posts were rated more highly than surgical posts, and general practice posts higher still. Overall, 38% of respondents regarded their training as having been of a high standard, and 37% felt that they received constructive feedback on their performance. Differences between men and women in their views about their jobs were small. Discussion The house officers of 2003 reported more positively on their experiences than did those of 2000–1. Although a substantial percentage were negative about specific aspects of clinical support and training, particularly in surgical posts, almost all the responses covering training and clinical support moved in a favourable direction over time.     

Practice preferences of primary medical care and traditional internal medicine house officers

In an academic medical centre between 1980 and 1985, the attitudes, preferences and career goals of house officers in a primary medical care residency training programme were assessed at entry and at the end of each house officer year. Primary care trainees who went on to practise in a general medicine setting were compared to primary care trainees who subsequently received subspecialty training and also to traditional internal medicine trainees. House officers in the primary care programme generally maintained attitudes and preferences central to the practice of primary care, and scored significantly higher than traditional track house officers on attitudes and preferences compatible with the practice of medicine in a primary care setting. However, primary care house officers who later went into subspecialty training received scores similar to those of traditional track house officers on practice preferences relating to specialty care. There were no significant differences between primary care and traditional track house officers on standard measures of knowledge and clinical skill.     

‘Hello,my name is Gabriel,I am the house officer,may I examine you?’ or The Objective Santa Christmas Examination (OSCE)

OBJECTIVE: To design a clinical examination of high content validity suitable for use as a formative assessment tool with pre-registration house officers (PRHO'S) towards the end of their first house officer post. DESIGN: A multicentre collaboration between four UK medical schools who offer undergraduate curricula which are problem-based, systems-based, patient-orientated, student-centred, jargon-laden and utterly staff-bewildering. MAIN OUTCOME: An objective structured clinical examination (OSCE) which is suitable for use with graduates of UK medical schools. It assesses the knowledge, skills and attitudes essential for future careers in a hierarchical system where protecting the senior staff from all forms of irritation is paramount. RESULTS: PRHO'S who excel in this examination get better references. CONCLUSION: The OSCE format can be used to provide 'real-life' scenarios appropriate to the season.     

Doctors' views of their first year of medical work and postgraduate training in the UK: questionnaire surveys

Objective The first year of postgraduate work for newly qualified doctors in the UK, the pre‐registration year, is spent working intensively in training posts under supervision. Our aim was to report the views of pre‐registration doctors on these posts. Design Questionnaire survey. Subjects All medical graduates of 1999 and a 25% sample of graduates of 2000 from all UK medical schools. Main outcome measures Doctors' views on the pre‐registration house officer (PRHO) year, recorded as ratings in answers to questions and statements about the year. Results In reply to the question ‘How much have you enjoyed the PRHO year overall?’, rated on a scale from 0?10 (0 = no enjoyment; 10 = enjoyed it greatly), 44% of respondents (1341/3068) gave scores of 8–10; in all, 83·2% of respondents gave scores in the upper half of the scale (≥6). However, there were criticisms of specific aspects of working conditions. Only a third agreed that their training during the year had been of a high standard. Posts in medicine were rated more highly than those in surgery for quality of training. Differences in views held by women and men junior doctors were few. However, where differences existed, women were slightly more positive about their work than men. Conclusion Most graduates enjoyed the pre‐registration year but there is still considerable scope for improvement in working conditions and training. Men and women gave similar responses, which suggests that later divergence in their career pathways is not attributable to different views formed about work in their pre‐registration year.     

Effectiveness of medical school admissions criteria in predicting residency ranking four years later

BACKGROUND: Medical schools across Canada expend great effort in selecting students from a large pool of qualified applicants. Non-cognitive assessments are conducted by most schools in an effort to ensure that medical students have the personal characteristics of importance in the practice of Medicine. We reviewed the ability of University of Toronto academic and non-academic admission assessments to predict ranking by Internal Medicine and Family Medicine residency programmes. METHODS: The study sample consisted of students who had entered the University of Toronto between 1994 and 1998 inclusive, and had then applied through the Canadian resident matching programme to positions in Family or Internal Medicine at the University of Toronto in their graduating year. The value of admissions variables in predicting medical school performance and residency ranking was assessed. RESULTS: Ranking in Internal Medicine correlated significantly with undergraduate grade point average (GPA) and the admissions non-cognitive assessment. It also correlated with 2-year objective structured clinical examination (OSCE) score, clerkship grade in Internal Medicine, and final grade in medical school. Ranking in Family Medicine correlated with the admissions interview score. It also correlated with 2nd-year OSCE score, clerkship grade in Family Medicine, clerkship ward evaluation in Internal Medicine and final grade in medical school. DISCUSSION: The results of this study suggest that cognitive as well as non-cognitive factors evaluated during medical school admission are important in predicting future success in Medicine. The non-cognitive assessment provides additional value to standard academic criteria in predicting ranking by 2 residency programmes, and justifies its use as part of the admissions process.     

