The impact of twice-daily consultant ward rounds on the length of stay in two general medical wards – effect on training?

Editor – While the reduction in the average length of stay and the increase in the number of discharges observed following the transition from twice-weekly to twicedaily consultant-led ward rounds described by Ahmad et al (Clin Med December 2011 pp 524–528) is admirable, we are concerned about the impact this change would have on training. In the same issue of Clinical Medicine, results of a 2010 survey of medical registrars showed high levels of dissatisfaction with UK training due to the impact of the European Working Time Directive (EWTD)¹. It would thus have been informative to include some reflection from trainees within the team on the effect of the changes on training and job satisfaction.

There has always been a dichotomy between training and service provision in UK postgraduate medical education, with perceived training inadequacies highlighted during successive postgraduate structural reforms.^2,3 Increasing consultant-led ward rounds and EWTD-compliant rotas leads to a reduction in learning opportunities for trainees, with the doctors involved in initial patient assessment not necessarily present on post-take ward rounds.⁴ Additionally, there is a perceived reduction in trainee autonomy when posttake ward rounds occur before the admitting doctor is able to institute a management plan.⁵ Feedback from trainees indicates that only a small proportion of junior doctor learning occurs on ward rounds^6–7 and specialist registrars (SpRs), especially in their latter years of training, value the opportunity to lead ward rounds in order to develop leadership and decisionmaking skills prior to consultant appointment.⁶ Furthermore, supervision and review of cases clerked by junior colleagues is an essential part of the development and training of SpRs.⁸

Whilst the change to twice daily consultant-led ward rounds may improve patient outcomes in the short term, we wonder whether this would lead to a further erosion of training opportunities for junior doctors and what would be the longerterm impact on the quality of future consultants.

• © 2012 Royal College of Physicians