Specialist Registrars Research Articles

The good doctor - strong and persevering.

In today’s society, doctors are confronted with a number of opposing interests, from other colleagues, patients and employers. The development and regulation of the medical profession have been widely studied. However, less research has been devoted to the doctors’ own perception of what it means to be a good doctor. We conducted eight focus-group interviews and three individual interviews among senior consultants and specialty registrars in the areas of surgery, psychiatry and internal medicine in two different hospitals. Total N = 48, of which 56 % were women. The interviews were analysed with the aid of systematic text condensation. «Professional dedication» demonstrated through «a high degree of attendance in the workplace» and «a high work capacity» were key topics for good doctors. Having a «high work capacity» was defined as being willing to go to great lengths, work overtime and work effectively. The senior consultants perceived their job as doctors more as a «lifestyle», while the specialty registrars more frequently regarded their work as a «job». Norwegian hospital doctors wish to appear dedicated to their profession. They can demonstrate this by showing great willingness to work intensively and effectively with patients, while also going to great lengths to be available beyond normal working hours.

The hospital doctor of today - still continuously on duty.

Norwegian hospital doctors emphasise the value of working hard and efficiently and of a high degree of attendance in the workplace. This helps establish social norms that guide behaviour within the professional culture. It is important to examine what consequences these values may entail when the doctor also needs to cater to his or her own needs. We conducted eight focus-group interviews and three individual interviews among a total of 48 senior consultants and specialty registrars working in the areas of surgery, psychiatry and internal medicine. Total N = 48; 56 % women. The interviews were analysed with the aid of systematic text condensation. When Norwegian hospital doctors wish to appear as good doctors, they see that this entails consequences for the interrelationships with colleagues, the management and the work-life balance. Conflicts of interest arose between senior consultants and specialty registrars. Management initiatives to deal with absence, adaptation of the job to the life stage of each individual doctor and increased management involvement among doctors were among the measures proposed. Better mutual knowledge between doctors and management with regard to each other’s values and responsibilities could constitute key premises for structural changes, for example in terms of better planning of leaves of absence and opportunities for adaptation of work schedules to the life stage of the persons concerned.

Perceptions of mono-specialty examinations in restorative dentistry training pathways

Specialty registrar training in restorative dentistry is intended to develop mono-specialty knowledge and clinical competence to ensure optimal treatment outcomes and improved quality of life in complex cases. There have been a number of changes to the training programme in recent years, with the introduction of structured curricula and increased emphasis on learning outcomes, assessed via mono-specialty examinations (MSEs). However, the views of trainers and trainees on these changes, the relevance of MSEs to training and their impact on development and future employment prospects are not clear.

Open Carpal Tunnel Decompression by Specialist versus Nurse Practitioner

To compare the outcome after open carpal tunnel decompression by specialists versus a nurse practitioner. Of 1361 cases of open carpel tunnel decompression under local anaesthesia from 1996 to 2008, 807 were performed by specialists (consultant, specialist registrar, or specialty and associate specialist) and 554 by a nurse practitioner (since May 2006). The 2 groups were compared in terms of surgical time, total theatre time, postoperative pain, and patient satisfaction with the service. The mean surgical time was shorter in cases performed by specialists (13 vs. 18 minutes, p<0.0001), as was the mean total theatre time (26 vs. 29 minutes, p=0.0154). The rate of postoperative pain was higher in cases performed by specialists (31.5% vs. 24.5%, p=0.0125), as was the rate of patient dissatisfaction (1.6% vs. 0.18%, 0.0113). Nonetheless, since May 2006, outcome was comparable for specialists and the nurse practitioner. This could be due to the change from short-acting to long-acting/mixed local anaesthetic, and the technique for infiltration. The waiting time for surgery reduced from a mean of 16 to 3 weeks. Specialists and the nurse practitioner achieved comparable outcome after open carpal tunnel decompression.

