Firm foundation for senior house officers

Editor—Gallen and Peile discuss establishing a firm foundation for senior house officers.¹ Concerns about trends in junior doctor training are growing in acute medical specialties. The proposed reforms may exacerbate a deteriorating situation.

In the past decade the competencies of junior grade doctors have collapsed. Previously junior house officers would rapidly acquire emergency medicine skills by being supervised participants in on-call ward cover and acute takes, consolidating these skills and acquiring considerable responsibilities as senior house officers.

Thus on-site medical competency has become extremely thin on the ground out of hours and in emergencies. Worse, prospective registrars are ill equipped to deal with emergencies owing to lack of exposure as senior house officers. Intensive care out-reach, increased tertiary or subspecialty referrals, and the appointment of acute medicine consultants may absorb some of this experience deficit, but it still represents a worrying threat to patients' safety in the face of increasing workloads.

The foundation year is likely to become a two year junior house officer year. This poverty of expectation is creating a cadre of underused, frustrated, demoralised junior doctors and inexperienced middle graders. Junior doctors should be becoming progressively more competent and enabled, not the reverse.