Junior House Officer Research Articles

Ian James Burns

Ian James Burns was born in Glasgow to parents James Aloysius Burns and Mabel Thomson Dick of Rutherglen. He attended Burnside Primary School and St Aloysius College, Glasgow, before gaining...

Peter J B Hubner

Peter Hubner was born in London in 1942, the third son of a Czech antiques dealer who emigrated to England after the first world war. Peter developed an interest in...

Maurice William Beaver

Maurice William Beaver was brought up in London and Cornwall during the second world war and was educated at Ilford County High School for Boys. In 1949 he went to...

Was there ever a golden age for junior doctors?

As junior doctors prepare for a new contract after fighting the government’s attempt to make them work more unsociable hours without extra pay, Caroline White asked seven doctors how the...

Nur Fiona Önen Albring

Nur Fiona Onen Albring was born in Izmir, Turkey, with her identical twin sister on 17 December 1975. They were the much loved daughters of a Scottish mother and Turkish...

The Most Isolated City in the World - An Elective Spent in Critical Care at the Royal Perth Hospital, Western Australia

Going into my elective period I had a number of aims and objectives. As this was my last rotation as an undergraduate I felt it was important to complete my elective in an environment that would allow me to practice the clinical skills and knowledge that I have developed during the last 5 years. I saw this as an opportunity to prepare myself for my practice as a Junior House Officer and to experience healthcare delivery in a different setting. I also felt that as I entered my elective at the end of my undergraduate studies I would have a lot to offer to the teams working in the hospital I went to.

Handover in Trauma and Orthopaedic Surgery - A Human Factors Assessment.

Handovers permeate healthcare delivery systems. They are critical for patient safety and continuity of care, but also for logistics and clinical efficiency. Poor handovers can cause reduced efficiency, delayed discharge or time to operation, and contributes to patient harm.The Objective was to conduct a human factors assessment (HFA) using a systems approach to study the handover process at an Orthopaedic unit, determine barriers to information transfer, and suggest improvements.A direct observation model was used to help provide insights on the evening handover process. A Systems Engineering Initiative for Patient Safety (SEIPS) model was used to provide a framework. A total of ten handover sessions were observed and the junior doctors were interviewed using a semi-structured approach.Participants had two chief centres of complaint: workspace and environmental issues (such as a small, hot, uncomfortable room), and the lack of the junior house officer at handover leading to ‘signal loss’ with respect to sick patients who may not be handed over fully. The process also lacked standardisation and structure compounding the potential loss of information.ConclusionGood handover remains a cornerstone of safe and effective clinical practice and continuity of care. This study has shown how an HFA can be useful in determining problems with the handover process locally. It suggests an approach for improvement and recommends better training at all levels in this aspect of patient care.

Language Traps

My first paediatric job in the UK was a locum junior house officer in 1975. It was at Northwick Park Hospital on the outskirts of London adjacent to the Borough of Harrow, for which the school of that name is an icon. Free access to the school's old squash courts was a much appreciated privilege bestowed upon junior staff at the hospital. The hospital itself was a burgeoning hive of academic and clinical expertise, which included the Department of Paediatrics. I was challenged by an admission in my first week on duty. An 11-month-old girl of Pakistani ethnic origin presented with a febrile convulsion. Investigations revealed hypocalcaemia. My examination identified short stature and, with some biochemical clues, clinical evidence of infantile rickets. I found the extraction of an accurate dietary history difficult because of language problems. As best as I could ascertain, the child had been fed on goat's milk. With some excitement but uncertainty, I conveyed my findings to the senior registrar. This happened to be Harvey Marcovitch, who has enjoyed an illustrious career in paediatrics and journalism, culminating in becoming editor-in-chief of Archives of Diseases of Childhood. Uncertain of the implications, Harvey pursued this to identify whether goat's milk was likely to be deficient in vitamin D. His enthusiastic search took him to the research centre of the hospital to which there was an attached veterinary section. After some hours of fruitless research, he returned to the parents to take his own history and conduct his own examination. He did not identify any dietary indiscretions. With some cynical and disparaging comments regarding ignorant Aussies who have lost touch with the Queen's English, he informed me that the child had never been on goat's milk. In fact, she had been on a very orthodox brand of formula, well known in the UK but not so well known in the Antipodes, called ‘Cow and Gate’.

