Source: BMJ Careers

Authors: Caroline White 

Publication date:  05 Mar 2013

Medical registrars are struggling to cope with “unmanageable” workloads, jeopardising the safety of patients and the quality of hospital care and compromising training, the Royal College of Physicians has warned.[1]

Hospitals cannot afford to let the situation deteriorate any further, concludes a report from the college on the future of the hospital workforce. The report draws on evidence gathered in 2011-12 from online surveys and face to face interviews with 2800 medical registrars (doctors in the later stages of training to become consultants and who specialise in hospital medicine rather than general practice or surgery) in England.

Hospitals are too reliant on medical registrars to provide the bulk of hospital services, particularly at night, the report says. More than one in three (37%) trainee doctors described the medical registrar workload as “unmanageable,” and more than half (59%) said it was “heavy.” Just one in 20 GP registrars thought this way about their workload.

This situation threatens patient safety and heightens the risk that the most able junior doctors will be put off pursuing a career in acute hospital medicine, the college suggests.

Its report calls on hospitals to review the workload of medical registrars and their associated teams as a matter of urgency. Hospitals should adjust rotas and redistribute basic clinical and administrative tasks to other staff, it says. Additional resources should be provided when the workload puts patient safety at risk, it adds.

Hospitals also need to change as a result of the increasing number of female trainee doctors in the workforce, the report says. It recommends that local education and training boards promote flexible training posts for medical registrars to ensure that women don’t desert medical specialties.

The report also argues that the quality of training provided is too variable and that training is further compromised by registrars’ heavy workload. Only 38% of registrars thought that their training in general medicine was “good” or “excellent,” compared with 75% in their main specialty.

Medical registrars and other trainees should routinely attend post-take reviews of all patients they have dealt with, including ward referral patients, the report suggests. Hospitals should also ensure that medical registrars can maintain their practical skills, including specialty skills required of them.

The report calls on the Department of Health to reassess the value of the second year of foundation training for those wishing to specialise in hospital medicine and to explore the benefits of extending core medical training.

The uneven distribution of consultants around the country serves to compound problems in the medical registrar workforce, it says. Patients in London have almost double the number of consultants per head of the population as those in the East Midlands, it points out.

Andrew Goddard, director of the Medical Workforce Unit at the Royal College of Physicians, said that medical registrars were the “unsung heroes of hospital care.” He said, “Their skills are not being used to best meet patients’ needs. The NHS will soon struggle to provide the best care for patients if this situation is not urgently reviewed.”

The data on the availability of consultants across the country reflected poor workforce planning, he added. “National and local education and training structures must get to grips with this straight away,” he urged.

Ben Molyneux, chairman of the BMA’s Junior Doctors Committee, said that medical registrars’ excessive workload was bad for training and for patient care. He called for hospital services to be redesigned.

“If we don’t do this we risk the next generation of consultants avoiding careers in acute medical specialties,” he said. “All junior doctors should get decent training and be properly supported if we are to deliver the highest standards of care for our patients.”

Caroline White freelance journalist, BMJ

cwhite@bmj.com

Source: BMJ Careers

Authors: Caroline White

Current doctors are more likely to train and work near where they grew up than previous generations were, indicates research published in the Journal of the Royal Society of Medicine.[1]

The authors assessed the geographical mobility of more than 31 000 doctors who qualified in the UK between 1974 and 2008, though cohorts that qualified after 2000 were excluded from some comparisons because they had not progressed far enough in their careers for the comparisons to be valid.

The proportion of doctors whose first career post was in the region where they trained was higher among those who qualified in 2000 (78%) than among those who qualified in 1974 (51%). The proportion whose first career post was in the region of their medical school was also higher in the 2000 cohort (50% versus 36%).

Overall, more than a third of doctors (36%) had gone to medical school near their family home, and almost half (48%) undertook specialty training in the same region as their medical school. Once they became hospital consultants or GP partners, a third (34%) settled in the region where they had lived before becoming a medical student.

The researchers said that younger doctors’ career expectations and practice patterns seemed to differ from those of their older colleagues. “Younger generations are more likely to take into account the preferences of their spouses than older generations,” they wrote. They added that greater emphasis in recent years on “work-life balance” may have prompted more doctors to stay close to their parental home.

But they warn that a reluctance to move could be problematic for patients and lead to an inequitable distribution of doctors around the country.

“We are already aware that the equity of distribution of general practitioners in England has fallen since 2002,” they wrote. “Reduced geographical mobility may not be sustainable: doctors have to go where the jobs are.”

Source: eHospice

HealthCare Chaplaincy has announced the publication of the new, expanded edition of the free “Handbook of Patients’ Spiritual and Cultural Values for Health Care Professionals.”