Re: A validation study on the use of intra‐operative video recording as an objective assessment tool for core ENT surgery

Objectives To investigate the reliability and validity of remote scoring a video assessment of a core ENT surgical procedure (myringotomy and grommet insertion) and its suitability as an objective tool for assessing the technical skills of ENT surgeons. Design Single-blinded (raters) video assessment. Setting Tertiary Care University Hospital. Participants Consultant and trainee [Specialty Registrar (StR) and Core Trainee (CT)] ENT surgeons performing a total of 30 consecutive index procedures. Main outcome measures To determine the construct validity and the reliability of video assessment scoring of myringotomy and grommet insertion by two raters at ENT Consultant level with a subspecialty interest in Otology. To measure the performance (by rating) of participants compared to operative time. Results A strong correlation between scores by the two blinded raters was demonstrated (ρ = 0.748; P < 0.001). Median scores (/45) for each group were as follows: CT 25.5 (IQR 21.13–31.25), StR 33 (IQR 24.88–35) and Consultant 40 (IQR 35.38–42.63). Kruskal–Wallis test analysis showed statistically significant mean rank scores between the three different levels of experience (H = 12.77, P = 0.002). Multiple group comparisons indicated a significant difference between CT and Consultant groups (P < 0.001) and StR and Consultant groups (P = 0.007). Analysis of the time taken between the experience groups demonstrated a difference (H = 8.689, P = 0.013) although individual intergroup comparisons indicated this was only significant between CT and Consultant groups (P = 0.004). There was a significant negative correlation (ρ = −0.842; P < 0.001) between time taken for procedure and score achieved. Conclusions Video assessment of myringotomy and ventilation tube insertion may represent a valid, feasible tool for use in summative and formative assessments of trainee ENT surgeons. Remote scoring of assessment procedures minimises bias and enables blinding of raters. ENT is well positioned to benefit from video assessment due to the high number of surgical procedures within the specialty that are performed utilising digital technology.

The prevalence of multimorbidity in an older acute general surgical population

The prevalence of multimorbidity in an older acute general surgical population

Trainers' and trainees' perceptions of workplace-based assessment in orthodontics

To explore trainers' and trainees' perceptions and experiences of Workplace-Based Assessments (WBAs) in Orthodontic Speciality Registrar (StR) training in England. Cross-sectional questionnaire survey. UK. Orthodontic StRs who had started their training in 2011-2012 and their trainers. Participants completed an anonymous on-line questionnaire in July-August 2013.Statistical analysis included descriptive statistics and frequency distributions. The questionnaire was completed by 42% (76/180) of trainers and 62% (46/74) of trainees. Half of the trainers spent 0.25 programmed activity (PA) per month undertaking WBAs. However, 88% of trainers had no PAs in their job plan for WBAs. The majority (53/66, 80%) of trainers undertook up to half of the WBAs in their SPAs. The trainers undertook a median of 5.5 (Interquartile range = 4) WBAs per trainee per year. Trainees spent an average of an hour per month undertaking WBAs. The mean number of completed WBAs per year was 12 (SD 4.2; 95%CI 10.7, 13.7) and mode was 10 WBAs. Almost all trainees, (33/34) had more than 80% of their WBAs undertaken by Consultants. There was no statistically significant difference in trainers' and trainees' perception of the WBAs, and were accepted by both the trainers and trainees. Trainers and trainees spent about 1 hour per month undertaking WBAs. The majority of trainers undertook the WBAs in their SPA time. Trainees appeared to be undertaking the recommended number of WBAs.

Survey of genitourinary medicine specialist registrars in the United Kingdom regarding genital dermatology training.

The British Association for Sexual Health and HIV Genital Dermatology Special Interest Group (SIG) conducted a survey of specialist registrar training in genital dermatology (GD) to inform future training provision provided by the group and other services. The survey shows that training in GD is variable with most trainees receiving GD training through formal lectures or ad hoc clinical teaching, with fewer trainees having access to specialist GD clinics. There is mixed confidence in diagnosis and use of topical steroids, and few trainees are independent in GD practical procedures. Many trainees feel training could be improved with requests for a formalised attachment, formal qualification and greater training in practical procedures. The GD SIG, in liaison with British Association for Sexual Health and HIV (BASHH), aims to optimise GD training for registrars. Plans for improved resources are in progress, including a practical skills course and e-learning. It is hoped this survey will also inform GD training at both local and national levels.

Occupational lung disease survey of respiratory physicians in Northern Ireland.

