Assessment of Junior Doctors’ Clinical Competence: A Feedback Loop

Abstract

The Postgraduate Medical Council in New South Wales, Australia oversees the education and training of about 1000 junior doctors each year. Until the Council was established in 1988, the early years of internship and residency (the house officer years) had been a somewhat neglected phase of medical education. Since its inception the Council has established and refined an educational feedback loop which relies on a clinician in each hospital having special responsibility for the education and training of junior doctors; consultants acting as term supervisors who complete a standard report in every term rotation; analysis of the reports across the state with prompt, confidential feedback to each of 40 participating hospitals about the performance of each junior doctor and feedback from the junior doctors to supervisors about the quality of the education and training they have experienced in each training term. Prompt identification of junior doctors who are not meeting standards of clinical competence prior to registration is now possible. This system also makes possible more rational decisions about which training terms should have highest priority and which terms are less suitable. If a reduction in training posts is necessary, clinical experiences of good quality can be preserved and less valuable experiences dropped. If the work force exceeds the number of established terms, criteria for good quality training can be used to ensure that new terms meet desired standards in the future.