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Changes to Trainee Doctor Rotations are needed to Improve Patient Safety and Quality of Care

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17 Apr 2014

The Academy of Medical Royal Colleges is today publishing proposals to end the so-called ‘black Wednesday’ phenomenon – the day in August every year when medical trainees across the UK move to a new post in a hospital, which has traditionally been accompanied by a spike in mortality rates.

With patient safety paramount, the Academy reviewed the current rotation system for trainee doctors and recommend changes where appropriate under the approval of the four UK Health Departments.  The proposals, produced by the Academy’s Staggered Trainee Changeover Working Group, which comprised medical Royal Colleges and medical education specialists, were considered by the four UK health department’s Medical Education Scrutiny Group’s Reference Panel in January of this year, which said that the paper’s recommendations should be considered in more detail within the initial scoping work that is underway to take forward the Shape of Training Review.

The paper, which has the support of all the medical Royal Colleges and Faculties, suggests all Foundation Year 1 posts should begin on the first Wednesday in August as has always been the case, but other training posts should begin in September. This simple change will ensure that in August each year the new Foundation Year 1 Trainees will always work with Core/Specialty Trainees who have already been in the post for between 5 and 11 months.


This recommendation builds on other changes already underway which have also begun to address the issue. These include: 

  • NHS Medical Director, Sir Bruce Keogh’s initiative to introduce a successful “shadowing period” whereby newly qualified doctors can familiarise themselves with their jobs in the week immediately before they actually start work
  • Joint guidance from the Academy of Medical Royal Colleges and NHS Employers on practical actions that can be taken by trusts to improve changeover


Dr Simon Newell co-author of the paper and Chair of the Academy Staggered Trainee Changeover Working group said:

“This has been an important piece of work which has been driven by concerns about patient safety. Evidence suggests that patients die because of the current arrangements. I believe our proposals, which were the subject of considerable debate and consultation, will improve quality of care and patient safety, and it is therefore important that this work, while it should form part of the Shape of Training proposals, does not get lost within its wider agenda”.

Click here to access the proposals.

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