Are graduate doctors adequately prepared to manage acutely unwell patients?

BACKGROUND: Medical schools face the challenge of equipping medical graduates with the skills and knowledge required in the early detection and management of acutely unwell patients. Studies reveal that junior doctors are inadequately prepared to manage acute illness, and lack the ability to resuscitate patients in cardiac arrest. A modified programme of learning, focusing on recognition and management of the acutely ill patient and cardiac arrest, was introduced for final-year medical students at the James Cook University Hospital. Evaluating the effectiveness of the teaching was vital, as junior doctors are often the first responders to deteriorating patients who require prompt life-saving interventions.
METHODS: This qualitative study involved interviewing a purposive sample of graduate doctors following 4 months of acute clinical experience. The study explored their encounters of acute illness and their levels of preparedness to manage such patients within the clinical environment upon qualifying. Content-thematic analysis was utilised to examine interview data.
RESULTS: Although anxious, participants expressed that they were adequately prepared to manage the acutely unwell patient and cardiac arrest upon qualifying. The programme of learning proved effective in providing learning experiences, mainly through clinical simulation, the use of the ABCDE (airway, breathing, circulation, disability, exposure) structured approach, and the Immediate Life Support course (Resuscitation Council, UK), and in equipping graduate doctors with the knowledge and skills required to manage critically ill patients. DISCUSSION: In essence, clinical tutors are indirectly responsible for saving patients lives. Evaluating the effectiveness of acute illness teaching is essential, as this ultimately will impact on patient outcome and survival. © Blackwell Publishing Ltd 2010.