The educational component of senior house officer posts: differences in the perceptions of consultants and junior doctors.

The aims of this study were to elicit general practitioner (GP) trainee''s perceptions of the educational structure of their hospital posts, to compare them with those of consultants who had GP trainees as senior house officers (SHOs) in their departments and to examine the use of educational objectives in the hospital component of vocational training for general practice. A confidential postal questionnaire was sent to all the GP trainees (165 doctors) in the hospital component of their vocational training schemes (VTS) for general practice in Trent Region and all the consultants (161 doctors) in Trent who had GP trainees in their SHO posts on that date. Responses were received from 136 trainees (82%) and 134 consultants (83%). Educational objectives were stated as existing in the SHO post by 31 trainees (23%) and by 62 consultants (46%). Of those doctors who said that objectives existed, 19 of the trainees (61%) and 40 of the consultants (65%) said that the objectives were useful. Only nine (29%) of the trainees who stated that educational objectives existed felt that they were being put into practice by senior staff, compared with 41 (66%) of consultants who had made that statement. Of all respondents, 113 trainees (87%) and 100 consultants (77%) agreed or strongly agreed that the use of educational objectives would be beneficial to the trainees. Only 10 (7%) of trainees said that they received no teaching in their current posts. Forty trainees (32%) and 88 consultants (67%) said that teaching took place in protected time. Both groups cited consultants as the member of staff giving the most teaching. Ninety-six consultants (73%) replied that it was possible for GP trainees to obtain study leave, but 102 trainees (75%) either had experienced difficulties in obtaining study leave or had not attempted to obtain study leave. Trainees and consultants differed appreciably in their perceptions of the amount of assessment and feedback which was provided for GP trainees. The use of educational objectives in the hospital component of vocational training was felt to be beneficial by both consultants and GP trainees. Consultants were more likely than trainees to report the use of educational objectives, protected teaching time, GP-orientated teaching, ability of trainees to attend VTS half-day release and the provision of assessment and feedback to trainees.     

Part-time medical training: 15 years' experience in the Oxford region

Part-time training of doctors with domestic commitments has taken place successfully in the Oxford region since 1966; 249 doctors have now passed through such training schemes and a further 120 are currently training part-time. Two training schemes are now offered for doctors at senior house officer and registrar level: one of six to eight sessions a week for those undertaking recognised training aiming for consultant or principal in general practice posts, the other of one to two sessions a week providing ad hoc training for those unable for personal reasons to follow a recognised training programme. For doctors at senior registrar level, part-time training entails five to eight sessions a week. Of the 115 doctors who have left the schemes and are now in career posts in the United Kingdom, 19% are now consultants, 30% in other hospital posts, 27% in general practice, and 18% are clinical medical officers; overall, 71% of those in career posts are working part-time. This experience shows that part-time training can be successful and that there is a continuing need for part-time career posts.     

Formal education programmes for senior house officers: comparison of experience in three hospital specialties

This study was designed to compare the attendance rate of senior house officers (SHOs) in three specialties at formal educational events, examine experiences of protected time, use of educational objectives, and perceived barriers to attendance and evaluate differences found in the context of variations in training practice within each specialty. A quantitative questionnaire survey was completed by Trent region SHOs in obstetrics and gynaecology, general medicine, and accident and emergency posts. An independent researcher visited a selection of educational programme events over a two month span, recorded attendances, and administered the questionnaire. Attendance rates ranged from 40.8% of those in obstetrics and gynaecology jobs to 55.4% of those in accident and emergency jobs. The questionnaire findings found that service commitments were a major obstacle to attendance for the majority of those in obstetrics and gynaecology and general medicine jobs, while relatively few of the accident and emergency SHOs specified any barriers. SHOs in accident and emergency jobs had significantly more protected time for education and found educational objectives to be more widely used by senior staff. The findings suggest that the planned integration of formal education programmes with appropriate working pattern systems--in this case full shifts within accident and emergency departments--will result in SHOs receiving a better deal in terms of provision and structure of education.     

