Modernising Medical Careers: impact on training in a district general hospital

Abstract

Modernising Medical Careers (MMC) resulted in Senior House Officer (SHO) posts being replaced by run-through Speciality Training (ST) posts and hospitals losing autonomy of candidate selection in favour of a central recruitment process. At our hospital, a cohort of four Acute Care Common Stem (ACCS) and three anaesthesia STs replaced seven anaesthesia SHOs. All four ACCS trainees were anaesthesia novices. Rota restructuring to suit training demands of ACCS trainees resulted in creation of an Intensive Care Unit on-call tier jointly manned by ACCS and anaesthesia trainees. Service demands meant that staff grade anaesthetists replaced SHOs on general and obstetrics on-call rota. Retrospective data of anaesthesia administered for emergency procedures over an 18-month period, 9 months before and after the introduction of MMC in August 2007 was obtained and analysed from the operation theatre database. Statistical analysis was carried out using a chi-squared test and resulting p values were obtained. Introduction of MMC did not influence total number and case mix of emergency cases over this 18 month period. Our results show a significant difference (p < 0.0001) in distribution of emergency workload and a sharp decline in the number of cases performed by junior anaesthetic trainees (ST1–2). Number of emergency cases, case mix and workload of anaesthetists before and after implementation of MMC is shown in Table 1. Introduction of specialist training reduced the number of experienced anaesthetic trainees and resulted in an increase in out-of-hours workload for consultant anaesthetists. The average number of cases performed by junior anaesthetic trainees over 9 months decreased from 216 pre-MMC to 113 post-MMC. Post-MMC, almost 50% of on-call cases were performed by staff grade anaesthetists. We were unable to allocate inexperienced anaesthesia and medical trainees positions on theatre and on-call rota. Staff grade anaesthetists replaced SHOs and rota restructuring meant that anaesthesia training opportunities formerly utilised by SHOs were lost to staff grade anaesthetists. This explains the decline in number of anaesthetics administered by STs as compared to SHOs. The New Deal and European Working Time Directive has reduced availability of junior doctors [1, 2]. Implementation of the 48-h working week in August 2009 may diminish experience even further. A reduction in volume of cases performed by trainees may have to be compensated for by improving the quality of training. Other Trusts in the country may face similar challenges with limited training hours and diminishing trainee experience. Modular training in obstetrics, airway, trauma and other cases within the scope of a district general hospital case mix may be an acceptable solution to this problem.