What are the clinical skills levels of newly graduated physicians? Self‐assessment study of an intended curriculum identified by a Delphi process

OBJECTIVE: To compare and contrast the learned and an intended curricula of practical clinical skills across the three Danish medical schools. CONTEXT: The three Danish medical schools had comparable discipline-based curricula with 3 years of mainly basic science and 3(1/2) years of mainly clinical education. Danish physicians work as pre-registration house officers (PRHOs) for 1(1/2) years after graduation. METHODS: An anonymous questionnaire listing 210 practical clinical skills was mailed to 226 newly graduated Danish physicians. They were asked if they could meet the minimum level for each of the skills listed as identified by a previous Delphi study. RESULTS: The response rate was 80%. None of the responders met the minimum of all the 210 skills. Only 8% (14) met the minimum level for at least 90% (189) of the skills. On average the responders met the minimum of 74% (155) of the skills. More than 90% of the responders mastered basic history and examination skills. The responders did not meet 28 medical emergency procedures. CONCLUSIONS: We found that the learned curriculum of clinical skills constituted 75% of the intended curriculum. Those responsible for pre- and postgraduate medical education should be aware of the discrepancy between expected and learned curriculum. We discuss the role of experts in the process of defining the core curriculum.     

Does problem‐based learning lead to deficiencies in basic science knowledge? An empirical case on anatomy

INTRODUCTION: Problem-based learning (PBL) is supposed to enhance the integration of basic and clinical sciences. In a non-integrative curriculum, these disciplines are generally taught in separate courses. Problem-based learning students perceive deficiencies in their knowledge of basic sciences, particularly in important areas such as anatomy. Outcome studies on PBL show controversial results, sometimes indicating that medical students at PBL schools have less knowledge of basic sciences than do their colleagues at more traditional medical schools. We aimed to identify differences between PBL and non-PBL students in perceived and actual levels of knowledge of anatomy. METHODS: Samples of Year 4 students in all eight medical schools in the Netherlands completed a questionnaire on perceived knowledge and took part in a computerised anatomy test consisting of both clinically contextualised items and items without context. RESULTS: Problem-based learning students were found to have the same perceived level of anatomy knowledge as students at other medical schools. Differences in actual levels of knowledge were found between schools. No significant effects on knowledge levels were found for PBL schools versus non-PBL schools. CONCLUSION: The results of this study show that PBL does not result in a lower level of anatomy knowledge than more traditional educational approaches. It remains to be ascertained whether the levels students attain are adequate. Subjects for further study are the desired level of anatomy knowledge at the end of undergraduate medical education and the effectiveness of basic science learning within a clinical context and with repetition over the course of the curriculum.     

Appraisal, assessment and career development for doctors in training: the Mersey Deanery personal development portfolio

OBJECTIVES: To develop a robust valid and exportable appraisal and assessment process for doctors in training which is portfolio based and works at all hospitals within the deanery. It is called the personal development portfolio. DESIGN: For every senior house officer, there was a recorded meeting with his or her supervisor, at the beginning, midterm and at the end of the post. An outside assessor witnessed the exit assessment meeting. SETTING: The Wirral Hospital, a District General Hospital with 72 senior house officers in 10 different specialties was used as a pilot site to develop the process. Then the process was exported and implemented at the other 12 trusts of the deanery. MAIN OUTCOME MEASURES: Records were kept of the induction, midterm and exit assessment meetings. A record was kept of the number of senior house officers succeeding and failing at their exit assessments. Also, the number promoted to the specialist registrar grade was recorded. RESULTS: The process was performed every 6 months on 11 occasions between 2000 and 2005. It involved 72 senior house officers in 10 different specialties. On each occasion, participation usually exceeded 70%: 623 were appraised and assessed and 609 of them (97.8%) had satisfactory exit assessments. For 14 doctors (2.2%), the process identified a cause for concern, which was usually accepted by the doctor and sometimes allowed remedial action to be taken. Twenty-six (4.2%) were promoted to the specialist registrar grade in this period. The process also identified the strengths and weaknesses of the senior house officer posts in the 10 different specialties that had such posts, and was used to encourage good medical teaching practice in them. Over 4 years, we exported the process to all the other 12 Trusts in the Mersey Deanery. Once established, the process was easy to use for both trainees and trainers, although it was time consuming. CONCLUSIONS: It was possible to develop and implement a portfolio based appraisal and assessment process, which was accepted by senior house officers and their trainers in all specialties at all hospitals within the deanery. Now that the senior house officer grade has been superseded by the Foundation and the training grade years, the principles of the personal development portfolio are being used to appraise and assess doctors in these grades too.     

