Tackle “killing season” by moving start dates

SPECIALTY trainees should start their jobs one month later than foundation doctors to cut patient deaths during the August changeover.

The Academy of Medical Royal Colleges (AoMRC) believes staggering start dates could bring down morbidity and reduce stress levels amongst doctors.

Figures show there is an increase in patient deaths in August as thousands of trainee doctors start new posts, leading to changeover time being dubbed the “killing season”. A UK study also suggested a six per cent increase in mortality for patient admitted on so-called “black Wednesday” – the first Wednesday in August when the majority of UK trainees change posts.

The AoMRC has recommended F1 posts should continue to start in August, but CT1/ST1 jobs should start in September. This means F1s would have the benefit of working with specialty trainees who had been in post for between five and 11 months. Smaller, run-through specialties could continue to start at times other than September.

The recommendations have been made in a report by an AoMRC working group set up to look at the issue.

It stated: “The beginning of August brings an apparent increase in patient morbidity and evidence suggesting increased mortality. It is a time that trainee doctors find stressful and difficult.

“This paper recommends that the most effective solution for safe trainee changeover is a roll forward model of staggering, where the more senior trainees rotate one month later. This model could take a number of formats, but a survey of Foundation doctors demonstrated support for a system where all specialty training programmes start at the beginning of September, one month after the end of the Foundation Programme.”

The report stressed that any change in start dates would leave no gaps in patient care. Individual trainee doctors, the report explained, would experience a one month gap at a single point in their medical career. For the first year of implementation, specialty trainees could be contracted to work for 13 months to avoid compromising patient safety.

The working group estimated that the change to start dates would be cost neutral, however extra funding would be required if employment or training was offered to doctors during the gap between programmes. This could provide “significant returns”, they believe, “in terms of staff retention, enhanced skill based and improved morale.”

A spokesman for Health Education England said, “We have received the academy’s report and thank them for their work in this important area. The most appropriate way forward is to consider the recommendations as part of the wider work around the Shape of Training report.”

Read the full report at https://www.aomrc.org.uk/reports-guidance/staggering-trainee-changeover-0314/