title: The influence of key clinical practices on the knowledge of first year doctors about the patients under their care.
abstract: OBJECTIVE
  In 2009 in the United Kingdom the 48-h working week was introduced for junior doctors. To comply with this traditional working practices have changed. This study aims to assess how much first year (FY1) doctors know about the acute surgical patients they manage and how this is influenced by changes in key working practices.
  
  
  METHODS
  Surgical FY1s working in NHS hospitals answered 16 clinical questions about a standard acute surgical patient under their care 48 h after admission. Scores were analysed according to how long the FY1 had been looking after the patient, whether they had clerked the patient in, attended the post take ward round (PTWR), used a handover sheet to answer the questions and had sole or shared responsibility for the patient.
  
  
  RESULTS
  Two hundred and seventy-four FY1s (92% response rate) from 36 hospitals were surveyed. The overall median score was 11/16 (inter-quartile range 8-13). Only 8.4% (23/274) FY1s had clerked in the patient and 58.4% (160/274) had attended the PTWR. Clerking patients and attending the PTWR resulted in significantly higher test scores compared to FY1s who did not perform these activities (p = < 0.001 and 0.001 respectively). The scores of the 67.2% who used a handover sheet were significantly lower than those who did not (p = 0.001). Having sole or shared responsibility and duration of care made no significant difference (p = 0.143 and p = 0.458 respectively)
  
  
  CONCLUSIONS
  The results demonstrate that junior doctors' knowledge of their patients is significantly enhanced when they have the opportunity to perform the admission clerking and attend the PTWR. Because of working hours' restrictions this is now rare. Although use of handover sheets appears to ensure that certain key facts immediately related to the current admission are passed on, it is associated with significantly poorer wider knowledge of the patient.
authors.affiliation: Department of General Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham, UK.
authors.forename: M
authors.initials: M
authors.lastname: Naqvi
authors.forename: S T
authors.initials: ST
authors.lastname: Ward
authors.forename: G
authors.initials: G
authors.lastname: Dowswell
authors.forename: J
authors.initials: J
authors.lastname: Donnelly
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D003266:Continuity of Patient Care / Q000592:standards; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital / Q000592:standards*; D010343:Patient Admission / Q000592:standards; D010817:Physician-Patient Relations; D006113:United Kingdom