Objectives To examine the delivery of postgraduate training in the emergency medicine setting and its impact on postgraduate doctor (Foundation Year 2) performance and competence.
Methods A national study in four emergency departments (EDs) in England between 2009 and 2010 was undertaken. Semistructured interviews with ED training leads (TLs) and focus groups with Foundation Year 2 (F2) doctors were carried out in each ED. Interviews and focus group data were analysed to compare the perspectives of F2 doctors and TLs on the delivery of training and performance and confidence of F2 doctors.
Results Interviews were carried out with eight TLs and focus groups with 30 F2s. F2 doctors and EDTLs agreed that ED was a valuable environment for F2 doctors to develop their competence, with exposure to a broad range of patients and the opportunity to make decisions about clinical care. Diverging views existed around competence and performance of F2s. F2 doctors had anxieties about decision-making (particularly discharging patients) and required regular feedback to feel confident in their care. TLs recognised a need for more supervision and support for F2 doctors but this was challenging in a busy, performance-led service.
Conclusions Emergency medicine placements were important in the development of confident and competent F2 doctors, particularly in the context of less clinical exposure in other specialty placements. However, there are competing tensions between elements of postgraduate learning and service delivery within emergency medicine that require addressing to enable trainees to optimally develop knowledge and skills in this environment.
- ACCIDENT & EMERGENCY MEDICINE
- MEDICAL EDUCATION & TRAINING
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Contributors CO'K managed the study, contributed to the design of the study, designed data collection instruments, wrote and revised drafts. AC contributed to the design of the study, designed data collection instruments and revised drafts. SM initiated the project, designed the study and monitored the study including data collection and revised drafts of the paper.
Funding This study was funded by the NIHR HS&DR funding stream (Ref. 08/1819/221). The study funders approved the final protocol and design of the study. However, the views expressed here are those of the authors alone.
Competing interests None declared.
Ethics approval Leeds (West) REC (09/H1300/80).
Provenance and peer review Not commissioned; externally peer reviewed.
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