The early experience of doctors training in pediatrics: patient safety culture and the role and influence of the registrar

Abstract

Introduction

Postgraduate medical training incorporates education, both formal and informal, combined with clinical service. This study explored the early training experience of pediatricians in Ireland and its potential impact on patient safety.

Aim

We sought to identify factors that contribute to the patient safety experience of new entrant pediatric trainees.

Methods

Trainees, or senior house officers (SHOs), in their first year of postgraduate training, participated in an interview conducted using a critical interview technique (CIT). They described an adverse event where the medical care delivered to the patient was not ideal. Thematic analysis identified themes that influenced the described event.

Results

Thirteen trainees participated in the interviews. This study identified influences on the relationship between the SHO and patient safety, including the SHO themselves, teamwork and communication. Colleagues within the workplace, including consultants, registrars, and nurses, also affect this relationship. The registrar is described as a central figure holding an active role in clinical care in 11 of the 13 stories told. In the participants’ experience, the registrar was the senior decision-maker, teacher, team builder, and communication intermediary within the teams’ hierarchical structure. The registrars’ previous clinical experience, communication style, along with their ability to supervise and provide feedback shaped the SHO experience.

Conclusions

Through a process designed to focus on exploring patient safety, it emerged that the registrar plays a crucial role in the working experience of their junior colleagues. The influence of the registrar needs to be recognized within clinical teams and by postgraduate training bodies.

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Fig. 1

Availability of data and material

The data of this study is the interview transcripts. They were recorded and treated as confidential. They were transcribed by the PI with preservation of participant anonymity.

Code availability

This qualitative study and thematic analysis involved developing a custom code as outlined in methods.

Abbreviations

CIT:

Critical interview technique

PI:

Principal investigator

RCPI:

Royal College of Physicians of Ireland

SHO:

Senior House Officer

SME:

Subject matter experts

TCD:

Trinity College Dublin

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Authors

Corresponding author

Correspondence to Catherine Diskin.

Ethics declarations

Ethics approval

Ethical approval was provided by the Health Policy and Management/Centre for Global Health Research Ethics Committee at Trinity College Dublin, the University of Dublin (TCD) and supported by the Faculty of Paediatrics, Royal College of Physicians of Ireland (RCPI). These are included as Appendix 1 and 2.

Consent to participate

All participants consented to participation in the study. No incentives were offered. It was made clear that a decision not to participate would not impact on their reputation or opportunities made available to them in the future. The right to withdraw from the study at any time was highlighted in written information provided and a time of interview. Written consent was obtained from participants prior to interview.

Consent for publication

Participants were advised in information leaflets provided in advance that results of the study would be presented and published without including any identifying information relating to them.

Conflict of interest

The authors declare that they have no conflicts of interest.

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Diskin, C., Byrne, D., Normand, C. et al. The early experience of doctors training in pediatrics: patient safety culture and the role and influence of the registrar. Ir J Med Sci (2021). https://doi.org/10.1007/s11845-021-02520-7

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Keywords

  • Postgraduate medical education
  • Registrar
  • Senior house officers (SHOs)