 |
 |
> Yes and no Matt. We are already heavily involved in acute > medicine, whether > or not we have obs wards, with many of us spending half of > our clinical time > in resus or advising on the "difficult" medical patient. So > yes we need to > maintain the acute medicine component. But we also spend a > lot of clinical > time dealing with difficult "minor" problems, at least we do in this > department; complex wounds, fractures, dislocations etc etc. > That's great- if a SpR spends the great majority of their time seeing or advising on critically ill patients or difficult 'minor' problems (which I agree can be complex and important) they are gaining useful experience. However, my experience across departments has led me to believe that the majority of workload (particularly in inner city departments) consists of simple 'minors'. If a SpR spends too much of their time dealing with these they lose the oportunity for valuable experience elsewhere. > But returning to trainees, I think as a profession we must > get away from > this blindly accepted premise that somehow service work is > "bad" for them. I > have always maintained that trainees learn most from real clinical > situations, as long as they are supported and have ready > access to a senior > opinion or other learning resource (textbooks, internet etc). Agreed. Again, a SpR with a high service commitment may be too busy to access learning resources. > All other > specialties work in this way, for example, surgeons and > anaesthetists spend > their lives scrabbling to get to theatre to gain more experience. In a procedure based speciality, yes. Continuing to do even relatively simple procedures is useful (akin to a musician practising scales and arpeggios). Service committment that consists of procedures particularly more complicated procedures is always useful. However in a more diagnosis based speciality, exposure to a wider range of conditions is important. Minor injuries are important, but it is likely that by the time of starting HST, a SpR has already seen sufficient of most of them. Where SpRs tend to be deficient is in management of the critically ill patient. Even in surgery, the more senior trainees are keen to learn and practice certain operations, but for a surgical SpR in the later stages to spend most of their time doing routine follow up clinics or simpler operations would not be considered acceptable- you learn by doing an operation for the first few times, but the learning curve does plateau. While practical experience is important, it is my belief that SpR training could be improved by increasing the emphasis on training at the expense of service commitment- even when I was a registrar there were cases where I was drawn away from seriously ill patients (or had to refer them on to inpatient specialities) in order to clear waiting times. The vibes I'm getting is that this problem is worsening. This compromises training, and in my view is analagous not to surgical SpRs spending time in theatre, but to surgical SpRs being drawn out of theatre to clerk in routine admissions. Matt Dunn Warwick This email has been scanned for viruses by NAI AVD however we are unable to accept responsibility for any damage caused by the contents. The opinions expressed in this email represent the views of the sender, not South Warwickshire General Hospitals NHS Trust unless explicitly stated. If you have received this email in error, please notify the sender.