Putting an end to Black Wednesday: improving patient safety by achieving comprehensive trust induction and mandatory training by day 1

Abstract

The term 'Black Wednesday' has been used to describe the August national changeover day, a day when a new cohort of inexperienced doctors start work, many of whom are absent from patient care to attend organisational induction and mandatory training. In this paper, we report on the development and implementation of a novel, interactive e-learning programme for induction and mandatory training for junior doctors in a district general hospital in south-west England from August 2013. This comprehensive mandatory-training programme with summative assessment saved 19.5 hours of trust time per trainee. Since the programme's inception, the completion rate has been 100% (n = 370). Subgroup analysis of starters from August 2013 (n = 141) showed that 85.7% completed by day 1 (mean time of completion 3.0 days before day 1, standard deviation 14.2 days). Importantly, 90 minutes of induction was freed on Black Wednesday, enabling earlier, ward-based clinical orientation, thereby enhancing patient safety. We believe that this is the fi rst programme to combine induction with fully assessed, comprehensive mandatory training in a single package. Such an approach is suitable for widespread application and is to be implemented regionally.

COVID-19: lessons for junior doctors redeployed to critical care

“…33 The UK General Medical Council has issued reassurance that complaints made against doctors acting outside their normal role will be considered in light of an unprecedented public health crisis. 34 The risk of poor patient outcomes can be mitigated by comprehensive local induction 35 and this must be prioritised by senior clinicians despite operational pressures. The Faculty of Intensive Care Medicine has created an online guide to support healthcare providers seeking to safely redeploy non-ICU-trained healthcare professionals to critical care.…”

The Effectiveness of a Foundation Year 1 Doctor Preparation Course for Final Year Medical Students

“…William Beedham 1,2 , Kasun Wanigasooriya 1,2,3 , Georgia R Layton 1,4 , Ley Taing Chan 1,5 , Adnan Darr 1,6 and Devender Mittapalli 1,7 themselves as 'unprepared' which can often be viewed by senior clinicians as incompetence. 5,6 These perceptions in combination with a noticeable but short rise in hospital-based mortality in the first few weeks of August, as new FY1 doctors take to their roles as doctors for the first time, have contributed to the origin of the term 'Black-Wednesday' in the UK.…”

FiY1: A reflective account of the foundation interim year 1 post

“…The first Wednesday in August is colloquially known as 'Black Wednesday'. 1 It marks the annual admission of freshly qualified junior doctors at their allocated hospitals, all beginning their first day as a foundation year 1 (FY1) doctor. However, the first Wednesday in August 2020 was somewhat different from previous years, as many final year medical students had graduated early with the opportunity to take an 'interim' post during the COVID-19 pandemic.…”