Respiratory physicians are likely to encounter occupational lung disease (OLD) in their daily practice. To assess the profile of cases being encountered by general respiratory physicians in Northern Ireland (NI) and determine satisfaction with training, confidence in diagnosis and management of OLD. An online survey of all consultant respiratory physicians currently practising in NI. Questions assessed the numbers of new cases seen over the preceding year, case type, satisfaction with specialist registrar training in OLD and degree of confidence in the diagnosis and management of these conditions. Of the 40 consultants identified, the response rate was 80% (n = 32) with 94% of respondents (n = 30) indicating they had dealt with patients suspected of having occupation-related respiratory symptoms. The most commonly encountered OLDs were pleural plaques (91% of respondents), occupational asthma (88%), asbestosis (84%), non-asbestosis pulmonary fibrosis (76%), hypersensitivity pneumonitis (67%) and mesothelioma (66%). Just over one third of consultants (36%, n = 10) indicated a lack of confidence in diagnosis and management of OLD with almost half (48%) dissatisfied with OLD training as a registrar and a further 78% (n = 25) indicating they would value additional training in OLD as a consultant. The majority of respiratory consultants in NI encountered OLD in their day to day practice and half were dissatisfied with their specialist registrar training in OLD and express a lack of confidence in the diagnosis and management of these conditions. This highlights the need for additional training at both registrar and consultant level.

Policy-driven practice: help or hindrance to medical training?

The Clinical TeacherVolume 13, Issue 6 p. 445-447 Insights Policy-driven practice: help or hindrance to medical training? Farshad Shaddel, Corresponding Author Farshad Shaddel [email protected] Learning Disability, Southern Health NHS Foundation Trust, Oxford, UKCorresponding author's contact details: Farshad Shaddel, Psychiatry Specialist Registrar, Senior Fellow of the Higher Education Academy and Medical Education Fellow, Oxford School of Psychiatry, Slade House, Oxford, OX3 7JH, UK. E-mail: [email protected]Search for more papers by this authorSubimal Banerjee, Subimal Banerjee Learning Disability, Southern Health NHS Foundation Trust, Oxford, UKSearch for more papers by this authorDenis O'Leary, Denis O'Leary Health Education Thames Valley, Oxford, UKSearch for more papers by this author Farshad Shaddel, Corresponding Author Farshad Shaddel [email protected] Learning Disability, Southern Health NHS Foundation Trust, Oxford, UKCorresponding author's contact details: Farshad Shaddel, Psychiatry Specialist Registrar, Senior Fellow of the Higher Education Academy and Medical Education Fellow, Oxford School of Psychiatry, Slade House, Oxford, OX3 7JH, UK. E-mail: [email protected]Search for more papers by this authorSubimal Banerjee, Subimal Banerjee Learning Disability, Southern Health NHS Foundation Trust, Oxford, UKSearch for more papers by this authorDenis O'Leary, Denis O'Leary Health Education Thames Valley, Oxford, UKSearch for more papers by this author First published: 16 July 2015 https://doi.org/10.1111/tct.12431 Funding: None. Conflict of interest: None. Acknowledgements: None. Ethical approval: Not required. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume13, Issue6December 2016Pages 445-447 RelatedInformation

Lung Cancer

Mariam Jamal-Hanjani Mariam Jamal-Hanjani is a Specialist Registrar in Medical Oncology. She studied physics and then medicine at University College London (UCL), and is currently pursuing her PhD in non-small-cell lung cancer tumor evolution and intratumor heterogeneity at the Cancer Research UK Lung Cancer Centre of Excellence, UCL Cancer Institute.

Educational Supervision in Public Health Specialty Training: Through the eyes of specialty registrars.

Educational Supervision in Public Health Specialty Training: Through the eyes of specialty registrars.

PTU-025 How accurately is rockall score calculated for patients with acute upper gastrointestinal bleeding (AUGIB)?

