Trainee doctors barely out of medical school are being asked to perform duties above their grade, are subject to bullying and inadequate supervision, and given poor feedback about their progress, according to a series of Medical Council reports on clinical training in nine hospitals.
They also regularly work in excess of a 48-hour week, which is illegal, are often not given protected training time and are asked to seek consent for procedures with which they are not familiar.
Stephen McMahon, director of the Irish Patients’ Association (IPA), said it beggared belief that bullying was still a feature of medical training a decade after he was involved in audits where it was also highlighted.
Moreover, he had “grave concerns” that interns — doctors in their first year of training after graduating from medical school — were been asked to act above their level of competency.
We’ve seen people struck off for that,” he said.
The Medical Council, which inspected training standards at five hospitals in the South/SouthWest Hospital group and four in the west of Ireland Saolta group, found substantial levels of compliance overall, but also shortcomings, including:
- Allegations of bullying at Letterkenny University Hospital. Trainees also reported a lack of professionalism between consultants, particularly when talking about consultant colleagues;
- Trainees being asked to take consent in surgery even though this should not happen unsupervised;
- Reports of signs on the radiology department door at Letterkenny saying “No NCHDs” (junior doctors);
- At Portiuncula University Hospital, evidence of very experienced trainees spending much of their time clerking patients;
- An alleged incident where trainees were left unsupervised when a consultant was absent for a week at Galway University Hospital;
- Interns left to complete patient charts at Sligo University Hospital regardless if they had seen the patient.
Substantial shortcomings were identified in South Tipperary General Hospital, including that bullying had gone unchallenged. Trainees there reported being left out of the loop in clinical discussions and raised concern about junior doctors not speaking in English, which they believed posed a risk to patients.
The Medical Council said this was “a particular issue in STGH, where there is a high percentage of non-national medical graduates”.
Responding to the Medical Council reports, the Irish Medical Organisation (IMO) said the unfair treatment of young trainee doctors was “encouraging emigration and adding to the recruitment and retention crisis amongst Irish doctors”.
The South/South West Hospital Group said it is currently recruiting two training leads whose remit will focus on “medical workforce training related issues” across the group.
“SSWHG will continue to proactively assess the findings identified in this report to ensure that the issues and deficiencies identified are effectively managed,” it said.
Trainee doctors ‘feeling belittled’ at Cork hospital
Complaints about unprofessional treatment by some members of the radiology department at Mercy University Hospital (MUH) in Cork, and examples of disrespectful treatment by some nursing staff, were among concerns raised by trainee doctors with the Medical Council during an inspection last year.
The trainees told the council that although MUH “has a respectful and professional working environment”, interns reported “a number of incidents when they were not treated with respect and described feeling belittled”.
“For example, interns reported incidents where some (but not all) members of the Radiology Department had treated them very unprofessionally, when attempting to order scans.”
The Medical Council team also said it “was concerned about an example where an intern was not able to eat while on a long shift, and had been criticised by nursing staff for attempting to do so”.
Moreover, male interns reported receiving preferential treatment to that of their female colleagues from nursing staff while on call.
Interns — in their first year of training after medical school — believed that reporting such incidents could have an adverse effect on them.
At Portiuncula University Hospital, a trainee reported not being provided with training in a particular procedure because their trainer did not have the required skills.
At Letterkenny University Hospital, it was reported that not all trainees are made aware of who their clinical supervisor is and it was also reported that a trainer was not aware that they had a trainee.
The council findings are on the back of inspections of hospitals in the South/South West Hospital Group and the Saolta west of Ireland group, last year, conducted to assess compliance with standards for training interns and specialist trainees.
Medical Council president Dr Rita Doyle said doctors “must be supported in their roles in caring for their patients, especially our interns and our specialist trainees who are the future of Irish healthcare”.
The council said it has raised concerns regarding access to protected training time for trainers with the HSE’s National Doctor Training and Planning Directorate, the Forum of Irish Postgraduate Medical Training Bodies, and the Department of Health.
The council said prioritising service delivery over education due to a lack of resources has been presented, repeatedly, as a barrier to compliance.
A spokesperson for the Saolta group said with no precedence for such inspections [it’s the first inspection of hospital groups] “we would like to acknowledge the efforts of all our staff in education in spite of their heavy workload and infrastructural challenges”.
The spokesperson said an implementation plan has been developed to address the recommendations outlined in the Medical Council reports.