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Wednesday, 19 June, 2002, 12:23 GMT 13:23 UK
Junior doctors 'lack knowledge'
Hospital
Critical care: Junior doctors do the assessments
Many junior doctors do not know the signs that a patient is critically ill, according to a report.

The survey of just under 200 recently-qualified doctors highlights "significant gaps" in their knowledge and understanding of basic life-supporting care.


We will discuss the issues raised by this new research with the GMC

Department of Health spokeswoman
The study, published in a specialist medical journal, makes alarming reading for patients.

Its authors recommend an urgent overhaul of the training provided by medical schools.

Officials in the Department of Health said they would discuss the findings with the General Medical Council, which oversees medical schools.

The researchers found almost a third of doctors failed to answer a question on how to deal with someone who was unconscious.

None of the trainees identified all of the steps involved in using an oxygen mask, and a fifth did not understand how it worked.

The revelation comes just days after the leak of a pilot study into accidents and error in the NHS caused a storm.

One of the co-authors of the latest study says patients should be reassured by the fact that steps are being taken to tackle medical errors.

Education call

The move towards a no-blame system of reporting mistakes is bound to lead to more known errors initially but should ultimately improve things, says Dr Gary Smith of Portsmouth Hospitals NHS Trust.

Dr Trevor Pickersgill
Dr Trevor Pickersgill: Reassured patients
He told BBC News Online: "We're going through a phase in medicine now where we are acknowledging our limitations and where errors occur.

"Hopefully with better education and better recognition of these errors the incidence is going to go down."

Dr Smith and a colleague at the trust asked 185 junior doctors to complete a questionnaire on basic aspects of critical care.

The group comprised 108 pre-registration house officers and 77 senior house officers.

In the UK, most patients admitted to hospital wards following surgery or because of illnesses like heart attacks are assessed initially by junior doctors.

Typically, they have one or two years of experience following medical school.

The questions included:

  • A dozen about the signs of critical illness, including how to recognise total airway obstruction and normal levels of blood oxygen

  • How to use an oxygen mask

  • The tests needed for an unconscious patient

  • Who can legally authorise surgery in those circumstances.

The doctors found:

  • Only five senior house officers correctly identified the signs that airways are blocked while almost half the pre-registration house doctors gave an incorrect answer.

  • Only one in five trainees knew the correct levels of maximum blood oxygen.

  • Almost a third of trainees failed to answer the question on how to deal with an unconscious patient

  • There was poor recognition that unconscious patients should have their blood glucose tested.

The report authors say an overhaul of medical school training is particularly necessary in view of the fact that medical students are getting less and less experience of medical emergencies and surgical procedures.

'Worrying'

They write in the Postgraduate Medical Journal: "Our study demonstrates that trainee doctors, many of them having just completed medical school training, have significant gaps in their knowledge and understanding of the signs of acute illness and the basic, but potentially life-saving, care required to support life."

A Department of Health spokeswoman said: "The UK has a solid reputation for its high standards of medical training and education and we want to ensure that we continue to provide the best medical training for our future doctors.

"We will discuss the issues raised by this new research with the GMC. After further analysis, if action is needed then we will work with the GMC on the steps they need to take to ensure course content is revised."

Mike Stone of the Patients Association described the findings as "worrying".

He told BBC News Online: "It's worrying that this report identifies that junior doctors are going on to the ward without being able to identify serious conditions within patients.

"We have to look at the training that they are getting in the first place to make sure it lets them identify those specific areas that have been identified in this report."

Trevor Pickersgill, chair of the junior doctors committee of the British Medical Association, said knowledge of signs of critical illness was an absolute requirement for any doctor.

"Assessment of emergency patients is something that doctors need at their fingertips," he told BBC News Online.

"Many of the errors we've been hearing about this week could be prevented if postgraduate medical training was better supervised."

 WATCH/LISTEN
 ON THIS STORY
The BBC's Niall Dickson
"Many cannot give life-saving treatment"
Report co-author Dr Gary Smith
"They are things we need to look at very seriously"

Talking PointTALKING POINT
NHS trust
Do you still have faith in the health service?
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