Problem Junior doctors have historically worked long hours, impacting upon their health and patient safety.¹ The 2016 Junior Doctor Contract dictated the hours a doctor can safely work and established mechanisms to address any requirement to exceed these. The contract’s impact is not well characterised, and it is unclear whether junior doctors are aware of its effect on their working hours.

We sent a survey to all junior doctors at a London hospital to assess their understanding. 58% of the respondents (45 out of 215 responded) did not fully understand what a work schedule was and 80% were not confident about how to exception report (rated their understanding 1–3 out of 5).

Intervention We devised an interactive teaching programme for final year medical students to address this knowledge gap. Support from the Guardian of Safe Working Hours (GSWH) facilitated access to two medical schools. The programme contained transformative assessments, lectures and workshops. Pre-lecture and post-lecture surveys enabled the lecturers to identify learning needs and adapt the teaching accordingly. A 3 month follow-up survey will assess the long-term value and areas for improvement.

Measurement The pre-lecture and post-lecture surveys asked medical students to rate their confidence in their understanding of various domains (1=not at all confident, 5=very confident). The pre-teaching survey identified a need for teaching about the contract; and the post-teaching survey demonstrated that the teaching programme significantly improved understanding (paired t-test p<0.001 for all domains). The mean ratings were (n=100):

• Terms and conditions of employment- pre-teaching (prior) 1.63, post-teaching (post) 3.51

• Work schedules- prior 2.21, post 3.67

• Exception reporting- prior 1.79, post 3.74

• Guardian of Safe Working Hours- prior 1.68, post 3.61

Effects Equipping final year medical students with an understanding of the importance of limiting working hours to enhance patient safety is fundamental. They need to know how to work safely – and what action to take if required to work extra hours or to miss breaks. The teaching programme should empower them to engage with their GSWH about safe service delivery.

Lessons Learnt The tight time schedule meant we were only able to deliver the teaching programme at two universities and weren’t able to publicise it much. The session might sit better within a cohesive module on life-skills for junior doctors.

Key Messages This work highlights junior doctors’ and final year medical students ’poor knowledge of the contract, including its importance in regulating their hours, highlighting staffing issues, and thus protecting patients. This study has shown that it is possible to improve medical students’ awareness of the contract through a teaching programme. This should become an essential part of the curriculum.

Reference

1. . Eddy R. Sleep deprivation among physicians. BC Medical JournalMay 2005;47(4):176–180.