Assessment of basic surgical trainees: can we do more?

Introduction: Changes to surgical training and reduction of junior doctors'' working hours has resulted in trainees spending less time in surgical specialties before becoming eligible to apply for specialist registrar posts. A high quality basic surgical training programme is needed to improve the competence of trainees during their shortened period, an essential part of which is to conduct a formal assessment at the end of each training post and regular appraisals during their period of training. Aims: To analyse the existing practice with regard to conducting assessment and appraisals for basic surgical trainees in the South East Wales region. Methods: A questionnaire was sent to all the basic surgical trainees in the South East Wales region. Results: A total of 52 questionnaires were sent out and 44 (84%) were returned. Four candidates were in the first post of their rotation, and were therefore excluded from the study. Nine of the 40 trainees (23%) did not have an assessment in one or more of their posts. There are 17 senior house officer posts available in general surgery in the rotation. Of the 31 "six month" episodes spent in these 17 posts, 27 (87%) underwent an assessment, 12 of the 17 (70%) episodes in trauma and orthopaedics (12 available posts) were assessed, and 31 of the 35 (88%) episodes in accident and emergency (eight available posts) underwent an assessment. Twenty eight of the 40 trainees (70%) did not undergo regular appraisals during the majority of their posts. Only 30%–50% of episodes spent in general surgery, orthopaedics, and accident and emergency underwent appraisals. The majority of the episodes spent in the other surgical specialties (12 posts available in total) had formal assessment and regular appraisals except for urology in which two of seven episodes underwent assessment and one underwent an appraisal. Twelve candidates (30%) expressed the view that operative experience and technical skills must form part of their assessment. Eight trainees (20%) felt that they needed more help from tutors with regard to career advice, preparation of curriculum vitae, and interview techniques for specialist registrar posts. Eight trainees mentioned that they had discussed unsatisfactory posts with their tutors but were not aware of any changes made to these posts. Conclusions: This study has shown that the formal assessment of basic surgical trainees at the end of each training post has to improve further. The existing practice of conducting regular appraisals for the trainees is grossly inadequate. There appears to be a need for formulating guidelines for conducting such appraisals, which would help to improve practice in the future.     

浙江省社区医生获取慢性病防治知识途径及解决临床疑难问题方式调查

目的了解浙江省社区医生对慢性非传染性疾病防治知识的获取途径、需求以及解决临床疑难问题的主要方式,分析影响社区医生将知识转化为临床诊治能力的因素。方法2011年1月至2012年12月,对参加浙江省科技厅公益性技术应用研究计划项目《高血压社区控制技术对心血管病人群防治基地建设的影响研究》基层医生培训的891名社区医生,进行有关慢性病知识的获取途径以及处理临床疑难问题的方式、目前常规培训存在的问题和影响自身能力提高的因素等内容的问卷调查。结果回收有效问卷855份。855名社区医生中,35．2％（301／855）选择“常规培训I课程”是获取慢性病防治知识的主要途径,其次是阅读专业期刊书籍（17．8％,152／855）和上级医生指导（17．2％,147／855）;不同级别医院、不同职称的社区医生获取知识途径不同,组间比较差异有统计学意义（P〈0．05）。当社区医生在慢性病防治临床工作中遇到问题时,36．5％（23／63）的高级职称医生常用的解决问题方式为“查看教科书籍或期刊”,其次是“查看有关疾病的诊疗指南”者占31．7％（20／63）;27．1％（68／251）的中级职称医生和29．4％（159／541）的初级职称医生采用的主要方式为“请教上级医生”。社区医生认为影响诊疗水平提高的原因为“工作忙无暇学习”的占30．1％（257／855）,“难以得到专家的实际指导”的占28．3％（242／855）,此外认为“相关指南新知识难以掌握理解”者占13．5％（115／855）,“外出参加学术会议机会少”者占13．1％（112／855）。社区医生认为目前常规培训存在的主要问题是“与临床实际联系不够”、“授课时间或地点安排不合理”。结论常规培训课程是社区医生获取慢性病防治知识的主要途径,但现有的培训模式和内容等都需要改进。     

Multiple applications for vocational training rotations: can we improve the system?

