More than 7,000 new junior doctors will today land on the wards, putting into practice years of training and study. But the really hard work is only just starting, writes Pallavi Bradshaw
Each year at around this time already worried juniors will read negative press murmurs of “black Wednesday”: the day when thousands of junior doctors are let loose on an unsuspecting public, to seemingly disastrous effect. Unsound statistics about increasing mortality rates are trotted out, leaving the public in fear of impending doom.
‘Surviving the first year of medicine is as much a test of endurance as it is enthusiasm’
Of course, this doesn’t paint an accurate or helpful picture and I feel compelled to challenge the scaremongers and defend my junior colleagues. Today’s doctors are far better prepared for the transition from medical student to junior doctor than previous generations. Medical school training is more patient and clinically focused. There is a period of pre-job shadowing, dedicated induction programmes and close clinical supervision.
There is no doubt, though, that this is a challenging time for both junior doctors and senior colleagues. We conducted a survey of over 1,000 junior doctors who were just completing their first year in hospitals. The results show a mix of professional and personal challenges on the wards.
Encouragingly, the majority of respondents said that they chose a career in medicine because they are motivated by a desire to help people. Even after the struggle of their foundation years, 65 per cent of junior doctors are still excited by the prospect of a career in medicine.
The influence of managers
But surviving the first year of medicine is as much a test of endurance as it is enthusiasm. Eighty-two per cent of first year doctors said that they had struggled with long hours; an increase of 7 per cent from our 2013 survey. Sixty-eight per cent struggled with heavy workloads.
When asked what they had found most challenging when dealing with patients during their first year qualified, most said that they didn’t have enough time to give patients the care they require, even though eight in 10 are working beyond their contracted hours and five in 10 said they don’t have enough time to study.
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One of the topics of the Berwick review, published a year ago, was whether to introduce minimum staffing levels – but this was discounted. Calls to increase exposure to training by asking juniors to opt out of the European Working Time Directive need to be supported by adequate supervision and teaching.
The profession clearly has a lead role to play, but so too do NHS managers. They have the power to provide appropriate resourcing and support on the wards, which can improve quality of care and learning experiences for trainee doctors.
Nurture new leaders
Sir Bruce Keogh’s 2012 report called for juniors to be the clinical leaders of today and not just of tomorrow, so it was disappointing to see that most first year doctors who had concerns about care did not feel able to raise them with clinical managers.
‘We must imbue junior doctors with a sense that it is not only right to raise concerns, but it is the hallmark of a true healthcare professional’
While two-thirds of second year doctors, having gained confidence and experience, did raise their worries with appropriate management, more must be done to empower all members of the clinical team to speak up and foster a culture of openness.
We must imbue junior doctors with a sense that it is not only right to raise concerns when patient care is compromised, but it is the hallmark of a true healthcare professional.
Most of all we must support junior doctors to become valuable and respected members of the team, and nurture them to grow into excellent clinicians providing a world class health service.
Dr Pallavi Bradshaw is a medicolegal adviser at the Medical Protection Society