Article
Clinical training experience in district general hospitals
Roderick MacFaula, Stephen Jonesa, Ursula Wernekeb
a Paediatric
Department, Pinderfields Hospital, Pinderfields and Pontefract NHS
Trust, Wakefield WF14 DG, UK, b Maudsley Hospital, Denmark Hill, London SE5
8AZ, UK
Correspondence to: Dr MacFaul email: mfrod{at}easynet.co.uk
Accepted 20 March 2000
AIMS
To estimate the nature and
quantity of clinical experience available for trainees in paediatrics
or general practice in acute general hospitals of differing sizes in
the UK. To discuss implications for training and service configuration
taking account of current Royal College recommendations (a minimum of
1800 acute contacts each year and ideally covering a population of
450 000 to 500 000 people).
METHODSObserved frequencies of
diagnoses in Pinderfields Hospital, Wakefield were compared with those
in five other hospitals in Yorkshire and four in the South of England,
and with expected frequencies from a review of selected marker
conditions using national routine and epidemiological data. Based on
the Pinderfields data, we modelled expected frequencies of a wider
range of diagnoses for different sized hospitals.
RESULTSSmall units (1800 or less
acute referrals a year) provide adequate exposure to common conditions
such as gastroenteritis (157 per annum) and asthma (171 per annum) but
encounter serious or unusual disease rarely. When modelled for units
serving larger populations, numbers of such disorders remain small. For
example, about 0.5% of admissions require intensive care to the level
of ventilatory support. Medium size units offer a wide range of
experience but differ little from those serving the population of
500 000 proposed as being optimal for training. This standard is not
justified by the evidence in this review. Closing or amalgamating units on the scale necessary to achieve this ideal would be impractical as
only five hospitals in England have a paediatric workload equivalent to
this population; it would also raise issues of access and equity.
Keywords: clinical training; general hospital; general practice
© 2000 by Archives of Disease in Childhood
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