Questionnaires were sent to 392 doctors who had applied for 10 vocational training rotations in South West Thames Region nine months previously. These 392 doctors had made 607 such applications in south west Thames during this time. Replies were received from 260 (66%) of those circulated. These doctors together had made roughly 4000 job applications nationwide, or 15 each: two thirds had found a post that was satisfactory for vocational training within the nine months, three quarters of them on organised rotations. There was no difference between men and women regarding success in finding a job. Both married and single women were more specific than men about the area in which they wanted to train and had made fewer job applications. Of those who answered the questionnaires, roughly three quarters thought that the present system of applying for training posts was unsatisfactory, and suggestions for improvements are made. It is concluded that although a regional clearing house scheme would help administration in the regions, only a national scheme would substantially help the applicants. To avoid frustration doctors might be more selective and limit their applications without harming their chances of success.     

四川省精神科专科医生培训基地带教师资现状调查

目的调查四川省精神科专科医师培训基地的带教师资现状,为提高带教师资能力和素质提供依据,从而促进精神科专科医师培训的顺利进行。方法采用自制调查表对90名带教师资进行调查,并用统计软件SPSS13．0进行统计分析。结果发放调查表90份,回收90份,其中有效问卷84份。分析结果显示,带教师资平均年龄38．56±8．04岁;平均教龄14．32±8．44年;本科及以上学历占80．95％;专职教师占5．95％;职称结构显示,初级占27．40％,中级占22．60％,副高占33．30％,正高占16．70％;参加过系统培训的占28．57％;受训时间在半年内占71．43％;希望得到全面、系统培训的占95．24％。结论四川省精神科专科医师培训基地带教师资的年龄、学历、职称构成方面较为合理;但教龄偏短,缺乏专职教师,受训时间较短。带教教师希望得到全面、系统的培训。     

四川省精神科专科医师培训基地带教师资现状调查

目的调查四川省精神科专科医师培训基地的带教师资现状,为提高带教师资能力和素质提供依据,从而促进精神科专科医师培训的顺利进行.方法采用自制调查表对90名带教师资进行调查,并用统计软件SPSS 13.0进行统计分析.结果发放调查表90份,回收90份,其中有效问卷84份.分析结果显示,带教师资平均年龄38.56±8.04岁;平均教龄14.32±8.44年;本科及以上学历占80.95%;专职教师占5.95%;职称结构显示,初级占27.40%,中级占22.60%,副高占33.30%,正高占16.70%;参加过系统培训的占28.57%;受训时间在半年内占71.43%;希望得到全面、系统培训的占95.24%.结论四川省精神科专科医师培训基地带教师资的年龄、学历、职称构成方面较为合理;但教龄偏短,缺乏专职教师,受训时间较短.带教教师希望得到全面、系统的培训.

Abstract：

Objective To survey the faculty doctors in psychiatric specialist training basement of Sichuan Province so as to provide a foundation for improving the faculty's ability and to promote the psychiatric specialist doctors training project.Methods To survey the 90 psychiatric specialist training faculty doctors by giving out a self-made questionnaire.Factor analysis were done by adopting SPSS 13.0.Results There were 90 self-made questionnaires given and 90 received.The effeetual questionnaires were 84.The results showed as follows:the average age of faculty doctors was 38.56±8.04,the average teaching time Was 14.32±8.44,faculty doctors with bachelor degree and more were 80.95%,the ratio of full-time teachers was 5.95%,the ratio of primary titles was 27.40%,the ratio of middle tides was 22.60%,the ratio of vice-senior titles was 33.30%,the ratio of senior titles was 16.70%;the ratio of the faculty doctors who enrolled in system training program was 28.57%,the ratio of the training time less than half year was 71.43%,the ratio of wanted to take part in system training was 95.24%.Conclusion The constitute of the faculty doctors'age.degrees and title were reasonable.But the teachingtime Was short and there were short age of full-time teachers.The time of system training was rather short.The faculty doctors demanded to take part in system training program.     