Introduction Documentation of Rockall score (RS) in patients with AUGIB should be accurate in order to prioritise patients for gastroscopy. We conducted a pilot study in 2012 which showed that RS was calculated incorrectly in 46% patients. We investigated this further with a larger cohort of patients. Method Information was collected retrospectively on patients who presented with presented with AUGIB from February 2012 to February 2013. Patients who had out-of-hours gastroscopy excluded. Demographics, time to perform gastroscopy, RS documented by the doctor requesting the gastroscopy, RS calculated by analysing patient records (including A&E, paramedic records) were collected. We analysed patients whose RS was either underscored or overscored by the requesting doctor (this was compared to the actual score calculated by us) and correlated the calculated RS with the need for endoscopic intervention. Results There were 248 patients with 149 (60%) males, age 16 to 98 years (mean 69). Presenting symptoms were melaena in 129 (51%), haemetemesis 35 (14%), coffee ground vomiting 64 (25%), rectal bleed 17 (7%), melaena and haematemesis 4. RS was calculated incorrectly in 194 (78%) patients with 110 (44%) over scored (Group A), 84 (34%) underscored (Group B). Mean RS on request form for Group A patients was 3.64 ± 1.97 while the calculated RS was 1.85 ± 1.61. In Group B, mean RS documented was 1.8 ± 0.96 while the calculated RS was 3.9 ± 1.04. Mean time from electronic booking to gastroscopy was 2.02 days – 1.67 days for Group A and 2.04 days in Group B. FY1s calculated incorrect scores in 83 (43%) patients, FY2s in 20 (10%), SHOs in 81 (42%), registrars in 7 (4%) and consultants 3 (2%). Of the 111 FY1s (45%) who calculated the RS, 46 (41%) overscored, 37 (33%) underscored and 28 (25%) calculated RS correctly. The numbers for 27 FY2 (11%) were 11 (41%), 9 (33%) and 7 (26%) respectively. Of the 95 (38%) SHOs, 47 (50%) overscored, 34 (36%) underscored and 14 (15%) calculated RS correctly. There were 11 specialist registrars (4 correct, 4 overscored and 3 underscored) and 4 Consultant request forms (3 incorrect). Of the 248 patients, 37 (15%) required endoscopic intervention. In Group A, 16 (15%) needed endoscopic intervention, compared to 11 (13%) in Group B. Ten (19%) of the 54 patients scored correctly required endoscopic therapy. Conclusion This study shows that it is important to document the RS at the time of first presentation of AUGIB rather than at the time when the patient is seen by the admitting doctor. This study however does not show a direct correlation between the RS and endoscopic intervention. It emphasises the fact that all doctors should be educated about the importance of documenting the correct RS as more than three quarter of the RS on request forms were found to be inaccurate. Disclosure of interest None Declared.

P191 Survey of genital dermatology training amongst genitourinary medicine (GUM) specialist registrars

Introduction There has been no recent review of genital dermatology (GD) training for GUM trainees. The 2010 GUM specialist registrar curriculum states specific learning objectives that trainees should meet by CCT. Aim In order to evaluate and improve training, the BASHH GD Special Interest Group (SIG) conducted an online survey to assess specialist registrar training in GD. Methods The survey was designed through Survey Monkey and cascaded to trainees across the UK in 2014. Results 42 trainees responded, representing several deaneries (50% London) and grades. 68% of trainees receive GD training through adhoc clinical teaching; 85% through formal lectures. 26%, 32%, 37% have attended specialist GD clincs by gynaecologist, GUM physician, dermatologist respectively. Mean confidence in managing specific conditions varied from 5 (vulval pain syndromes) to 7.5 (fungal infections) (1–10 confidence scale). 47% were ≥7/10 confident in topical steriod use (1–10 confidence scale). Independently able to perform procedures: 21% punch biopsies, 63% fungal scrapings, 15% curettage. 50% of trainees are satisfied with GD training with 69% feeling they will be adequately trained by CCT. 58% would like a formal qualification in GD to be available. Discussion Training in GD is variable with mixed confidence in diagnosis, treatment and practical procedures. Many trainees feel training could be improved with requests for a formalised attachment, formal qualification and greater training in practical procedures. The BASHH GD SIG, in liaison with BASHH, aims to optimise GD training for registrars. Plans for improved resources are in progress, including a practical skills course and e-learning.

Paediatric Surgery (2nd edn).

