Pre-registration House Officer Training Research Articles

Pre-registration house officer training in psychiatry: the London experience

AIMS AND METHOD To evaluate whether new pre-registration house officer posts in psychiatry deliver training leading to increased confidence in target skills, based on General Medical Council requirements, and to evaluate trainees9 satisfaction with these posts. A structured questionnaire was filled out by the first nine incumbents of the PRHO posts before and after the placements. RESULTS Trainees9 confidence improved in all the target skills and the posts were all rated as good or excellent. The posts attracted trainees who were potentially interested in a career in psychiatry or general practice. CLINICAL IMPLICATIONS PRHO posts in psychiatry deliver training that meets General Medical Council objectives, and trainees9 confidence with core psychiatric skills improves after undertaking the placements.

Assessment of Psychometric Properties of a Modified PHEEM Questionnaire

An effective tool in analysing the learning environment, customised to the Sri Lankan setting, is vital for the assessment and delivery of quality healthcare training of preregistration house officers. Such a tool should be reliable and valid. We assessed psychometric properties such as internal reliability and construct validity of a modified version of the Postgraduate Hospital Educational Environment Measure (PHEEM). A modified PHEEM questionnaire customised to the Sri Lankan context was developed in accordance to the Sri Lanka Medical Council guidelines. The questionnaire was distributed to all interns at the National Hospital of Sri Lanka, Colombo North Teaching Hospital and Wathupitiwala Base Hospital during a calendar year (n = 100, response rate = 86%). Internal reliability and construct validity of the inventory were assessed by using Cronbach's alpha and exploratory factor analysis respectively as statistical methods. PHEEM consists of 3 subscales: perceptions of autonomy, social support and teaching, which are factors perceived to be influencing the educational environment. This administration demonstrated high internal reliability as reflected by a Cronbach's alpha value of 0.84. Exploratory factor analysis identified 12 factors with eigenvalue >1. However, the first factor had an eigenvalue of 6.7 (accounting for 19.7% of variance), while the rest had eigenvalues < 2.5. These results suggest a single predictive factor and thus a one-dimensional scale as opposed to the three-dimensional scale which is used in the current questionnaire. The psychometric properties of this tool reflect a high degree of internal reliability in assessing the educational environment of intern doctors in Sri Lanka. It is possible that the clinical educational environment is collectively represented as a single dimension. This may be due to the complex interplay between individual items in the questionnaire. Therefore the psychometric properties do not justify the interpretation of the educational environment through specified subscales.

Foundation training: first experiences

Foundation training is the first step in the delivery of Modernising Medical Careers. Significant changes are occuring in the first year of foundation compared with previous preregistration house officer training. Career planning, new academic programmes, changes in general practice and interprofessional learning are all areas of real change. Some trusts are also developing innovation and creativity in the way that the curriculum is being delivered.

Comparison of aspects of preregistration house officer training from traditional and new medical curricula

As medical graduates from the new (problem-based learning) curriculum at University of Liverpool undertook their first post in the postgraduate clinical setting, this study investigated whether their views of preregistration training in the Mersey Deanery differed from the last cohort of preregistration house officers who had graduated from the traditional lecture-based medical curriculum at University of Liverpool.

Flexible (part-time) preregistration house officer training: review of Thames and London deanery experiences

Flexible training has been in greatest demand at the specialist registrar grade, and to a lesser extent in the senior house officer grade. This article describes the experiences of a much smaller group, flexible preregistration house officers.

Pre-registration house officer training: a role for nurses in the new Foundation Programme?

To explore senior nurses' views of pre-registration house officer (PRHO) training, including the scope for their contribution to the new Foundation Programme. Data reported here are drawn from a larger, national project, which aimed to identify a curriculum for the PRHO year. The project was based in the Education Development Unit, Scottish Council for Postgraduate Medical and Dental Education (SCPMDE), Dundee. As part of the project, 40 semistructured interviews, each lasting about 1 hour, were held with senior nurses. Interviews were fully transcribed and coded in the qualitative software NVivo for further analysis. Codes were studied for emergent themes and categories. Senior nurses (10 from each of the 4 postgraduate regions of Scotland), from diverse specialties. Data suggest considerable cross- regional/specialty consistency. Key emergent themes concerned the process of training as much as the educational outcomes. The nurses focused on the development of outcomes such as communication and teamworking in addition to clinical and practical skills. They guided the PRHOs informally, but were concerned that their own extended roles were detracting from this. Nurses are gaining increasingly advanced professional, clinical and practical skills. Traditionally, experienced nurses guide and support PRHOs, at least informally. Data collected suggested there may be scope for capitalising on their expertise, including formalising aspects of their contribution to the proposed PRHO Foundation Programme. However, this is a potentially sensitive area and more interprofessional dialogue is needed.