电子转诊现状研究及对策措施

目的：了解贵州省乡镇卫生院院长管理知识培训需求,为制定培训计划提供依据。方法设计调查表并实施调查,统计分析贵州省乡镇卫生院院长培训需求。结果60．84%的院长接受过3个月内讲座培训;39．51%的院长希望接受6个月以上的培训,大多数院长希望增加培训内容。65．09%和53．78%的院长认为工作繁忙和责任心是影响培训效果的主要因素,67．45%的院长认为建立培训管理考核制度可提高效果。结论乡镇卫生院院长培训现状不能满足需求,应增加培训时间和内容,建立培训管理考核制度以提高培训效果。     

提升乡村医生专业师资培训有效性的调查与分析

目的了解附属医院临床教师参加师资培训的动机、需求方式以及期待解决的问题。方法采用问卷调查及抽样访谈方式进行调查,问卷内容包括个人基本情况、参加培训的动机和影响因素、对培训内容的需求以及对乡村医生专业教学工作的认知度;并在参加问卷调查的人员中按照年龄段分别抽取一定人员进行访谈。共发出问卷162份,回收有效问卷148份;个别访谈14人。结果参加师资培训的动机中,主集中在“力争成为专业骨干或带头人”“提高教学理论水平”和“增强竞争力、以求发展”上。对于影响个人参加培训的因素选择最多的是“医疗任务比较繁重,精力有限”。在开展乡村医生培养的教学中,主不足在于“对乡村医生工作模式和内容的了解不够”和“缺乏临床实践与乡村医生教学融会贯通的能力”上。结论在师资培训时除一般的临床教学能力外,还将乡村医生岗位的各项需求纳入培训内容以提高有效性。     

某三甲医院住院医师岗前培训内容调查分析

目的：描述某三甲医院住院医师的一般情况,了解该院住院医师对于岗前培训内容的评价与需求情况,初步探索适合该院住院医师岗前培训内容的课程与授课方式.方法：采用结构式自填问卷的方法,对2010年至2012年参加该院规范化培训的160名住院医师进行问卷调查并分析,由经过培训的调查员现场发放问卷,问卷不记名,不讨论,现场完成收回问卷.分别从2010年至2012年选取6～8名住院医师进行深入访谈,了解住院医师对岗前培训的评价与需求.结果：1.该院住院医师以本科和硕士学历为主,外单位委托培训人员较多,培训人员女性居多.2.医患沟通技巧、医疗法规教育、医德医风教育、病历书写教育、医院感染（传染病）常识和急诊急救技能训练得到住院医师认可.3.文献检索与应用、临床与科研等内容是住院医师希望学习的课程.4.住院医师希望岗前培训的师资为高级职称,希望培训时间延长到1～2周.结论：住院医师的来源与学历构成是岗前培训内容要考虑的因素,加强临床技能培训和人文素养培训为岗前培训指明了方向,在培训内容、培训时间长度、师资和形式方面进行调整,提高培训效率.     

Managing alcohol problems in general practice

A questionnaire on the management of alcohol problems was sent to 467 general practitioners. Of the 312 who replied, nine tenths thought that they had a legitimate role in working with patients with drinking problems, but less than a half thought that they were adequately equipped to perform this role. Only two fifths felt motivated to work with drinkers, less than a third were satisfied with the way in which they worked with drinkers, and fewer than one in 10 obtained work satisfaction from working with drinkers. Only 29% of doctors regularly gave advice to patients to reduce alcohol consumption, but 56% believed that their advice was effective. Doctors who had positive attitudes to working with drinkers undertook more work related to alcohol problems in their practice. There is a need to provide further education for general practitioners about alcohol related matters, and this education should include advice on intervention with heavy drinkers.     

