Junior doctors’ training ‘risks patient safety’

26 November 2010

PATIENTS are being put at “unnecessary risk” because trainee doctors are working beyond their capabilities, a critical report has warned.

Foundation year doctors are being asked to perform “beyond their level of competence and without adequate supervision”, according to an evaluation by Medical Education England.

Professor John Collins led the review into the effectiveness of the two-year Foundation Programme. His 128-page report, Foundation for Excellence, raised a number of concerns around design, content, safety and quality of junior doctors’ training. It warned: “We are extremely concerned that some foundation trainees are expected to practise outside their level of competence and without appropriate supervision.

"This places patients at unnecessary risk and gives the trainee the message that suboptimal care is condoned, neither of which is part of the professional values and aspirations of a good doctor."

It continued: "The belief by some that 'being thrown in at the deep end' remains an acceptable way to learn reflects a failure to recognise the centrality of safe patient care and a lack of understanding of the major advances in learner-centred education."

The Foundation Programme was introduced in 2005 and more than 5000 juniors enter training every year at 25 foundation schools. And while Professor Collins highlighted the programme’s “many strengths”, including the fact it is a national, standardised scheme, he said there was a need to “prioritise patient safety” as well as the interests of trainees.

Foundation for Excellence makes a number of recommendations including reviewing the two-year duration of the programme in 2015. It also questions the appropriateness of focusing placements primarily on adult secondary care, rather than primary care.

Dr Tom Dolphin of the BMA junior doctors’ committee said many junior doctors found the first two years of training “characterised by inadequate levels of supervision”. He added: “We also need to urgently investigate problems with the selection of doctors into the programme, the length of work placements, and the excessive levels of assessment.”