BMJ research paper adds to evidence of increased patient mortality associated with trainee doctors

A recent Healthcare Governance Review post focused on Dr Foster’s research into the association between increased patient mortality and the August intake of new junior doctors (click here).

The British Medical Journal (BMJ) has published a research paper describing a study that sought to determine whether an increase in the rate of undesirable events occurs after care provided by anaesthetic trainees at the beginning of the academic year.

The ‘retrospective cohort’ study was carried out at the Alfred Hospital, a University affiliated hospital in Melbourne, Australia. The study used administrative and patient record data and the participants involved 19,560 patients having an anaesthetic procedure carried out by first to fifth year trainees starting work for the first time at the hospital over a period of five years (1995-2000).

The study found that “The rate of undesirable events was greater among trainees at the beginning of the academic year regardless of their level of clinical experience. This suggests that several additional factors, such as knowledge of the working environment, teamwork, and communication, may contribute to the increase.”

The study concluded that “Strategies to minimise the rate of undesirable events at the beginning of the academic year should look at improving trainees’ orientation and integration during the first weeks, by developing, for example, mandatory introductory courses, hospital settings’ visits, and interprofessional meetings and, beyond all the rest, by avoiding residents’ involvement in clinical tasks from the first day. The orientation period could also include close one to one supervision, particularly when cross cover work is done in different hospital settings. The systematic use of written documentation of standard working practices should be encouraged to minimise the loss of tacit knowledge associated with staff turnover. Crew resource management programmes such as those developed in aviation and now increasingly introduced in the healthcare environment could be used to improve team coordination and interprofessional collaboration. Finally, early training sessions in simulators could be scheduled to favour rapid improvements in junior trainees’ technical skills.”

The full research paper Rate of undesirable events at beginning of academic year: retrospective cohort study can be freely downloaded here.

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