Training for rural practice in Australia 1990

There is a shortage of general practitioners in rural Australia. Several recent State and federal government reports have highlighted the difficulties of rural practice. One of the reasons commonly cited for the shortage of country doctors is the lack of appropriate training in Australia's medical schools and the Family Medicine Programme. This survey of the heads of departments of community medicine/general practice of Australia's 10 medical schools and of the State directors of the Family Medicine Programme documents the present efforts to train doctors for rural general practice. A 100% response was achieved. The responses indicate much interest and effort from the Family Medicine Programme in developing rural training schemes. Though the community medicine/general practice departments demonstrate considerable interest and innovation, they are hampered by lack of resources and negative attitudes of some specialist colleagues. Overall, the main impediments are: lack of "affirmative action" admissions policies to recruit rural students; insufficient curricular time for teaching the principles of general practice; students' lack of confidence in the procedural aspects of rural practice; lack of appropriate training posts in anaesthetics; lack of appropriate general practice training posts at regional hospitals; and lack of financial resources. Some suggestions are given to improve training for rural practice in Australia.     

Female doctors in Victoria, 1977

A survey of medical manpower in Victoria in 1977 revealed that 17% of registered medical practitioners were female and that the proportion of females was much higher among younger graduates. Seventy-eight per cent of female doctors were currently working in Victoria, compared with 82% of male doctors; 3.8% were "not working temporarily" compared with 0.6% of male doctors; and 3.9% were "retired" compared with 1.9% of male doctors. Female doctors accounted for only 8% of specialists in private practive, compared with 15% of general practitioners, more than 20% of salaried staff members of hospitals and other semigovernment and government bodies, and 40% of the staff members of community health centres. Thirty-eight per cent of female doctors were working part time. The need for part-time training programmes and part-time work, and the difficulties of female graduates becoming specialists are discussed. The implications of increasing proportions of female doctors entering the medical work force during the next decade, and the lower average working hours of female doctors compared with those of males, are considered in relation to the increasing supply of medical manpower in Australia.     

A comparative study of postgraduate medical education in North East Thames Region.

As a prelude to more detailed formal contracting, North East Thames Region undertook a review to examine whether the content of postgraduate medical education (PGME) varies according to the type of hospital in which junior doctors are trained. The study covered a sample of 83 trainees at different grades in four types of hospital (postgraduate, university, district general hospital involved in off-site undergraduate medical education, and district general hospital with no formal involvement in undergraduate medical education) and was designed as a qualitative comparative study. The results of the study point to a perceived lack of structure in PGME and indicate that hospital type alone does not determine a trainees'' PGME experience. Moreover, different training grades have different educational needs, which will need to be addressed under more formal contracting arrangements. The Region plans to take this work forward by convening one or more consensus conferences to examine how a more structured approach to PGME could be implemented.     

Improving hospital doctors' working lives: online questionnaire survey of all grades

Background: In 2001, the Department of Health produced the Improving Working Lives (IWL) for Doctors document. This is the first national survey which asks hospital doctors what changes are needed to improve their working lives. Methods: An online questionnaire was run over a period of six weeks and was open to all doctors of all grades. Doctors were asked to choose their top five factors from a list of 35 diverse choices or to provide alternatives in free text. Demographic data were also collected. Results: 1603 hospital doctors working in the UK completed the online questionnaire. Improved secretarial or managerial support was the first IWL choice for consultants, with different aspects of clinical and non-clinical support representing their top four choices. Junior hospital doctors and staff and associate specialist grades (staff grades, associate specialists, and clinical assistants) identified improved support for education and training as their first choice, while among the female specialist registrars, it was improved support for childcare. Greater opportunities to develop new skills was an important issue for doctors in the surgical specialties and improved access to mentoring was important for all junior doctors, staff and associate specialist grades, and doctors from black and ethnic minority groups. Conclusions: Hospital doctors in the UK need more support to improve their working lives. The principle needs are better secretarial and managerial support for consultants; education, training, and mentoring for junior doctors and staff and associate specialist grades; and improved opportunities to develop new skills for those in surgical specialties. Support with childcare is an important issue for female specialist registrars. The Department of Health, NHS trusts, deaneries, and Royal Colleges need to endorse policies that promote a training and working environment that will improve working lives for all hospital doctors, ensuring that appropriate and continuing support is available from the time doctors enter the new foundation programmes and proposed run-through grades, to their time spent as consultants in today''s NHS.     

