Message text written by " nick jenkins"
> I'd be interested to hear what both SpR's and Consultants feel both about
the concept of the job plan and any comments on the one we use<
Interesting to see how different Regions plan out a working week. I
understand the idea of protected sessions for each aspect of the training,
but there must still be some flexibility. Thoughts that occur immediately
from the plans as seen:
- the average working week is 40 hours. Where does the on-call commitment
fit into the picture?
- when on the shop floor is the other staffing limited, making the SpR
essential to patient flow, and is this in place of or with a consultant?
- how much of the time would be regarded by the Faculty as directly
"supervised" or taught rather than service?
- what happens with the clicincal sessions when somebody takes annual
leave (another SpR or consultant)
There is a need to see "interesting and unusual" or just plain difficult
cases as well as get numbers under the belt during clinical sessions. One
of the major criticisms of the Calman system is that people get through
without the wide experience of previous generations. I would want to be
involved or at least informed and educated when these are in the
Department, whatever the plan says I should be doing.
Equally I could not sit in an office or the library when I know that my
colleagues on the floor are being swamped. Not good for my position/status
with my colleagues (medical and nursing) or for my own self-respect.
Fixed sessions such as morning review clinics, short stay ward rounds and
departmental administration meetings are readily placed. Patients however
do not attend at a fixed and smooth rate. Certainly one department I worked
in operated a policy that registrars would be pulled from any non-clinical
activity to crowd control when the waiting time passed a certain threshold,
or when a seriously ill person arrived either to manage directly or
supervise a junior. Accounting for your time was required and
reviewed/disussed with the supervising consultant. A significant clinical
load was expected but there were periods of relative calm when non-clinical
work got done.
It is not difficult to get a feel for how much weight a particular person
pulls on the floor. If this were quantified (in more than just numbers
seen) then I would prefer a flexible approach. However in the traditional
sense: fixed sessions and clinics with Consultants on the shop floor -
fine, acting as a buffer between juniors and seniors for clinical problems
at all times - fine, shift pattern work to give wider more experienced
cover - fine.
This is adult education in a variable environment, explain what is expected
and stand back. The output, in terms of clinical load and non-clinical
productivity will guide the supervisor to alter the work pattern if
indicated.
Are we generating a system that is too regimented? Are todays SpRs like
schoolchildren that need to be TOLD what to do with each part of their day,
is this personal time-management not part of the training?
Darren Walter
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