Linking appraisal of PRHO professional competence of junior doctors to their education

In the UK, new medical graduates are known as Pre-registration House Officers (PRHOs). Postgraduate Deans are responsible for the PRHO year and for the final certification of PRHOs to allow them to be fully registered by the GMC as medical practitioners. However, as much as appraisal of professional growth is central to PRHO training, they are in need of a robust assessment mechanism to detect, at an early stage, individuals with significant clinical and professional deficiencies. Documented, reliable and valid ongoing information on PRHO performance will provide information for early intervention and will establish ‘hard’ observable evidence, for certification decisions. Thus, an approach that links appraisal/assessment of professionalism and clinical skills to education is the way forward. This paper describes a new approach to appraisal/assessment of PRHOs, which is currently being piloted in a number of regions in Scotland. The conceptual paradigm was developed during the last three years as a proposal for a Scottish national PRHO reform. ‘Grounded’ qualitative studies were employed to explore trainees’ and trainers’ perceptions of the expected competences (outcomes) of PRHO performance for appraisal/assessment purpose. The GMC recommendations are reviewed in light of the study results. An assessment model emerged that links appraisal to education. PRHOs’ cumulative performance is documented over one year of training resulting in diagnostic profiles that provide guidance for evaluation and training of PRHOs. Poor performers are flagged in the early stages of training, thus allowing early intervention. The feasibility and acceptance of the model by educators, the health system and PRHOs has yet to be established.

Pre-registration house officer training in psychiatry

I was struck by Rebecca Mason's claim ( Psychiatric Bulletin , October 2003, 27 , 394-395) that, in 1981, she was involved in one of the first pre-registration house officer posts in psychiatry in this country. In fact, in 1960, at the Sefton General Hospital in Liverpool, I held the post of pre-

Pre-registration house officer training in psychiatry

I was interested to read your article regarding pre-registration house officer training in psychiatry (Herzberg et al , May 2003, 27 , 192-194). I am also interested and glad to hear of your findings regarding trainees' improved confidence and target skills as well as high rates of satisfaction. In

Pre-registration house officer training in psychiatry

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Pre-registration house officer training in psychiatry: the London experience

Aims and MethodTo evaluate whether new pre-registration house officer posts in psychiatry deliver training leading to increased confidence in target skills, based on General Medical Council requirements, and to evaluate trainees' satisfaction with these posts. A structured questionnaire was filled out by the first nine incumbents of the PRHO posts before and after the placements.ResultsTrainees' confidence improved in all the target skills and the posts were all rated as good or excellent. The posts attracted trainees who were potentially interested in a career in psychiatry or general practice.Clinical ImplicationsPRHO posts in psychiatry deliver training that meets General Medical Council objectives, and trainees' confidence with core psychiatric skills improves after undertaking the placements.

Pre-registration house officer training in psychiatry: the London experience

Aims and MethodTo evaluate whether new pre-registration house officer posts in psychiatry deliver training leading to increased confidence in target skills, based on General Medical Council requirements, and to evaluate trainees' satisfaction with these posts. A structured questionnaire was filled out by the first nine incumbents of the PRHO posts before and after the placements.ResultsTrainees' confidence improved in all the target skills and the posts were all rated as good or excellent. The posts attracted trainees who were potentially interested in a career in psychiatry or general practice.Clinical ImplicationsPRHO posts in psychiatry deliver training that meets General Medical Council objectives, and trainees' confidence with core psychiatric skills improves after undertaking the placements.