This is the second edition of a well-respected and popular textbook. The editors establish their primary aim in the preface – to provide trainees in paediatric surgery with a textbook that will cover their requirements for both training and preparation for specialist examinations such as the UK intercollegiate and Australasian fellowships. This aim is achieved. The opening section deals with ‘General Principles of Care’, ranging from chapters on the congenital causes of disease, general basic sciences and related specialties such as paediatric anaesthesia and radiology. In addition, this section covers increasingly important contemporary topics including the ‘Child and Law’, and ‘Communication Skills’. Thereafter, the breakdown follows the standard subspecialty areas of paediatric surgery but the book also very wisely includes a section on the ‘General Surgery of Infancy and Childhood’, which will immediately broaden this book's appeal to the general surgeon who operates on children and to the many other professionals involved in the care of children with surgical conditions. Reflecting the target audience's requirements, each chapter is prefaced with learning objectives. The basic sciences relevant to the clinical subject are included and most chapters finish with clinical scenarios. While these features are to be highly commended, the clinical scenarios, in particular, might be usefully extended into clinical management algorithms, which would enable senior trainees to develop the powers of higher order thinking that are key to success in the modern style ‘exit’ FRCS examination. Criticisms are few. The colour plates are grouped together in the centre of the book, no doubt in an effort to contain costs. However, this does reduce their pertinence to the related text. In addition, the spectrum of illustrations seemed slightly disparate, including a page devoted to the stages of healing burns, which in most centres are the responsibility of plastic rather than paediatric surgeons. A reasonably comprehensive appraisal of the recent literature is not included in many chapters and longer reference lists would be helpful. The index appears comprehensive but some anomalies are present. For instance, cystic hygroma (lymphangioma) is included in two separate sections, which take diametrically opposed approaches to the treatment of these rare tumours. Furthermore, one of the sections is not even indexed. In a slightly similar vein, my specialist registrar who co-wrote the excellent chapter on congenital diaphragmatic hernia was delighted to discover that she had suddenly received a chair! These relatively minor quibbles aside, this book can be highly recommended for the target audience and others such as the general surgeon who operates on children, paediatricians and other healthcare professionals involved in the care of children with surgical conditions.

Top Knife: The Art and Craft of Trauma Surgery

This book is written by two trauma surgeons from the Ben Taub General Hospital in Houston, Texas. Between them, they clearly have many years of experience in the management of trauma victims. The book is concise, well written and very easy to read. The text is also well supported by frequent good-quality illustrations. The book is divided into four sections. Section 1 is essentially an introduction and sections II, III and IV deal with trauma to the abdomen, the chest, and neck and extremities, respectively. The important principle of damage limitation in trauma surgery is emphasised throughout the book and the authors have succeeded in conveying the potential pitfalls in relation to particular trauma operations. A useful summary of key points is also given at the end of each chapter. The principles of trauma surgery are clearly set out with an emphasis on decision making in particular scenarios. A practical summary of the salient points of the operative technique are given, rather than a detailed description such as that provided by a standard operative textbook. The book also does not discuss the non-operative management of trauma or pre- and postoperative care. In addition, there are no references to key research papers to support the text. These factors limit the usefulness of the book in the preparation for examinations but, despite that, it does represent a useful practical guide to dealing with general surgical trauma on a day-to-day basis. My biggest criticism is the lack of an index, which I found quite irritating when one wishes to look up a specific scenario. This book would be invaluable to general surgical trainees, in particular specialist registrars in general surgery who, with changes in surgical training, are likely to have increasingly limited opportunity to become confident in the operative management of trauma. I would also recommend it to all basic surgical trainees involved in the care of trauma patients.

Are respiratory specialist registrars trained to teach?

Respiratory SpRs are interested in medical education but rarely observed when teaching and receive little feedback http://ow.ly/Our0m

The use of the “Objective Structured Assessment of Technical Skills” as an Assessment Tool Among Danish Vascular Surgeons in Training

The concept of the Objective Structured Assessment of Technical Skills (OSATS) is to quantify surgical skills in an objective way and, thereby, produce an additional procedure-specific assessment tool. Since 2005, a 2-day practical course for upcoming specialist registrars in vascular surgery has been obligatory. The aim of this study is to describe the results from a tailored OSATS test as a tool for the evaluation of practical skills during an intensive training session in a simple simulator box for vascular anastomoses. Between 2005 and 2013, we registered the OSATS scores of all course participants. The following data were collected from the questionnaires: years as a candidate, months in vascular surgery or in another type of surgery, and the number of vascular anastomoses performed before the course. The assessment of surgical skills was conducted with an OSATS score template specifically made for this purpose. It consists of a 12-item table with a 5-point grading scale. OSATS score (points) and time for the procedure (OSATS time in min) were registered at baseline (OSATS I) and at the end of the course (OSATS II). OSATS scores were given in both OSATS I and OSATS II for the 83 trainees, and the mean difference was 8.1 points (95% CI: 6.7; 9.5, p < 0.001). OSATS time was given for 69 trainees, and the mean difference was 2.8 minutes (95% CI: 1.4; 4.2, p < 0.001). We found no relationship between years since graduation, months in any surgical specialty, or the experience with vascular anastomoses and outcomes. OSATS is a valuable tool for evaluating the advancement of technical skills during an intensive practical course in performing vascular anastomoses.

