Objectives To investigate–

1. How neurology speciality registrars are supervised when seeing in–patient ward referrals.

2. To see if supervision differs in different regions within Great Britain.

3. To compare the supervision of neurology trainees with 3 comparable specialities: rheumatology, dermatology and infectious diseases.

Design A cross–sectional, questionnaire–based survey.

Participants Questionnaires were distributed to neurology speciality registrars from 9 deaneries throughout the Great Britain, and dermatology, rheumatology, and infectious disease speciality registrars from the London deanery. In total 123 neurology registrars (87% response rate) and 90 non–neurology registrars (77% response rate).

Results (see Figure 1)

Results Results did not differ significantly between deaneries. The neurology respondents were skewed towards the early years of training with 30% in their first year, 27% in second year, 19% in third year and only 12% each in years 4 and 5. In contrast in the other specialities trainees were more evenly distributed throughout their training years. Most neurology and non–neurology trainees saw more than four ward referrals per week, and most referrals were seen in teaching hospitals, with only about 20% of referrals seen in district general hospitals alone.

Overall, when trainee neurologists were asked about the most common method of supervision, 7% reported that they see ward referrals with a consultant, 51% reported that they discuss them with a consultant, and 46% reported that they ring a consultant if they feel it is necessary. 62% of trainees stated that consultants rarely, or never, write in the patient's notes. Only 11% of 1st year neurology trainees reported that the most common method of supervision was for a consultant to actually see the patient. The figures for non–neurology registrars suggested closer levels of supervision; 22% of trainees reported that seeing referrals with a consultant was the most common method of supervision, 31% reported that they discussed referrals with a consultant, and 48% reported that they contacted a consultant if they needed help.

Conclusion Nearly 90% of first year neurology trainees, and a not dissimilar percentage of first year trainees in comparable specialities, regularly see ward referrals without direct consultant supervision. The two most common ways consultants supervise first year speciality registrars is split evenly between “discuss” and “call me if you need me”. There needs to be wide discussion about the level of supervision needed, as it has potentially serious implications for both the quality of patient care and junior doctor training.