Are specialist registrars fully prepared for the role of consultant?

Abstract

The step-up from specialist registrar (SpR) to consultant has been acknowledged by doctors as being large. It can involve relatively sudden change, and can be both stressful and demanding.1,2 There is increasing pressure on available time for training, with shortened training programmes and fewer hours spent at work as a result of the European Working Time Directive.2,3 Medical education research has not fully addressed this transition or explored ways of improving it for the benefit of patients and doctors.
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\nNewly appointed consultants are more prepared for some aspects of their work than others. The quality of training in clinical skills is rated most positively, although even this has room for improvement.2,4 New consultants feel less well prepared for their management responsibilities than they do for clinical work,2,4,5 including self-management.6 Training and experience in handling complaints, dealing with difficult professional relationships, recruitment and disciplinary proceedings have also been identified as weaker areas of specialty training.5,6 Feeling inadequately trained in communication and management skills can impact on stress, burnout and the mental health of consultants.4,7 It is notable that two-thirds of cases referred to the National Clinical Assessment Service (NCAS) involved behavioural issues (including difficulties with colleagues), either on their own or in conjunction with other concerns.8
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\nIn the light of these issues, a research project was developed to determine the extent to which specialty training provides doctors with the skills they require when they become consultants.