Career choices of the United Kingdom medical graduates of 2005, 2008 and 2009: Questionnaire surveys

Abstract

In 1978-87, case fatality rates for all hospitals combined were 39.7% at 30 days and 56.9% at one year (table). In 1988-97, the corresponding figures were 32.9% and 48.9%. The table shows that case fatality rates were lower for the region's teaching hospital (I) than for all other hospitals combined. Significant differences were also seen between individual nonteaching hospitals. Variation between the teaching hospital and individual non-teaching hospitals reduced over time.Differences in case fatality rates during the first 30 days accounted for the differences between hospitals and most of the difference over time (table ). For 1988-97, the low case fatality rate for in-hospital deaths in hospital III within 30 days, calculated without data linked to death certificates, was as high as that in other hospitals when linked data were used. Otherwise, case fatality rates for in-hospital deaths were good predictors of hospitals' relative rankings when rates were calculated with data linked to death certificates (Spearman's rank correlation coefficients between in-hospital deaths and deaths anywhere at 30, 90, and 365 days were 0. 83, 0.86, and 0.88 in 1987-98 and 0.93, 0.81, and 0.71 in 1988-97).Age and sex standardised case fatality rates at 30 days in 1978-87 and 1988-97 were 33.2 and 24.7 in people < 75 years and 27.5 and 19.8 in those < 65. Differences between hospitals for case fatality rates in patients < 75 and < 65 years were similar to those found for patients of all ages, although with diminishing statistical power not all comparisons reached significance (see tables A-C on bmj.com). CommentCase fatality rates after hospital admission for stroke were high: about half of all patients died within one year. Differences in case fatality rates over time, and between hospitals, might be explained by differences in the case mix and particularly by differences in the severity of stroke and the extent to which patients were managed at home rather than in hospital. For these reasons, differences are hard to interpret. If the differences can be attributed to standards of care, rather than case mix, their impact is greatest in the acute phase of care: the reductions over time, and the differences between hospitals, were predominantly seen in fatality rates within 30 days of admission.We thank Ruth M Ripley for advice about statistical methods. Contributors: SR designed the study, analysed the data, and wrote the manuscript. MG designed the study and wrote the manuscript. MG and SR are guarantors for the paper. The career choices of doctors at the end of their preregistration year have been studied for doctors who qualified in the United Kingdom in 1974Kingdom in , 1977Kingdom in , 1980Kingdom in , 1983Kingdom in , 1988Kingdom in , 1993Kingdom in and 1996 We report here on the graduates of 1999 and 2000. Participants, methods, and resultsThe survey population comprised all graduates from all medical schools in the United Kingdom in 1999 and 2000. We used graduation lists from each medical school to compile our...

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