Survey of core medical trainees in the United Kingdom 2013 - inconsistencies in training experience and competing with service demands.

There is currently considerable concern about the attractiveness of hospital medicine as a career and experiences in core medical training (CMT) are a key determinant of whether trainees continue in the medical specialties. Little is understood about the quality and impact of the current CMT programme and this survey was designed to assess this. Three key themes emerged. Firstly, the demands of providing service have led to considerable loss of training opportunities, particularly in outpatients and formal teaching sessions. Trainees spend a lot of this service time doing menial tasks and over 90% report that service takes up 80-100% of their time. Secondly, clinical and educational supervision is variable, with trainees sometimes getting little consultant feedback on their clinical performance. Finally, 44% of trainees report that CMT has not prepared them to be a medical registrar and many trainees are put off acute medical specialties by their experiences in CMT.

Training in general medicine - are juniors getting enough experience?

There is a widespread perception that trainees in medicine in the UK are 'not as good as they used to be' and reduction in hours of training is often cited as one cause. However, there are no data on the current experience of medical trainees in general medicine. The experience of foundation year doctors (FY1/2) and core medical trainees (CTs) in the management of 10 common medical conditions, eight common medical procedures and other aspects of medical training were collected by national survey in 2011. Trainees reported finding out-of-hours care the best setting for acute general medical experience and that the medical registrar was a key part of training. There was a significant lack of experience in both the management of medical conditions and the use of common procedures. These results highlight the challenges in general medical training and show that there is substantial room for improvement.

Career choices of junior doctors: is the physician an endangered species?

There are increasing concerns regarding the recruitment and retention within general medicine. National surveys were conducted among foundation year 2 doctors (FY2), year 1 and year 2 core medical trainees (CT1 and CT2) and medical registrars (StR/ST3+) exploring their enjoyment of medicine, overall satisfaction, career aspirations, influencing factors and perceptions of the medical registrar. The results highlight that many doctors at the FY2, CT1 and CT2 levels are being deterred from general medicine by the perceived unmanageable workload and poor work-life balance of the medical registrar. Medical registrars themselves are less satisfied in general internal medicine than they are in their main specialties. Therefore, priority needs to be placed on clarifying the roles, and improving the morale, of medical registrars. If current trends persist, these will have a significant impact on patient safety, patient care and workforce planning.

Research activity among physicians in the United Kingdom: results from the Royal College of Physicians Census 2022.

We present the results of the 2022 Census of the Federation of Royal Colleges of Physicians of Edinburgh, Glasgow and London on whether physicians undertake research and the barriers they have encountered. 40% of physicians reported that they undertook research alongside their clinical work. Multivariate analysis of the responses showed that men were 1.6 times more likely to say they undertake research than women. The main barriers to undertaking research were having enough time, organisational factors and a lack of confidence. In this opinion piece we discuss some of the challenges and how they could be addressed.

The UK physician workforce: one-third at increased risk of death from COVID-19.

INTRODUCTION: 21% of NHS staff are from Black, Asian and minority ethnic (BAME) backgrounds yet account for a disproportionately high number of medical-staff deaths from COVID-19. Using data from the published OpenSAFELY Collaborative, we analysed consultant physicians to determine those at increased risk of COVID-19 related death. METHODS: Data from 13,500 consultant physicians collected by the Royal College of Physicians were analysed to determine those at an increased risk of death from COVID-19, assuming no comorbidities. RESULTS: The data reveal a picture in which a third of consultant physicians have a hazard ratio (HR) >1 for dying from COVID-19; one in five have HR >2; one in 11, HR >3; and one in 40, HR >4. Of concern are the risks to male physicians aged ≥60 with HR >3.8. Sub-specialties including cardiology, endocrine and diabetes, gastroenterology, haematology, neurology and rheumatology have a greater risk profile due to high proportion of men, physicians of older age, and proportion of BAME individuals. CONCLUSION: A third of consultant physicians have an increased risk of a COVID-19-related death, and one in five have a higher relative risk (HR >2). The risk is mainly driven by age, gender, and ethnicity, the risk is highest in male consultant physicians over 60, especially from BAME backgrounds.

Impact of EWTD on patient:doctor ratios and working practices for junior doctors in England and Wales 2009.

The European Working Time Directive (EWTD) has resulted in large changes in the working patterns of junior doctors in the U.K. All consultant physicians in England and Wales were invited to anonymously submit data on their teams for 11 am and 11 pm on 5 November 2009. Data on doctor number, grade, location and patient number were collected. Data were available on 887 hospital teams at 11 am and on 670 teams at 11 pm. At 11 am, the average number of patients per ward doctor was 11 (2-65). At 11 pm the average number of patients per doctor was 61 (1-400). Consultants were present overnight in 6.1% of teams. Doctors in the first two years of training were the most senior medical cover in 63 teams. Sickness rates varied between 1.5% and 3.5% for junior doctors, and were significantly higher in the second foundation year. Vacancy rates at the specialist registrar level were 8.6%. Trainees were available for training 66-80% of the time. These findings have significant implications for patient safety and quality of medical training in the U.K.

'Training gap' - the present state of higher specialty training in adolescent and young adult health in medical specialties in the UK.

Young people often experience worse health outcomes and more dissatisfaction with healthcare compared with other age groups. This survey sought to determine the state of adolescent and young adult health training across medical specialties in the UK. An online questionnaire was distributed to higher specialty trainees in adult medical specialties. Training in adolescent/young adult health/transition was rated as minimal/non-existent by 70/73% of respondents, respectively; 52% reported that they had received no formal training and 61% had never attended a dedicated young person's or transition clinic. The most significant barrier to delivering good adolescent and young adult healthcare was felt to be lack of training to deal with adolescent issues. This survey has identified a 'training gap'; a lack of preparation to meet the specific care needs of the adolescent and young adult population. Improved interventions are required to help drive improvement in care for young people in the UK.

Medical professionalism: the trainees' views.

Medical professionalism is deeply embedded in medical practice in the UK but, with changes in the modern healthcare climate, its nature and role have been increasingly challenged. The Royal College of Physicians (RCP) therefore convened a working party to consider the concept of medical professionalism, to clarify its value and purpose, and to define it. As part of this project, the RCP Trainees Committee was commissioned to survey trainees to obtain their views on the matter. A questionnaire was sent to 19,190 medical and surgical trainees, and 4,576 medical students; 2,175 responses were received. The results were clear. Junior doctors and medical students see medicine as a profession which is learnt through apprenticeship and defined by responsibility towards patients, and which requires qualities such as altruism and humility. They believe that professionalism maintains and improves patient care; that standards of care should be defined and regulated by the profession; and that training should be directed by the profession. Furthermore, the overwhelming majority think that a reduction in medical professionalism would lead to people leaving the profession.

Consultant perception of general internal medicine: a survey of consultant physicians.

The Future Hospital Commission has highlighted the need for increased general medical skills in the medical workforce in order to meet the increasing demands on the NHS in terms of patients with increasing age, frailty and complex comorbidities. However there continues to be a lack of clarity around the concept of generalism and general internal medicine (GIM), with differing views on the physician's role in GIM. This survey sought to explore further the roles in which current physicians perceive they are practising GIM as well as views on training in GIM. The survey highlights three key points: (i) that consultant perception and practice of GIM continues to vary dependent on physician specialty; (ii) that the practice of GIM is not limited to the front door but includes the management of patients under the care of a specialty team with general medical needs, be that in an inpatient, outpatient or acute care setting; and (iii) that training in GIM needs to reflect this variation in roles and practice.