Cultural and spiritual sensitivity contributes to patient-centered care and, in the United States, helps meet Joint Commission requirements.

Cultural and spiritual sensitivity requires knowing what those values, beliefs, practices, and traditions entail.

That is why a number of years ago HealthCare Chaplaincy in New York introduced its first Handbook (or Dictionary) of Patients’ Spiritual and Cultural Values for Health Care Professionals and made it available for no charge on its website.

Sandra Stimson, executive director of the National Council of Certified Dementia Practitioners, said: “The handbook is a guide that should be on the desk of every person who is working with patients – including chaplains, physicians, nurses, activity professionals, volunteer coordinators, recreation therapists, dieticians, dietary managers, social  workers, admissions staff, discharge planners, administrators, physical therapists, occupational therapists, speech therapists, nursing assistants, etc.”

The handbook, currently 89 pages long, is updated periodically when HealthCare Chaplaincy obtains new or revised information from specialists in a given area. This new edition adds content on three areas not covered before – Africa, Asia, and Hawaii and standardizes the categories.Download it as PDF file.

HealthCare Chaplaincy encourages the use of this free handbook by health care professionals, and requests, when distributing it, credit as follows: “This content is used with the permission of HealthCare Chaplaincy in New York, the leading multifaith organization for the integration of spiritual care within health care and palliative care through research, professional education and clinical practice.” Learn more on the HealthCare Chaplaincy website.

HealthCare Chaplaincy welcomes new contributions for content and feedback on the handbook’s value for one’s organization. Please send those to the Reverend George Handzo.

Credit for the new content on Africa, Asia, and Hawaii goes to:

• Stefanie Mercado Altman, a senior at Ithaca College majoring in medical and cultural anthropology and minoring in writing
• Kanoelani Davis, Cultural Health Navigator Manager at the Molokai Community Health Center.

Additional cultural sensitivity resources are available on HealthCare Chaplaincy’s website, including “Cultural & Spiritual Sensitivity – A Learning Module for Health Care Professionals” along with links to materials from the Joint Commission, City of Hope Pain & Palliative Care Resource Centre, and the Association of Professional Chaplains.

Source: eHospice

The National End of Life Care Programme in the UK has helped increase the proportion of cancer deaths that happen at home and in hospices, and reduce hospital deaths.

In a new study published in PLOS Medicine, researchers found that there has been an increase in the number of home and hospice deaths for people with cancer since 2005. They suggest that this is due to the work of the National End of Life Care Programme, which was established in 2004.

The researchers used death registration data from the Office of National Statistics to identify place of deaths for all the adult cancer deaths in England between 1993 and 2010. They then used this data to look at the changing pattern of place of death, and identify the factors that influenced place of death.

Over the period of the study, 48% of cancer deaths occurred in hospital, 24.5% at home, and 16.4% in hospices. The proportion of deaths at home and in a hospice increased from 2005, while the proportion of hospital deaths declined.

The research identifies cancer site, marital status and age as the three most important factors associated with place of death for patients with cancer – patients who died from haematological cancer, who were single, widowed or divorced or aged over 75 were less likely to die in home or hospice.

They also highlight a ‘worrying trend’ that shows that the differences between place of death for those who lived in advantaged and disadvantaged areas widened during 2001–2010.

The authors call for further efforts to reduce hospital deaths and increase home and hospice deaths. They suggest that people who are single, widowed or divorced should be a focus for end of life care improvement, along with known at risk groups such as haematological cancer, lung cancer, older age and deprivation.

The paper ‘Changing Patterns in Place of Cancer Death in England: A Population-Based Study’ by Wei Gao, Yuen K. Ho, Julia Verne, Myer Glickman and Irene J. Higginson was pubished in PLoS Med 10(3): e1001410. doi:10.1371/journal.pmed.1001410

Source: BMJ

Source: GMC

New GMC guidance will help doctors to act within the law when a patient asks for advice on how to end their life.

The law in the UK is clear: providing information that could encourage or help someone to kill themselves is a criminal offence. However, doctors must listen to their patients, treat them with respect and compassion, and be prepared to discuss the patient’s reasons for wanting to end their life. This can be a  difficult balance to achieve. 

The new guidance When a patient seeks advice or information about assistance to die combines key principles from our existing guidance Good Medical Practice and Treatment and care towards the end of life. 

We hope that it will support doctors faced with important but difficult conversations with patients and ensure they do not put themselves at risk of unethical or illegal behaviour. 

At the same time, we have published guidance for our staff who deal with complaints about doctors. This will help them assess whether a doctor has acted in accordance with our guidance and the law. 

In the past 10 years there have been only three fitness to practise linked to assisting suicide, one resulting from a conviction for assisting suicide in Canada. None of them arose from a conviction for assisting suicide in the UK.