Heavy workload blamed for emergency medicine recruitment crisis

HEAVY workloads and inadequate supervision are deterring trainee doctors from applying for jobs in emergency medicine, a study by the General Medical Council has revealed.

The report found the supervision of junior doctors working nightshift was inconsistent and inadequate, while concerns were also raised about the quality of education and training within the specialty.

The GMC carried out checks at six hospitals in England and one in Jersey between December 2012 and February 2013 for its report Medical education’s front line – A review of training in seven emergency medicine departments. It said the action was prompted by the “increasing number of concerns reported to us about education and training in emergency medicine, particularly about very junior doctors in training working unsupervised at night.”

The College of Emergency Medicine was quoted in the report highlighting “severe difficulty” in recruiting to the specialty due to “the continued rise in attendances and the severity and complexity of patient conditions presenting, without provision of adequate resources for assessment and admission”.

An audit of emergency departments (EDs) found 20 sites without on-site supervision by a senior doctor in the ED overnight while a London regional visit also highlighted concerns about supervision and handover which varied depending on the ED.

The report also highlighted increases in unfilled core training posts within the specialty. In 2012, 177 foundation doctors in England and Wales applied for the first stage of EM specialty training (ACCS), of those 115 were offered a place but only 61 accepted, making it the second lowest acceptance rate of any specialty.

The consequences of such a shortfall include difficulties in delivering patient care, the need to use expensive and potentially poor quality locums, additional pressure on other medical staff, and a negative impact on rotas and educational opportunities for other trainee doctors.

The regulator said it had concerns about postgraduate training in EDs in 16 NHS trusts. These concerns included:

• a lack of clinical supervision for doctors in training during weekdays and, to an even greater extent, out of hours

• providing services across two sites with insufficient staffing

• doctors in training being asked to work beyond their competence or to carry out inappropriate tasks

• poor quality of locum doctors who are being used to fill rota gaps.

GMC chief executive Niall Dickson said: “The evidence from this admittedly limited review is serious and underlines what others have found. Emergency departments are under very significant pressure – with limited resources, they are coping with huge demand, staff shortages and heavy workload.

“Training the next generation of senior doctors in this area of medicine is absolutely vital and we need to make sure they are given the supervision and support they need to develop.”

The report did highlight good practice at some hospitals and made seven recommendations on how to improve quality. These include ensuring risk is shared by senior trust staff and not held solely within the ED, better education to address the public’s “overdependence” on EDs, and improvements to education that should include the use of simulation.

Dr Ben Molyneux, chair of the BMA’s Junior Doctor Committee, added: “With senior emergency medicine consultants describing working conditions akin to that of a ‘war zone’ it can hardly be surprising that doctors are reluctant to opt for a career in emergency medicine.

“Inadequate levels of supervision and an over reliance on locum doctors makes it very difficult for doctors in training to do their jobs properly.”

He called on the government to “act urgently” to improve education and training within the specialty.

Link

Medical education’s front line – A review of training in seven emergency medicine departments