Catherine Smith finds out what a trainee doctor does when nerves take over and a patient is waiting for treatment
Trainee doctors everywhere feel the pressure of adapting to life on the wards, but the first rung of the ladder as a pre-registration house officer (PRHO) is particularly nerve-wracking. After five years at university, they have left medical student life behind and are for the first time responsible for people's lives.
They are also negotiating their way through a labyrinth of departments and differing work styles. Many are reluctant to ask for help for fear of being judged incompetent. Busy ward life is a time constraint on everyone. Many rely on a sympathetic minority of staff to guide them through their first few weeks.
But life could get easier for them if the "buddies" scheme piloted at Stockport's Stepping Hill Hospital proves a success. Buddies are experts in different hospital departments who can be freely contacted and consulted on all queries in relation to patients' treatment. Manchester University's department of postgraduate medicine and dentistry is trialling buddies as part of its "Blending service with training initiative", which has projects running across the Northwest Regional trusts to improve the working lives of doctors in training. Stockport is involved in two projects: one to improve induction and the other reviewing ongoing training and support.
Buddies were the idea of the trust's director of clinical support services who saw them as an alternative to more traditional mentor schemes. Each participating department appoints buddies for trainee doctors. So, for example, a PRHO may want to ring their buddy in pharmacy to check the dosage and potential interactions of a drug or to contact their physiotherapy buddy to confirm whether a patient would benefit from a referral.
Buddies are volunteers. They are impartial and approachable. With buddies across different departments, each PRHO has access to people who between them possess an extensive knowledge base. This results in less stressed doctors and a better service for patients.
The system was first trialled on new recruits in February and now includes the August intake. It targets PRHOs who have not previously worked in Stockport National Health Service Trust and the aim is to integrate them faster by encouraging contact between doctors and departments. This gives them support in their training. Only clinical support departments were involved in the February trial, but, since August, buddies have spread across the whole trust.
Each buddy and trainee gets an information pack to explain the system and each other's role, accompanied by contact details. The trainees also get a checklist from each department that contains the sort of questions they may need to ask buddies at their current stage of training. This is intended to reassure PRHOs that their inquiries are not inane. No one wants a situation in which there is a reluctance to ring a buddy with a question crucial to patient care for fear of being thought silly.
In February, all participants were invited to a lunchtime "Nosh and Natter" after three weeks to give their opinion on the system and make suggestions for improvement. Acting as judge and jury, the participants gave a positive verdict. There was such enthusiasm that all buddies volunteered to help again. Hiccups included shift work, which meant PRHOs and their buddies sometimes worked at different times, and buddies who did not carry pagers were difficult to contact. A minority of trainees felt that they did not need a buddy.
The act of buddying is not totally altruistic. Buddies can use the experience as part of their own development and display it on their CV. To encourage this idea all buddies last month were given a certificate as proof of their participation to display proudly on their office walls and to serve as a reminder when they themselves are calling on colleagues for help - that we are all only human.
- "I've had lots of interaction with pre-registration house officers that I probably wouldn't have had otherwise."
- "It enables the building of relationships."
- "We can correct any potential problems before they occur."
- "It overcomes juniors' reluctance to make contact."
...and the buddied
- "Having buddies means you are able to find answers to questions not in textbooks."
- "Buddies provide reassurance."
- "It's good to see a friendly face."
Catherine Smith is project manager of Doctors in Training.