Survey of UK Health Care First Responders' Knowledge of Personal Protective Equipment Requirements.

An adequate level of personal protective equipment (PPE) is necessary when treating patients with highly infectious diseases or those contaminated with hazardous substances. Following National Institute for Health Research's Research Centre (London, United Kingdom) approval, the authors of this study conducted a survey of specialist registrars' knowledge of the respiratory and skin protection requirements needed during a resuscitation scenario with Advanced Life Support. Participant responses were compared to UK national recommendations and to a previous survey in 2009. A total of 98 specialist registrars (in Anesthesiology, n=51; in Emergency Medicine (EM), n=21; and in Intensive Care Medicine (ICM) n=26) completed hand-delivered surveys. The best knowledge of PPE requirements (76%) was found for severe acute respiratory syndrome (SARS), with less knowledge about PPE requirements for anthrax, plague, Ebola virus disease (EVD), and smallpox (60%). The results show limited knowledge of PPE requirements (20%-30%) for various chemical warfare agents. Personal protective equipment knowledge regarding treatment of sarin-contaminated casualties was over-rated by 80%, and for patients with EVD, it was over-rated by up to 67% of participants. The results of the tested cohort indicate that current knowledge regarding PPE for chemical warfare agents remains very limited.

G285 Paediatric preparation day: smoothing the transition for yorkshire and the humber foundation and gp trainees

Background Delivery of safe, high quality healthcare relies upon adequate training and education. 1 Concern exists regarding the preparedness of junior doctors for their expected clinical roles despite Tomorrow’s Doctors and the implementation of the Foundation Programme. 2,3 Foundation and General Practice (GP) trainees rotate through secondary care paediatric rotations expected to perform clinical skills. Yet, the vast majority will have very limited practical paediatric experience. As traditional teaching methods including ‘see one, do one, teach one’ become increasingly unacceptable, simulation-based medical education (SBME) is being advocated to provide opportunities for deliberate practice and avoidance of patient harm. 4 Internationally, paediatric bootcamps are starting to emerge. However, both regionally and nationally, bespoke opportunities for Foundation and GP trainees to develop practical paediatric skills prior to paediatric rotations are lacking. Methods A one-day regional paediatric and neonatal skills course was developed and piloted for Foundation and GP trainees rotating into secondary care paediatrics. This provided trainees with the opportunity to observe and practice fundamental procedural and resuscitation skills on part-task trainers and low-fidelity manikins under the supervision of senior paediatric trainees. Course evaluation was achieved through a comparative pre and post-test design using confidence levels and a bespoke MCQ to assess knowledge acquisition for qualitative and quantitative data respectively. Observation/Evaluation 58 doctors attended four pilot courses. Complete pre and post-course comparison data was achieved from 57 trainees. The mean MCQ score rose from 60.7% (95% confidence interval, 58.5% to 62.9%) to 83.9% (82.4% to 85.3%), p Conclusion This simple intervention is a feasible way to support Foundation and GP trainees ahead of paediatric rotations. This should facilitate a smoother transition into their clinical roles, when complemented with departmental induction programmes. The opportunity to practice skills in a safe environment without the risk of patient harm is highly desirable in modern healthcare. We hope that our bespoke Paediatric Preparation Day course will be adopted to enhance future trainee and patient safety. References Department of Health. Delivering high quality, effective, compassionate care: Developing the right people with the right skills and the right values. A mandate from the Government to Health Education England: April 2014 to March 2015 Brennan N, Corrigan O, Allard J, et al . The transition from medical student to junior doctor: today’s experiences of Tomorrow’s Doctors. Med Educ. 2010; 44:449–458 Matheson C, Matheson D. How well prepared are medical students for their first year as doctors? The views of consultants and specialist registrars in two teaching hospitals. Postgrad Med J. 2009; 85:582–589 Aggarwal R, Mytton OT, Derbrew M, et al . Training and simulation for patient safety. Qual Saf Health Care 2010; 19(Suppl 2):i34–i43