Teaching clinical skills to preregistration house officers

Abstract

We agree with Goodfellow and Claydon (October 2001 JRSM1) that the training of final-year medical students and preregistration house officers (PRHOs) in clinical skills can be improved. Better use can be made of the induction programme for PRHOs to include training in clinical skills, particularly as there is a substantial gap between MB BS final examinations and the start of the first house job. This year, our induction programme at Barts and The London NHS Trust was extended to 2 days and the structure was changed. The purpose of this was threefold—foremost, to enable the new PRHOs to spend more time on the wards with the outgoing house officers; secondly, the number of talks was reduced to those deemed essential, to prevent information overload, and a less formal approach of ‘stands’ for other information was adopted; finally, the increased length of the induction allowed us to include small-group ‘hands-on’ training in cardiopulmonary resuscitation and also training in the patient database system. We would like to expand on clinical skills for the new PRHO induction in August 2002 to include urinary catheterization, venepuncture, intravenous cannulation, arterial blood sampling and electrocardiography interpretation, using the facilities of a clinical skills laboratory. Training in needle-stick injury should be included either in induction or early in the weekly teaching sessions for PRHOs. Post-induction, we have used our Simulation Centre to train PRHOs in management of acute emergencies in respiratory medicine and cardiology, and this year two more sessions have been added in head injury and diabetic emergencies. Extending induction to more than 2 days may pose logistical difficulties—e.g. payment for PRHOs, and accommodation. Since the starting day is always a Tuesday, greater than 2 days is not feasible.