Psychiatric training of pre-registration house officers

Aims and methodThe aim of the paper is to describe the pre-registration house officer training in psychiatry available in Sheffield. The report is the result of a postal questionnaire, involving all of those who undertook pre-registration house officer training in psychiatry, since the inception of this option.ResultsThe results suggest that the psychiatry option as part of pre-registration house officer training was regarded as useful by almost all undertaking this training. Some of the suggestions to improve the experience are already incorporated into the current posts.Clinical implicationsThe findings support the development of further posts of this type, and such developments may assist in overcoming some of the difficulties in recruitment into psychiatry as a career.

Resuscitation training for medical students

This paper describes the systematic training of undergraduate medical students in resuscitation skills, aimed at overcoming the well known deficiencies in the resuscitation skills of junior doctors. This training can be integrated with the medical curriculum, but takes a considerable commitment in teaching time. To give each of our 240 medical students 36 h of resuscitation training, including an advanced life support (ALS) course for all students, 2442 h of teacher’s time is required each year. It is important that teaching is continued on the wards as part of the training of pre-registration house officers. The amount of teaching time required justifies the appointment of Medical School Resuscitation Officers, dedicated to teaching medical students, dental students and pre-registration house officers.

Preregistration house officers in eight English regions: survey of quality of training.

To assess the quality of preregistration house officer training in eight English regions. Postal questionnaire. Thames, East Anglian, Mersey, Northern, and Wessex regions. 1670 preregistration house officers. Education, hours of work, workload, conditions of work, and attitudes to job and medicine as a career. Response rate was 69% (1146 replies). Most house officers had attended induction courses (1036/1129 (92%)); 74% (757/1024) found them satisfactory. The proportions who had never received adequate guidance on how to break bad news and how to control pain were 59% (670/1135) and 56% (634/1136) respectively. There was much variation between regions. Overall, 65% (736/1138) reported confidence in performing cardiopulmonary resuscitation. Most respondents (95% (1089/1142)) worked an on call rota, 3% (36) a partial shift, and 0.6% (seven) a full shift; 19% (202) were on duty for average weekly hours that exceeded the targets for 1 April 1993. House officers had a median of 20 patients under their care and clerked a median of 10 emergency cases, six routine cases, and two day cases a week. Over half (690/1128 (61%)) could not obtain hot food after 8 pm, 20% (223/1095) did not always have clean sheets available in their on call room, and 45% (462/1036) did not consider the protection of staff against violence to be adequate at their hospital. The most important problems with the preregistration year were inappropriate or non-medical tasks (ranked first by 360 respondents), hours of work (359), and pay for out of hours work (167). Overall 57% (646/1125) would encourage a friend to apply for their post, but only 24% (266/1112) would encourage a friend to take up medicine and 44% (494/1112) would discourage the idea. House officers' training is deficient in important respects, with inappropriate tasks and heavy clinical workloads impeding the provision of proper education.

Education and training of preregistration house officers: the consultants' viewpoint.

To determine the opinions, attitudes, and requirements of consultants responsible for preregistration house officers in the light of the General Medical Council's Recommendations on General Clinical Training. A questionnaire was piloted asking 28 questions under the headings professional details, present training arrangements, effectiveness of current training, and perceived help required for implementing the recommendations. Two teaching hospitals and nine district general hospitals in the Yorkshire region. 33 consultants (19 physicians, 14 surgeons) responded to an hour long interview. The traditional teaching ward round, with clinical meetings, was the main educational provision for house officers. Under a quarter of respondents provided specific teaching, which rarely exceeded 30 minutes weekly. Many delegated teaching to other junior or non-medical staff. Few consultants assessed the effectiveness of teaching, and feedback to juniors was rudimentary. There was strong support for the apprenticeship system and concern that it should not be downgraded. Appointing educational supervisors and introducing a structured educational programme were approved theoretically. Pressure on consultants to work faster, participate in audit and management, and accept financial responsibility for their clinical work, coupled with the reduction in junior doctors' hours, were considered to militate against educational developments. Many respondents felt frustrated and powerless. They would welcome an increased educational role but considered there must be conceptual, contractual, and financial changes. Fundamental changes are required by both consultants and management before the preregistration year can have proper educational value. Training in educational methods for consultants and a structured curriculum and formative assessment for trainees require recognition and financial support.