Patients at risk as junior doctors lacking basic skills

Patients lives are at risk due to a lack of basic skills among graduate doctors, including performing cardiopulmonary resuscitation (CPR), according to two new surveys.

Nearly half (45 per cent) of newly qualified doctors asked about their CPR skills made "fatal errors", according to one study, while a second survey uncovered "a significant discrepancy" between the skills of first-year graduate doctors and what was expected of them, The Press newspaper reported today.

Canterbury emergency medicine specialist, Professor Mike Ardagh, was one of three authors behind a survey of 233 newly qualified doctors which found "suboptimal" resuscitation knowledge and confidence "with some doctors displaying dangerous deficiencies", the paper reported.

Prof Ardagh said some new graduates were in hospitals "where they were the only doctor responding to patients in need of resuscitation".

Writing in the latest New Zealand Medical Journal, Prof Ardagh called for immediate action to close the gap between ability and expectation.

"Having junior doctors who do not have the skills expected of them is unsafe, inefficient, destructive and unethical."

The comments comes on the heels of a survey of graduate Auckland doctors which found less than half had performed even one-third of the skills defined by the Medical Council as important to achieve by the end of their first year out of medical school.

Published by Andrew Old in the same edition of the journal found just one of the 28 skills expected of year one doctors and contained in medical school curriculums, had been performed by all 25 of the doctors by the end of their first postgraduate year.

Mr Old said there needed to be a shift away from the "service-dominated" workload of junior doctors to put a greater emphasis on education. Increasing public accountability meant "a more systematic approach to ensure junior doctors are adequately trained to provide safe, competent care is fast becoming a necessity", the paper reported.

Prof Ardagh has also called for changes in undergraduate clinical experience, saying the current system was largely ward-based, giving students limited experience in the management of undiagnosed patients.

The Medical Council should clearly define the skills expected of graduate doctors while district health boards and medical schools should make resources available to teach those skills, he told the paper.

Those who had mastered them to the required level should be certified as having done so, he said.

Medical students and junior doctors should spend time in areas such as the emergency department to gain experience interpreting symptoms and making decisions about the management of undiagnosed patients, he said.

Speaking to The Press yesterday, Mr Old said his study had emerged from his own experience as a first-year medical graduate and the anecdotal reports of others.

"Some faced expectations that because you've graduated with this degree you can do something, but you never have," he said.

"One of the concerning things you end up with is the question of patient safety."

Christchurch Hospitals' Medical Staff Association chairwoman Ruth Spearing told the paper medical schools needed to address the issues raised in the studies so that students were competent by the time they qualified with key areas tested in their final exam.

- NZPA