The problem with doctors

I'm a rather neurotic and distressed surgical trainee almost half way through a self constructed basic surgical training. I wasn't always like this. In fact, when I was at medical school in Aberdeen I felt quite competent and enthused with where I was going in medicine. I was going to be a surgeon. Getting there was easy I thought: junior house officer, senior house officer, registrar for five years, and then bingo, I would be my own boss. Lovely—a nice secure career. At university, no one wanted to explain in much detail—or perhaps we didn't want to listen, I'm not too sure. As junior house officers we were more concerned with having to spend a full day at work actually doing things and working out how we were going to spend all our new found wealth in the three days off we had every three weeks. I thought in the “there and now,” never thinking beyond the next six month job. It all hit me when I started my first senior house officer job. It was as though reality had come up behind me …

Clinical Intensive Care and Acute Medicine, 2nd Edition.

University of Virginia Health System, Charlottesville, Virginia. en3x@virginia.eduClinical Intensive Care and Acute Medicine, 2nd Edition. By Ken Hillman and Gillian Bishop. Cambridge, U.K., Cambridge University Press, 2004. Pages: 685. Price: $80.00.Clinical Intensive Care and Acute Medicine is intended as a handbook or minitextbook for residents and serious medical students rotating through the intensive care unit (ICU). As such, it joins a relatively “crowded” field filled with numerous manuals, guides, and pocket references. Despite this fact, the authors succeed in making the book both relevant and unique.As with many books about ICU care, the book begins with several chapters dedicated to general patient treatment, discussing principles common to all patients in the ICU. Issues including cardiopulmonary resuscitation, fluid management, nutrition, and sedation are discussed in detail. The remainder of the book is dedicated to discussion of specific disease processes. In addition, the book also includes several unique chapters aimed at providing young physicians with information that might otherwise be difficult to find in a single source. For example, the book includes an entire chapter dedicated to the interpretation of the portable chest film. Indeed, there are few things as beguiling to the junior house officer as incorporating data from a chest film into a plan when a patient is rapidly deteriorating (often, in the early morning). The book provides a step-by-step guide for general interpretation before discussing specific disease processes, such as the interpretation in patients with blunt chest trauma.The relative conversational tone of the book provides for easy and interesting reading. Each chapter begins with several bulleted points that emphasize the key aspects of each subject. Every chapter ends with a short bibliography that refers the reader to more detailed information on each topic. The book includes several “troubleshooting” sections designed to provide on-call physicians with ready, bulleted advice regarding commonly encountered problems. In addition to the somewhat routine subjects common to many handbooks such as “arterial blood gas tricks” or “hypoxia: where to go when the patient is already on 100% oxygen,” the authors also include a discussion of unique topics. This is the only book that includes a discussion of the transportation of ICU patients around the hospital. In addition, I was particularly fond of the tips regarding assessment of patients by telephone. A discussion designed to help on-call residents to manage ICU transfers and referring physicians is absent from most textbooks. Many chapters include mnemonics that help to remind young physicians of important principles.Nevertheless, some of the specific information, especially regarding infection pharmacotherapy, is somewhat out-of-date. For example, the authors suggest benzylpenicillin as first-line treatment of community-acquired pneumococcal pneumonia. This approach is inconsistent with guidelines published by the American Thoracic Society (New York, New York), the British Thoracic Society (London, United Kingdom), and the Infectious Diseases Society of America (Alexandria, Virginia). In addition, the authors should have included a chapter regarding the care of victims of bioterrorism. Although I hope for such information never to be necessary, it should probably be included in any current text.Despite these few problems, I believe this is an excellent book. I am certain that its practical approach to ICU care will be popular among medical students and residents rotating through the ICU.University of Virginia Health System, Charlottesville, Virginia. en3x@virginia.edu

I want to start work in the United Kingdom as a junior house officer after I've finished my education in 18 months' time. What extra efforts should I make in order to secure a job?

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Uncertainty

Everything pointed to the same diagnosis: an ectopic pregnancy. Nonetheless, I was nervous making the diagnosis by myself. I was a very junior house officer in obstetrics and gynaecology, alone on call at a municipal hospital. My patient had an abnormal last menses about 8 weeks ago, no recent use of contraception, and vague pelvic pain. Her pulse and blood pressure were normal without orthostatic changes. She looked uncomfortable but not in acute distress. Her abdomen was tender, and the pelvic examination caused her discomfort, more on one side than the other. I could feel no adnexal mass, but my clinical experience was very limited. Her haemoglobin was around 110 g/L; not unusual for our indigent patients.

Do junior house officers routinely test visual acuity and perform ophthalmoscopy?

