Improving the preregistration experience: the New Zealand approach.

There is currently much debate about how to improve undergraduate medical education, and in particular on how best to prepare students for clinical responsibility. For 20 years a period of trainee internship has formed part of New Zealand medical students'' undergraduate training, and the model could have much to offer the United Kingdom. Students take their final examinations at the end of the second clinical year; they spend their final year in a series of eight clinical attachments, during each of which they shadow a preregistration house officer or senior house officer. As trainee interns they are paid 60% of a house officer''s salary for their clinical work, which is supervised by the firm''s registrars and consultants under the overall responsibility of the head of the academic department. The order of the attachments is determined on educational, not service, grounds, and trainees have to attend educational sessions and pass assessments on each attachment. The trainee internship, funded jointly by the education and health departments, offers a more seamless transition from student to house officer and aims at improving both general medical education and clinical training.     

The Safety Net and preregistration posts.

The Safety Net is a clearing system that collects and distributes information about preregistration posts remaining unallocated after as many doctors as possible have been placed by local efforts. Provided that the local systems operate in the final year, the Safety Net should ensure that each student has a post allocated to him before he sits the final examination.     

Association of use of a log book and experience as a preregistration house officer: interview survey.

OBJECTIVE: To determine whether use of a log book improved the experiences of preregistration house officers. DESIGN: Confidential questionnaire and interview survey of preregistration house officers carried out as part of University of London inspection process. MEASURES: Preregistration house officers were asked to rate educational and pastoral elements of their posts and about the use made of previously distributed log books. SUBJECTS AND SETTING: Preregistration house officers in North Thames. RESULTS: The incumbents of 535 of 560 (95%) preregistration house officer posts in the region were surveyed between June 1994 and July 1995, 490 by questionnaire and interview, 45 by questionnaire alone. House officers who had discussed the log book with their consultant expressed more satisfaction with their induction, consultant supervision and feedback, and formal and informal education and were more likely to recommend their job to a friend. CONCLUSION: Preregistration house officers who had discussed the log book with their consultant expressed more satisfaction with the educational elements of their jobs. The structured discussion with their consultant about the job and their performance seemed to make the difference.     

The preregistration houseman in general practice.

During 1979-80 an experimental preregistration house physician post in general practice was conducted at Aldermoor Health Centre in Southampton in rotation with medical posts at Southampton General Hospital. Ten house physicians took part in the experiment that lasted for 19 months and each doctor spent two months in general practice. The house physicians settled quickly into general practice and found the experience both enjoyable and worth while. The hospital consultants, general practitioners, and the house physicians themselves thought that this was a valuable extension to preregistration education. The experiment raised several questions, some of which were specific to the type of rotation organised and others that were more fundamental to the whole concept of the preregistration house physician in general practice. If the experiment is to be repeated a longer period in general practice is strongly recommended. A full year rotation is suggested with four months each of surgery, medicine, and general practice.     

Education and training of preregistration house officers: the consultants' viewpoint.

OBJECTIVE--To determine the opinions, attitudes, and requirements of consultants responsible for preregistration house officers in the light of the General Medical Council''s Recommendations on General Clinical Training. DESIGN--A questionnaire was piloted asking 28 questions under the headings professional details, present training arrangements, effectiveness of current training, and perceived help required for implementing the recommendations. SETTING--Two teaching hospitals and nine district general hospitals in the Yorkshire region. SUBJECTS--33 consultants (19 physicians, 14 surgeons) responded to an hour long interview. RESULTS--The traditional teaching ward round, with clinical meetings, was the main educational provision for house officers. Under a quarter of respondents provided specific teaching, which rarely exceeded 30 minutes weekly. Many delegated teaching to other junior or non-medical staff. Few consultants assessed the effectiveness of teaching, and feedback to juniors was rudimentary. There was strong support for the apprenticeship system and concern that it should not be downgraded. Appointing educational supervisors and introducing a structured educational programme were approved theoretically. Pressure on consultants to work faster, participate in audit and management, and accept financial responsibility for their clinical work, coupled with the reduction in junior doctors'' hours, were considered to militate against educational developments. Many respondents felt frustrated and powerless. They would welcome an increased educational role but considered there must be conceptual, contractual, and financial changes. CONCLUSIONS--Fundamental changes are required by both consultants and management before the preregistration year can have proper educational value. Training in educational methods for consultants and a structured curriculum and formative assessment for trainees require recognition and financial support.