title: Does the current use of junior doctors in the United Kingdom affect the quality of medical care?
abstract: Current proposals in the U.K. envisage a reduction in both junior staff numbers and the hours which they work. The proponents of change argue that this will improve patient care, although there are also opposing arguments, based mainly on the need to maintain continuity of care and ensure juniors gain sufficient clinical experience. By means of a literature review and interviews with junior doctors, this paper examines the effect of the existing system of hospital medical staffing on quality of care. There is evidence that the existing system reduces the quality of care, principally through mistakes associated with inadequate supervision, and lowered humanity of care due to tiredness. The training value of night-time and weekend work is low, and many doctors find it unsatisfying. In contrast, many doctors value providing continuity of care and a few appreciate the opportunity to gain unsupervised experience. Overall, the disadvantages of the existing system outweight the advantages, and change is required to improve the quality of care. There are, however, several obstacles to change, and there are doubts about the extent to which the current proposals will be implemented.
authors.affiliation: Health Services Research Unit, London School of Hygiene and Tropical Medicine, U.K.
authors.forename: M
authors.initials: M
authors.lastname: McKee
authors.forename: N
authors.initials: N
authors.lastname: Black
mesh_terms: D003266:Continuity of Patient Care; D004501:Education, Medical; D007407:Interviews as Topic; D007588:Job Satisfaction; D008505:Medical Staff, Hospital / Q000592:standards*; D011787:Quality of Health Care; D012892:Sleep Deprivation; D006113:United Kingdom; D014940:Work Schedule Tolerance