Educational supervision of pre-registration house officers.

An annual survey of the educational supervision of pre-registration house officers has been carried out since 1987 by the Northern Ireland Council for Postgraduate Medical Education and the Queen's University of Belfast. Educational supervision was considered by house officers to be unsatisfactory in 27% of medical posts and 52% of surgical posts. Regular teaching was provided at least weekly in 77% of the posts, but 50% of house officers wanted mor experience of managing common medical emergencies. Over one-third felt administrative duties were excessive. There is a strong argument that hospitals should designate within clinical units a consultant with responsibility for educational supervision of the pre-registration house officers. Creation of the hospital counterpart of the General Practitioner trainer--the educational supervisor--would enhance the educational value of the pre-registration year. This might avoid withdrawal of approval for training purposes from some pre-registration posts.     

Assessing the consultation: methods of observing trainees in general practice

We compared two different methods of observing trainees at work in general practice: the traditional one of a senior or training general practitioner sitting in during selected surgeries and the more modern video recording, with the patients' written consent. Patients who had experienced the presence of a second doctor during the consultation were less likely to show an increase in arousal after their consultations than those who had been recorded on video. Patients who refused consent to be recorded were more highly stressed than those who agreed and showed smaller decreases in stress after consultations. The presence of two doctors generated fewer reductions in stress after the consultation than video recording did, but this was a non-significant trend. The group that was recorded on video did not differ appreciably from a control group in changes in stress or arousal.     

General practitioners' retirement plans and what influences them

The results of a study of the attitudes of 197 general practitioners aged 55 and over towards retirement and their plans for retirement are reported. Few wished to retire very early, and only a further 40% definitely planned a clean break from practice. Nearly half planned on taking "24 hour retirement," even though most (78%) will be entitled to full pension rights. Job satisfaction and health were the most important factors influencing the timing of the retirement. Seventy seven per cent thought that there should be no formal retirement policy, 79% wanted no compulsory retirement age, and 80% wanted no further controls or safeguards directed at older practising general practitioners. Half of the general practitioners in the sample were not looking forward to retirement. Personal discussions with respondents aged 65 and over suggested that there are many older general practitioners who plan to practise for some time, who feel that they will know when the time has come to stop, but who often express the hope that they may "die in harness." A large proportion of older doctors are in single-handed practice. In view of this, and also of the evidence from North America which suggests that older doctors may practise inferior medicine, it is thought that the ability of such general practitioners to evaluate their competence should be studied by methods such as peer assessment techniques.     

The acceptability of personal learning plans in vocational training.

Personal learning plans have been advocated as a means of introducing the principles of adult learning into general practice vocational training. The aim of this study was to investigate attitudes amongst general practice trainers and registrars to the introduction and use of personal learning plans. A questionnaire was sent to general practice trainers and registrars in one vocational training scheme prior to the introduction of personal learning plans. Overall, doctors in the training scheme were positive to the idea of personal learning plans. Trainers were significantly more positive towards introducing learning plans than their registrars. Registrars in their final general practice posts were significantly more positive towards the idea of learning plans than their hospital counterparts. Doctors who had completed membership of the Royal College of General Practitioners, usually trainers or final year registrars, were also more positive in their attitude. This pilot study suggests that most trainers and registrars were positive in their attitude towards personal learning plans prior to their introduction in the Lincoln vocational training scheme. The study cautiously suggests a wider use and evaluation of personal learning plans in vocational training.