Junior doctors don’t get enough teaching

I am a returning doctor. I qualified in the late 1980s and went through a general practice training programme of my own making, working all around the United Kingdom. Having been away for a few years because of ill health, I thought that the safest route back into medicine might be via a foundation year one (FY1) job, where the chance of doing anything catastrophic might be mitigated by the many layers of supervision.

What has happened to the profession in my absence?

New drugs have evolved and practices have changed—and this is good and exciting (β blockers in heart failure was a bit of a shock though). But what has happened to education? In the past, you applied for a six month stint that looked interesting, and off you went. The consultants took pride in their work and saw teaching as a major part of their role. Consultant ward rounds were an opportunity to learn. Awkward questions were asked, to test and expand knowledge. Different treatment modalities were discussed and explained. The hard work and long hours were worth it, because we were learning. We worked in teams, and, as the junior house officer, you knew all your patients because you had personally clerked them in. You saw how patients with different treatment regimens progressed. Often, two consultants had different approaches, and you could compare the outcomes and reach your own judgment as to which was better.

Life as an FY1 is so different. Consultants are so pressured that they can’t wait to get off the ward. They are in and out before the notes have even been found. There is no pride in teaching and no time between busy clinics. Nowadays, a poorly presented weekly lecture suffices, and the topics are chosen according to which poor registrar can be coerced into giving a talk.

The junior doctor no longer knows the patients. They see them once or twice and then have a day off or do a different shift, so missing out on the ward round. Thus, the FY1 sees patients that they don’t know and only briefly, and there is little continuity of care and little chance to follow a patient’s progress.

The FY1 is becoming deskilled: now, health support nurses insert intravenous catheters and make up infusions. A phlebotomist takes blood samples. The ward round is constantly interrupted by the need to visit a computer, either to check results or to administer urgent discharge protocols. Computers demand more and more of doctors’ time, to the detriment of time spent with the patient. Each programme demands its own username and password. Blood test results presented on computer screens have to be transcribed by hand into the notes. Who thought this was a good idea? The old system of results being stuck in the notes worked so much better, but somebody thought progress means that we computerise everything.

During the bad weather earlier this year the weekly lecture was packed with FY1s eager to work, learn, and progress in their chosen discipline. Despite terrible snow storms we were all there, working and learning. Immediately after the lecture, I visited the deanery. Acres of office space, hundreds of computer stations, and so many desks and chairs all lay empty. Only one administrator and a secretary had made it in because of the snow. Such is the commitment to training.

Is education being squeezed out of the junior doctor’s role because of workload or because of indifference? Certainly the new system by which job applications are centralised through the deanery has not improved teaching or eased the path to employment.

What has happened to our profession? The consultant grade has not served us well. Consider the iniquitous hours that junior doctors used to work. The consultants ducked that issue and we got stuck with the EU Working Time Directive. Now they are ducking the issue of teaching, and we are stuck with an overly complex deanery system that works to no one’s benefit. Consider: the junior cannot choose the job and the consultant cannot choose the junior. So who benefits? Consultants complain about a system that silts up the wards with patients awaiting their package of care, but they are unwilling to take the action necessary to resolve the situation.

Consultants need to take charge and protect the profession of which they are the senior leaders. Their job is not merely to heal patients and fulfil an administrator’s target, but to leave behind them a profession better than the one they entered. You cannot help but feel that this is something to which many consultants have given little consideration; that they are content, instead, to become little more than technically advanced civil servants.