The pre-registration year, where junior doctors work in hospital before being awarded full registration by the General Medical Council (GMC), seems finally to be changing. This year is notorious for its long hours and often tedious work, and junior doctors often find themselves in positions of responsibility where they have to act beyond the bounds of confidence, without the necessary senior support.
Now, the GMC is keen to improve the educational perspective of the year, to make it more of a continuation of medical school than an abrupt cut-off point. The New Doctor, the booklet handed to me when I began my year as a junior house officer (JHO) last summer, sums up this new approach. It lays out lists of bullet-pointed skills, ranging from 'keeping accurate records' to the more amorphous 'develop and maintain respect for the dignity, privacy and rights of patients and concern for their relatives'.
All these things are surely important to learn. But doesn't such a bullet-point approach risk destroying the point of being a JHO?
Most important for JHOs is learning how to cope independently, which is the one skill you will need throughout your career as a GP or a brain surgeon. If you are covering 40 patients on three different wards, and you haven't learned to 'manage time efficiently', then you have problems. As for the active learning programmes encouraged by the GMC, the weekly tutorials we are expected to attend are not to be sniffed at. But by our stage, people have to have some idea of how they learn best and what they want to learn, and are capable of getting on with it themselves. Probably the most productive method is to get interested in a patient and read up on their condition.
The GMC is under pressure from the press and the public to account for the actions of doctors. The problem is, if it does that too tightly with junior doctors, precisely the independent skills the GMC needs to cultivate could be undermined. After all, there's no point telling us our post 'should provide a sense of being a valued member of a team'. It's up to us to prove that.
Reproduced from LM issue 121, June 1999