A shortened training programme for UK doctors was introduced in 2005, amid fears that it would lead to a reduction in competence and confidence among trainees.
Seventeen trainee doctors working in the emergency care department of one large teaching hospital were surveyed in 2005 and 2006, exactly one year apart.
They were quizzed about their experience of performing six practical procedures commonly performed in emergency care. These included the manipulation of a wrist (Colles) fracture and a dislocated shoulder, suturing and exploring wounds, draining an abscess, and inserting a chest drain.
The doctors were asked to respond on a scale, ranging from no experience to feeling confident to carry out the procedure unassisted. Fourteen doctors responded in 2005 and 16 in 2006. Both groups had been working in the department for around four months and had recently qualified.
The 2006 group said they had less experience of all six procedures, and significantly less experience of shoulder manipulation and wound suturing and exploration. The authors speculate that this drop-off in experience could be attributed to several factors. These include trainee doctors being advised not to take on procedures until they have been thoroughly taught how to do them, rather than learning on the job, referred to as 'see one, do one.'
Secondly, junior doctors may actually be acquiring less 'hands-on' experience as they spend more time undertaking formal teaching and assessments, they suggest.
And finally, more senior and experienced staff may be performing certain procedures themselves, on the grounds that they will be faster, so minimising the risk of missing waiting time targets.
But whatever the reasons, the decline in practical experience needs to be addressed, to ensure that junior doctors are appropriately trained and continue to provide a much needed resource in emergency care, the authors conclude.