Trainee satisfaction before and after the Calman reforms of specialist training: questionnaire survey
BMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7238.832 (Published 25 March 2000) Cite this as: BMJ 2000;320:832
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EDITOR- Paice et al report increased overall job satisfaction amongst
specialist registrars following the introduction of the Calman reforms.1
They also demonstrate similar increased satisfaction amongst pre-
registration house officers and senior house officers over the same time
period, despite the Calman reforms largely effecting higher specialist
training, this would perhaps indicate an alternative reason or reasons for
this improvement. It is possible that this increased satisfaction is just
as likely to be due to the New Deal which eventually came into force at
the end of December 1996, that is to say immediately after the first
questionnaire. The New Deal or at least its stated aims were all those
that should have improved working conditions and hence job satisfaction
i.e. decreased working hours, increased rest periods and the increased use
of support services.
Additionally their questionnaire did not address a very important
aspect of job satisfaction- career progression or doctors' perception of
it. Obtaining a national training number is increasingly difficult since
the numbers of junior trainees do not necessarily match the numbers of
specialist registrar in some specialities.2 In addition national training
numbers are likely to be reduced.3 Even once completion of specialist
training has been reached there is no guarantee of a consultant post at
the end with insufficient vacancies being available in some specialities
such as obstetrics and gynaecology.4 The Calman reforms have doubtless
improved many aspects of higher specialist training but they are no
panacea.
Adrian Thuraisingam
trust grade (desperately seeking NTN)
North Manchester General Hospital, Manchester, M8 5RL
1 Paice E, Aitken M, Cowan G, Heard S. Trainee satisfaction before
and after the Calman reforms of specialist training: questionnaire survey.
BMJ 2000;320:832-6
2 Galasko CS, Smith K. Ratio of basic surgical trainees to type 1
specialist registrar programmes 1999/2000/2001/2002. Annals Royal College
Surgeons England 81(3 Suppl):124-8, 1999.
3 Wilson C. Reduction in SpR numbers leads to service fears. Hospital
Doctor 2 Dec1999 1.
4 Ryde K. Planning the medical workforce. BMJ 1999;319:2
Competing interests: No competing interests
Trainee satisfaction and the New Deal
Dr Thuraisingam raises an important question, and one we asked
ourselves. While most of the changes resulting from the New Deal on junior
doctors' hours in North Thames took place between 1993 and 1996, there
were further improvements in on-call rotas between our two surveys. In
1996/7 most SpRs were on 1:4 or 1:5 and in 1998/9 most were on 1:5 or 1:6.
However, we found little correlation between the frequency of on call and
overall satisfaction with the post. There was a correlation between
overall satisfaction and hours of continuous uninterrupted rest during a
night on call. This appeared to get worse between the two surveys ie the
SpRs were on call less often but working harder when on. However, we were
not confident that we were comparing like with like as there were many
variations in patterns of work. We concluded that, at least at SpR level,
the improvements in trainee satisfaction could not be explained simply by
the New Deal, which in any event was unlikely to have affected educational
objective-setting, induction, use of log books or consultants' feedback,
all of which were strongly associated with overall satisfaction.
As to the question of career progression, I can only say that we did
not address this in the study.
Competing interests: No competing interests