Our objective was to assess junior house officer (JHO) practice of visual acuity testing and ophthalmoscopy in clerking patients. Cross-sectional questionnaire-based study using a standardised structured interview technique. A Scottish university teaching hospital employing 65 JHOs. All medical and surgical JHOs from this hospital were interviewed over a three month period. Questionnaire-based data on the subjective responses studying current practice of visual acuity testing, and direct ophthalmoscopy with and without topical mydriatics. 18.5% and 4.6% of participants perform daily ophthalmoscopy and visual acuity testing respectively. Most do not routinely use the Snellen chart (80.0%) or topical mydriatics during ophthalmoscopy (75.4%). JHOs claimed these were not easily available in the wards. The majority of JHOs fail to test visual acuity or perform ophthalmoscopy in clerking patients. This study highlights the poor availability of Snellen charts, functioning ophthalmoscopes, and topical mydriatics in the wards. This warrants further investigation.

Historical review. Inherited bone marrow failure: the men behind the empty space.

Historical review. Inherited bone marrow failure: the men behind the empty space.

Medical restrictions to driving: the awareness of patients and doctors

The study was set up to investigate the awareness of elderly patients and medical doctors of medical restrictions to driving. Separate questionnaires were completed by patients and doctors. All were...

Junior house officers one year on: Changes in psychological distress and error-making

The present study followed junior house officers from a study conducted by Houston and Allt (1997). Doctors were contacted at the end of the junior year and again eight weeks into the senior house officer year. Changes in psychological health and propensity to make errors were examined. It was predicted that there would be a significant decrease in psychological disturbance and error-making compared to that found at the beginning of the junior house officer year. Questionnaires were administered twice-at the end of the junior year (Time 3) and eight weeks into the beginning of a senior house officer post (Time 4). All participants completed the General Health Questionnaire, the Cognitive Failures Questionnaire and the Medical Errors Questionnaire at Times 3 and 4. The levels of anxiety, insomnia and somatic symptoms found by Houston and Allt (1997) persisted into the senior house officer year. However, there were significant decreases in errors made in medical work and in everyday life. It is concluded that newly qualified doctors continue to experience considerable amounts of emotional distress in their senior house officer post. There is some evidence that they may be finding ways to manage this level of stress, reflected by the decline in everyday and medical error-making.

Consent obtained by the junior house officer--is it informed?

Of 30 junior house officers questioned, 21 had obtained patients' consent for colonoscopy. Of these 21, about one-third did not routinely discuss with patients the risks of perforation and haemorrhage. Ideally, consent should be obtained by a person capable of performing the procedure. If it is to be obtained by junior house officers, they need to know exactly what must be disclosed about each procedure. This could easily be done as part of the induction package.

Psychological distress and error making among junior house officers

Objectives. The study examined the impact of beginning a junior house officer post on possible changes in psychological health and propensity to make errors. It was predicted that there would be a significant increase in psychological disturbance and error making following the onset of the post.Design. Questionnaires were administered at two times—prior to and eight weeks after the beginning of a junior house officer post.Methods. Thirty graduates of medicine/junior house officers were recruited from a university medical school in the UK. All participants completed the General Health Questionnaire and the Cognitive Failures Questionnaire at Times 1 and 2, as well as a Medical Errors Questionnaire at Time 2.Results. Significant increases were found in reported levels of anxiety, insomnia and somatic symptoms. There were also significant increases in the number of errors that the respondents reported making in everyday life. These everyday errors were significantly related to the reported frequency of errors made in a medical context.Conclusions. Despite recent revisions to the working hours and conditions of junior doctors in Britain, the respondents in this study were experiencing considerable increases in stressful symptoms and consequent increases in the number of errors they made. These findings suggest that further research and policy development is required to explore means of easing the transition to work for junior doctors.

The ICU Therapeutics Handbook

The ICU Therapeutics Handbook

Fear of death and strategies for coping with patient death among medical trainees

This paper describes a longitudinal study of fear of death following up fourth-year medical students in their junior house officer year. It confirms previous findings that the fear of death is and remains multidimensional, with fear of being dead having the lowest score on both occasions and fear of someone close dying being consistently the highest. Fear of death reduces on each dimension over time, though not significantly. An analysis of descriptions of strategies used by students to cope with patient death showed that passive acceptance through rationalizing was the most commonly used, especially by men, followed by supporting the patient emotionally or clinically, which was used especially by women. The highest fear and stress scores were associated with avoidance, dismissal and seeking advice, while the lowest were shown by those who rationalized the event. The paper goes on to describe the relationship of fear of death to various individual differences including empathy, gender, parental death, parental anxiety, and stress.