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

Lydia Eccersley and Lionel Tan
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DOI: https://doi.org/10.7861/clinmedicine.12-2-186
Clin Med April 2012
Lydia Eccersley
London and Honorary SpR in Haematology, Imperial College Healthcare NHS Trust
Roles: Clinical research fellow, Imperial College
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Lionel Tan
SpR in Infectious Diseases and General Internal Medicine, Imperial College Healthcare NHS Trust
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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 rounds6–7 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

References

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    . Effects of changing work patterns on general surgical training over the last decade. Postgraduate Med J 2011;87:795–9doi:10.1136/postgradmedj-2011-130297
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    . Time for change: teaching and learning on busy post-take ward rounds. Clin Med 2010;10:231–4
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    1. Qureshi NS,
    2. Swamy NN
    . Postgraduate trainees' assessment of the educational value of ward rounds in obstetrics and gynaecology. J Obstet Gynaecol 2008;28:671–5doi:10.1080/01443610802421858
    OpenUrlCrossRefPubMed
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    1. Claridge A
    . What is the educational value of ward rounds? A learner and teacher perspective. Clin Med 2011;11:558–62
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    . The value of the post-take ward round. Clin Med 2010;10:93–4
    OpenUrlFREE Full Text
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The impact of twice-daily consultant ward rounds on the length of stay in two general medical wards – effect on training?
Lydia Eccersley, Lionel Tan
Clinical Medicine Apr 2012, 12 (2) 186-187; DOI: 10.7861/clinmedicine.12-2-186

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The impact of twice-daily consultant ward rounds on the length of stay in two general medical wards – effect on training?
Lydia Eccersley, Lionel Tan
Clinical Medicine Apr 2012, 12 (2) 186-187; DOI: 10.7861/clinmedicine.12-2-186
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