Foundation Year Doctors need more support

Study design

A survey was designed consisting of 10 questions (Table 1). The survey was circulated through contacts sourced on the UKFPO website and respective healthcare trusts for onward transmission to Foundation Year (FY1 & FY2) doctors.

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Table 1.

Questions included in the survey.

1. Medical school

2. Aware of need for indemnity cover

3. Have you needed to contact indemnity provider

4. Prepared by medical school to handle this

5. Has the Bawa-Garba case influenced you

6. How has the Bawa-Garba case influenced you

7. Experiences of bullying

8. Understand “risk averse” medicine

9. Witnessed risk averse medicine

10. Understand crown indemnity

Results

Four hundred and forty-eight FY1 and FY2 doctors completed the survey. Four hundred and thirty of the 448 (96.0%) had trained in one of the 33 different UK and Irish medical schools. The remaining 18 had trained at medical schools outside the UK and Ireland.

Of the 18 respondents who had trained overseas, 14 had never been informed of the need for medical malpractice cover; there was no response to the question in the other four. Of those who had graduated from UK or Irish hospitals, 22 did not know that they required malpractice indemnity cover.

Two hundred and sixteen (48.2%) responded that they had not received sufficient teaching about medical litigation at their medical school. Twenty-eight respondents (6.25%) had needed to contact their malpractice indemnity provider.

One hundred and ninety-one doctors (42.6%) had experienced bullying in the workplace, 122 (27.2%) by more senior doctors, 45 by a nurse (11.8%), three by a peer, two by a manager, one by a patient and eight had been bullied by more than one group.

Three hundred and thirty of the respondents (74%) stated that the Bawa-Garba case had influenced them. In 74 cases (16.5%), they stated that they would not consider a career in paediatrics in the UK. Thirty-six (8%) wrote that they would not continue a medical career in the UK. Fifteen wrote (3.3%) that they would be likely to stop practising medicine.

Three hundred and forty-two respondents (76.3%) replied that they understood the term “risk averse medicine” and 330 (73.7%) had seen it in practice.

Four hundred and thirteen (92.2%) of the respondents did not understand the term “crown indemnity”.

Discussion

There is much evidence that morale amongst junior doctors has been eroded for a variety of reasons. ^1,2,3,4,5 Retention of doctors has reduced and poses a threat to the supply of doctors. ^6,7,8,9,10 During the data collection, we encountered problems circulating the survey. We did not consider that we needed to seek ethical approval or approval from the UKFPO since this was an anonymous survey. Our points of contact were taken from the UKFPO website and respective healthcare trusts and a number of email addresses were incorrect. Some points of contact declined to pass on our request. We cannot be sure how many of the 7200 FY1s and FY2s received the survey. In any future study, we need to find a way to access our target audience more accurately. Nevertheless, we believe that the results of our survey have revealed relevant and important data.

Twenty-two (5.1%) from UK and Irish medical schools reported that they had never been informed of the need to arrange malpractice insurance, but there was no pattern to identify that any one particular medical school had failed to provide this teaching. Of more concern is that none of the 18 doctors who had trained overseas were aware that they needed malpractice indemnity cover. Since all 18 had registered provisionally with the General Medical Council, the responsibility to inform overseas doctors of the need for indemnity protection could reasonably be taken by them.

Our results show that the clear majority are aware of the need to have indemnity cover; however, nearly half of the participants did not feel adequately prepared to handle this issue. According to the National Health Service Resolution (NHSR) report (2017–2018), there are more than 10,000 claims annually and this risk varies according to specialties. This highlights the need for comprehensive education of medical students and junior doctors, which could be provided through sufficient teaching at medical school.

The Bawa-Garba case has had a significant impact on the career intentions of those who replied to the survey. ⁷ Our results show that 74 FY1 and FY2 doctors would not consider a career in paediatrics in the UK. If these results were to be consistent on a larger scale, this could adversely impact training numbers in paediatrics. As a consequence of the Bawa-Garba case, 36 doctors stated that they would not now pursue a career in medicine in the UK, and a further 15 stated that they would stop practising medicine altogether.

A total of 175 (39%) FY1 and FY2 doctors reported that they had been bullied, 116 (26%) by more senior doctors, 45 (10%) by nurses, two by managers, one by a patient, three by peers and eight by more than one person. This study quantifies the culture of bullying that has been identified in the census from the British Orthopaedic Trainee Association. ¹⁰

Ninety-two percent of FY1 and FY2 respondents do not understand the term “crown indemnity”. This raises the question whether the medico-legal teaching they have received is sufficiently comprehensive. This question was included to demonstrate the need for private indemnity support, highlighted by the Bawa-Garba case. This lack of knowledge must be considered to be the responsibility of both the medical schools and the organisations that offer indemnity.

Conclusions

Medical schools need to review the teaching that they offer in medical negligence.

The UKFPO needs to be persuaded that surveys such as this provide evidence that is of value and contribute to improving future research. Exploring such evidence can make a positive contribution to the on-going development of a medical school curriculum and can help to identify issues affecting the morale of junior doctors.^11,12