Trial systems for assessing and reviewing patients may have a negative effect on the training of junior doctors, according to a new study of acute care at the Royal Liverpool University Hospital. The findings, published in the journal ‘Clinical Medicine’ show that while NHS targets are being met trainees’ learning opportunities have suffered.

The study found that accident and emergency waiting times and the wait to be assessed by a consultant in acute settings improved after reforms in the hospital. The restriction of hours, however, prevented junior doctors from being present when patients they had admitted to the wards were seen by a consultant. About half of diagnoses are changed at that stage but the system has no mechanism for feedback to the initial assessing team.

The authors say systems and patterns of work at the Royal Liverpool are likely to exist in other hospitals which are struggling to balance waiting time targets with the new target of reducing junior doctors’ working hours.

Dr Solomon Almond, from the research team said: “Ideally all emergency admissions would be seen straight away by consultants accompanied by the junior doctors. This would re-establish the link between hands-on clinical medicine, training and experience that was for many years the foundation of post graduate medical education in this country.”

The Director of Workforce Planning at the Royal College of Physicians, Dr Andrew Goddard said the study showed that increasing the input of consultants into the care of medical patients admitted to hospital changed the way doctors were trained. He added: “The short term benefits to the patient of seeing a consultant first may be offset by loss of training opportunities for the consultants of the future.”