Training junior doctors

Editorial

There will be older readers who reflect on their former practices, and wonder how they were taught to do (and, usually, to do well) the day-to-day activities they performed as registrars. Often these skills were learnt when we were House Surgeons or House Officers and were junior members of a consultant firm or team; as team members we were given responsibilities and we stayed until they were done. Within obstetrics and gynaecology, our patients and territory were defined within the realms of labour ward, ante and postnatal wards, Accident and Emergency and gynaecology admissions, the wards and theatres (not always in the same hospital). In other specialties, the on-call junior might cover more wards, more subspecialties and many more consultants. In the past, we might have done a 3-day weekend without relinquishing responsibility to anyone else; nowadays there may be new staff every 12 h.

Therefore, the role of handovers has become important to avoid mistakes or patients falling through the net. I wrote an editorial with my medically qualified son and daughter last April (MacLean et al. 2010), but this issue has two further articles on these events. SHARING by Toeima (2011) tabulates items of Staff, High risk patients, Awaiting theatre, Referrals and outliers, Inductions waiting to be done or reviewed, Neonatal Unit status and Gynaecology ward activity. This serves as a useful mnemonic to quickly structure undone or unresolved patient management, and prioritise for where the on-coming junior might start. Edozien (2011) defines SMITH as Structured Multidisciplinary IntershifT Handover as a similar pro forma to stop patients disappearing from under the radar.

A third article on training matters by Touqmatchi et al. (2011) highlights apparent inadequacies in the junior doctor's review and ‘de-briefing’ of patients following operative deliveries, e.g. overnight and before the patient or junior doctor goes home. This should be expected, if not for the patient, even more for the trainee to see the outcome of management. The same importance should be placed on reviewing postoperative gynaecology patients, either to explain the findings or plan of management, or to assess the recovery before the doctor leaves the hospital. This assessment is aided by another mnemonic VAGINAL:

• V = Vital signs

• A = Analgesia requirements

• G = Gastro intake (or remain nil by mouth)

• I = Intravenous intake and drugs

• N = Nurses observations and comments

• A = Antibiotics: if prophylaxis given, limitation of further doses

• L = Legs: lower limb and pelvic vein thromboembolism prophylaxis.

The fourth article on training (Siraj et al. 2011) has surveyed postgraduate trainees on prioritisation of teaching topics using the Delphi technique. As a tutor, it is very easy to launch into your favourite topic oblivious as to what has been done recently by others. It will be assumed that someone else has already covered high priority subjects, leaving you to cover what you will.

Training is being better discussed and more important areas are being audited or reviewed. Readers are invited to contribute their own views on training within our correspondence pages, or to submit an article based on data gathered but needing the encouragement to publish.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.