A qualitative study of the perceptions and experiences of Pre-Registration House Officers on teamwork and support

A qualitative study with semi-structured interviews with 33 PRHOs, stratified by gender, ethnicity and maturity, from two study cohorts, qualifying in 2001 and 2002, from one medical school in the UK, in their first three months following medical graduation.Most PRHOs reported positive experiences for their inclusion as a full member of their first ward teams. This contributed to their increasing confidence and competence in this early period of career transition. However, a number of organisational barriers were identified, e.g. incomplete teams, shift work, which produced problems in their integration for one third of newly qualified doctors.Recently introduced policies, intended to improve the working lives of newly qualified doctors have produced both benefits and unintended adverse impacts on PRHOs. The changes of the new PRHO Foundation programme will have further impact. Foundation doctors may need to relate to wider teams with more interaction and less protection. Such changes will need to be managed carefully to protect the PRHO at a vulnerable time.There is increasing emphasis on multi-disciplinary teams in modern clinical care [1-3]. Medical schools have attempted to embrace this through interdisciplinary learning [1,4-6] and stressing relevant attitudinal, ethical and behavioural issues [7-9] in relation to teamwork.Concern has been expressed about whether such teamwork skills can be effectively practised by junior doctors during the PRHO year while they cope with multiple professional, personal, physical and emotional demands [10-12]. The General Medical Council document, The New Doctor [13] stated that one of the professional learning outcomes of the pre-registration year is 'to work in a team and to take collective responsibility for patient care'. Several authors [14-17] have recognised difficulties in delivery of these goals although most PRHOs appear to acquire the ability to work in a team by the time of qualification [18,19]. More recent policy c