>
> Again, as with other points, the key to getting more efficient work out of
> juniors is to put consultants and/or middle-grades on the shop floor to
> get
> involved in juniors' cases, rather than queue-busting.
I couldn't agree more: no doubt this would also greatly increase the quality
of the training they receive in the ED! It's always seemed kind of crazy
that we let SHO's see and dispose of patients without any direct supervision
except when they actually ask for help. Why do we expect (very) junior
doctors to "know what they don't know", particularly in emergency medicine
with its sick, tremendously varied and unselected patient population?
Can you imagine anaesthetic / ICU training along similar lines?: "Ok, you've
had your 1-3 day induction period of lectures, now go anaesthetise sick
patients on your own...but you can call me if you need a hand..."
By comparison, from talking to various emergency physicians in the US, there
seems to be much closer supervision of trainees there. Apparently Emergency
medicine residency training there has evolved (for various reasons) into a
system whereby every patient seen by a trainee has to be 'signed off' by a
fully trained ER doctor. In the first year or two of training this tends to
mean the supervising doctor at least 'casts an eye' on every patient and
their investigation results etc. In the final year it can just mean that
each case is discussed before admission / discharge.
Of course, I'm not suggesting that every (any?) emergency department in the
UK has the resources to do this right now...but if we're serious as a
specialty about training (not just 'working') junior staff and providing the
best possible care for patients, maybe we should be declaring this level of
supervision necessary for effective training and then demanding the
resources necessary to make it happen.
What do you folks think?
Ghufran syed
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