Education and training in the senior house officer grade: results from a cohort study of United Kingdom medical graduates

INTRODUCTION: This paper shows the findings from a survey of 439 senior house officers undertaken as part of the British Medical Association cohort study of 1995 medical graduates. The aim of the study was to assess the quality of senior house officer training in the United Kingdom. METHOD: In July 1997 a postal questionnaire was sent to a sample of 545 doctors who graduated from medical school in 1995. Responses were received from 515 (95%). Only those doctors who had worked as a senior house officer in the previous 12 months were included in the analysis (n = 439). RESULTS: Encouraging results are that 69% of the senior house officers surveyed had discussed their progress directly with their consultant, and 24% rated their supervision by their consultant as 'excellent'. Of concern are the findings that 47% of respondents did not receive protected teaching time and 16% were unable to take study leave. DISCUSSION: The study revealed wide variability in the quality of training received by senior house officers in the United Kingdom. Whilst some respondents - notably those in general practice, accident and emergency, paediatrics and psychiatry - had enjoyed a high standard of education and training, it was clear that a minority of posts continue to offer little if any educational value to the post holder. The results point to a need for a more systematic approach to maintaining standards in senior house officer training with greater incentives for under-performing trusts.     

Traditional finals and OSCEs in predicting consultant and self-reported clinical skills of PRHOs: a pilot study

INTRODUCTION: As we move from standard 'long case' final examinations to new objective structured formats, we need to ensure the new is at least as good as the old. Furthermore, knowledge of which examination format best predicts medical student progression and clinical skills development would be of value. METHODS: A group of medical students sat both the standard long case examination and the new objective structured clinical examination (OSCE) to introduce this latter examination to our Medical School for final MB. At the end of their pre-registration year, the group and their supervising consultants submitted performance evaluation questionnaires. RESULTS: Thirty medical students sat both examinations and 20 returned evaluation questionnaires. Of the 72 consultants approached, 60 (83%) returned completed questionnaires. No correlation existed between self- and consultant reported performance. The traditional finals examination was inversely associated with consultant assessment. Better performing students were not rated as better doctors. The OSCE (and its components) was more consistent and showed positive associations with consultant ratings across the board. DISCUSSION: Major discrepancies exist between the 2 examination formats, in data interpretation and practical skills, which are explicitly tested in OSCEs but less so in traditional finals. Standardised marking schemes may reduce examiner variability and discretion and weaken correlations across the 2 examinations. This pilot provides empirical evidence that OSCEs assess different clinical domains than do traditional finals. Additionally, OSCEs improve prediction of clinical performance as assessed by independent consultants. CONCLUSION: Traditional finals and OSCEs correlate poorly with one another. Objective structured clinical examinations appear to correlate well with consultant assessment at the end of the pre-registration house officer year.     

Teaching disability and rehabilitation to medical students

Summary. A survey of UK medical schools was undertaken to determine the teaching that was being offered on disability and rehabilitation. In general, teaching on this topic appeared fragmented and inadequate but a number of interesting innovations were identified. These included: a drama workshop run by a group whose members mainly have learning disabilities at St George's Medical School, student-directed learning at the University of Dundee and structured teaching programmes at the Universities of Leeds and Edinburgh. The General Medical Council Education Committee's 1991 discussion document on the undergraduate curriculum specifically mentions disability as an important topic. A number of schools mentioned that they were in the process of revising their curriculum as a consequence. Recommendations arising from the findings of the survey include integration of disability and rehabilitation into clinical teaching, focus of teaching on those types of disability which are common in the community, greater emphasis on functional assessment in teaching the physical examination, and the wider use of standard assessment instruments, for example for activities of daily living, cognitive impairment and locomotor disability. There is a need for improved communication between medical schools to facilitate the spread of educational activities on this topic.     

Undergraduate public health education in UK medical schools - struggling to deliver

INTRODUCTION: Recent policy initiatives in the United Kingdom (UK) have underlined the importance of public health education for health care professionals. We aimed to describe teaching inputs to medical undergraduate curricula, to identify perceived challenges in the delivery of public health teaching and strategies that may overcome them. METHODS: We undertook a cross-sectional survey; questionnaires were sent electronically to 28 teaching leads in academic departments of public health in UK medical schools. These were followed-up by telephone interviews. RESULTS: We obtained a 75% response rate. We found a great deal of variability between schools in teaching methods, curricular content and resources used. In 76% of medical schools, public health and clinical teaching were integrated to some extent. The proportion of teaching delivered as lectures is decreasing and that of self-directed learning is increasing. A range of methods is used to assess students and in 33% of schools these assessments contributed to final Medical School marks. More than half the medical schools had difficulty finding teachers and staffing levels had deteriorated in 55% of schools. Many interviewees felt that their contributions were undervalued. Few were aware of the level of funding received to support teaching. DISCUSSION: There is a need to increase the supply of well-trained and motivated teachers and combine the best traditional teaching methods with more innovative, problem-based approaches. Faculties need to share 'learning about what works' and teaching resources across medical schools as well as addressing a culture of neglect of teaching in some departments. Suggestions are made as to how undergraduate public health teaching can be strengthened.