title: Management confidence and decisions to refer to hospital of GP registrars and their trainers working out-of-hours.
abstract: BACKGROUND
  There is concern about the educational impact and possible stress on registrars of new out-of-hours co-operatives.
  
  
  OBJECTIVE
  To compare the confidence in managing out-of-hours problems of registrars in traditional on-call rotas and co-operatives with that of their trainers. To determine how frequently registrars discussed problems out-of-hours with their trainers, and to compare the referral pattern of registrars with their trainers out-of-hours.
  
  
  METHODS
  Analysis of log diaries of out-of-hours experiences kept by registrars and trainers over two, two-month periods in winter and summer.
  
  
  RESULTS
  Thirty registrars (out of a possible 51) and 34 (out of a possible 52) trainers took part in the winter, and 18 registrars and 29 trainers in the summer. Registrars were confident in their management, and their confidence increased over the year (59% versus 72% difference = 12%, 95% CI = 6% to 20% for very confident). Registrars varied in their discussion of problems with trainers. When 'a little worried' they discussed their management 30 out of 53 times (57%); if 'very confident', 36 out of 576 times (6%). Registrars during the summer segment of the study referred more frequently to hospital than trainers (20% versus 10% difference = 10%, 95% CI = 3% to 17%. Registrars in traditional rotas recorded a slightly higher but statistically insignificant level of confidence in their management of problems than those registrars in cooperatives.
  
  
  CONCLUSIONS
  While many registrars are confident in their work and are using their trainer for information appropriately, some are not. Registrars may be referring to hospital at a much higher rate than their trainers. More research is required to confirm and further explore these findings.
authors.affiliation: Lister Postgraduate Institute, Edinburgh.
authors.forename: B
authors.initials: B
authors.lastname: McKinstry
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D003657:Decision Making; D004503:Education, Medical, Graduate / Q000592:standards; D005194:Family Practice / Q000458:organization & administration*; D006801:Humans; D008503:Medical Staff / Q000523:psychology*; D009551:Night Care / Q000458:organization & administration*; D010821:Physicians, Family / Q000193:education; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012606:Scotland