Junior doctors leaving medical school have knowledge gaps

Claire McKenna BMJ

Preregistration house officers and senior house officers have notable knowledge gaps in basic aspects of acute care, according to a recent study published in the Postgraduate Medical Journal.

The study assessed the skills of 185 preregistration house officers and senior house officers at six hospitals in England through a questionnaire containing 12 questions on acute care topics.

Many of the doctors tested were unaware of the signs of total airway obstruction, confusing them with those of partial obstruction (preregistration house officers 11%, senior house officers 14%) or apnoea (preregistration house officers 47%, senior house officers 26%). There was also found to be poor knowledge of the function of non-rebreathing oxygen masks and pulse oximeters. Similar deficits in knowledge and understanding were found in relation to the normal capillary refill time, minimum hourly urine output, and the role of blood glucose testing in unconscious adults.

In the United Kingdom, most of the initial assessment and treatment of acutely ill patients on wards is provided by trainee doctors. The authors of the study designed the questionnaire to cover many of the areas of clinical practice that related specifically to being able to recognise clinical deterioration. Knowledge gaps in junior doctors could therefore have a potentially disastrous outcome for the patient, they argued.

The study implied that medical school training may not prepare medical students for their forthcoming responsibilities and clinical experiences, particularly in the "generic" signs, symptoms, and management principles of acute illness.

Surprisingly, the authors found that the performance of preregistration house officers and senior house officers was similar in the skills tested. This is of concern because many of preregistration house officers learn directly from senior house officers, creating a potential for misunderstandings to persist.

Patients' groups have described the study as "worrying."

Trevor Pickersgill, chairman of the Junior Doctors Committee of the BMA, said: "Assessment of emergency patients is something that doctors need at their fingertips. Many of the errors we've been hearing about this week could be prevented if postgraduate medical training was better supervised."



studentBMJ 2002;10:259-302 August ISSN 0966-6494