11 June 2009
The latest report from NCEPOD, Acute Kidney Injury: Adding Insult To Injury highlights how inexperience among junior doctors in treating acutely ill patient is a key factor in over half of acute kidney failure deaths. This should serve as a wake up call to those wishing to further reduce training time and opportunities within NHS hospitals.
“The cut backs in hours, the inevitable punishing full-shift rota systems, and cross-cover of other specialties enforced on trainee doctors are destroying medical training in this country,” said John Black, President of The Royal College of Surgeons. “This report provides a clear example of how patients suffer as a direct result. NHS Trusts are being placed under intolerable pressure to keep services running with less doctor time, and inevitably it is training time that suffers. No amount of calls for “innovative solutions” from the Department of Health can change this – the arithmetic simply does not add up. Fewer hours, equals fewer doctors on duty, equals less training, and poor patient care is the result.”
Surgeons not only operate, but also look after some of the most unwell patients in the hospital, including those highlighted in this report suffering from sepsis and other life-threatening illnesses. Today's medical graduates are well equipped with the knowledge to manage this type of situation, but lack the day to day exposure as a direct result of reduced working hours and shift systems. They no longer have the experience required to spot impending disasters and put their expert knowledge into practice.
This college has worked hard to try and remediate the problem and recognising the earliest signs of acute kidney failure, and other vital organ-systems, is part of the formal training curriculum. We also provides a well-established training course – Care of the Critically Ill Surgical Patient (CCrISP) – which is delivered at the college and regionally. Completion of this course is not currently mandatory, and the take up has decreased dramatically since trainee study leave budgets were cut drastically two years ago. Trainees generally now fund the cost of this and other vital courses themselves. This important report provides a timely signal that improving patient safety will not happen without investment, and the funding of CCrISP and other vital training courses must be restored for all surgical trainees, particularly as the EWTD sharply reduces training time*.
*Adding Insult To Injury report author Dr James Stewart on Today Programme; July 11 2009; 6:55am:
"With the European Working Time Directive, training time for Junior Doctors has been reduced and they are simply not exposed to as much acute medicine as they used to be.”
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