Continuing medical education: experience and opinions of consultants.

The right of consultants to study leave and expenses is not binding on trusts and has been eroded in directly managed units. Complaints led to a survey of consultants in North West Thames region. This showed that most consultants use their own time and money to maintain their knowledge by buying and consulting journals and textbooks, attending local meetings, and using their annual leave for study, but they feel the need for study leave to attend meetings of specialist societies and courses. Leave is usually granted readily but without cover provided by a locum and with a very limited contribution to expenses. To maintain quality of medical care both the right and obligation to take study leave should be contractual.

A physician who qualified in the 1920s said as he retired, "When I was a house physician I had only half a dozen effective drugs at my disposal, now I have several hundred. Nothing in my medical training prepared me for this explosion of clinical pharmacology." Consultants retiring in 1992 look back on many more dramatic developments during their graduate careers most of which they were unprepared for. They range from scientific milestones such as the cracking of the genetic code, the birth of molecular biology and modern genetics, the discovery of the HLA system, and the start of organ and tissue transplantation to everyday medicine such as coronary care and thrombolysis, coronary angiography, angioplasty, and bypass surgery, to mention only a few.

Self evidently, medical and scientific education must continue unabated throughout a consultant's life. This was recognised in 1971 in the conditions of service of consultants set out in a document often referred to as the "red book."[1] A retrospective analysis of study leave in 1990 by the Standing Committee on Postgraduate Medicine showed that consultants took less than their allowance--an average of 6.2 days a year.[2] During 1991 the public health directorate of North West Thames Regional Health Authority received complaints from several consultants about further erosion of these provisions after the responsibility for continuing medical education was devolved to units and trusts in April 1991. The authority had distributed its budget for continuing medical education to district health authorities before the April 1991 deadline. The complaints arose during the period after the transfer, when it was widely believed that the budget had not always been used for its intended purpose.[3]

We conducted an initial survey by telephone which showed that this was not just the view of a disgruntled few. We therefore conducted a wider survey of the experience and opinions of consultants. A questionnaire was sent to a 1 in 5 sample of the 1338 consultants in the region. These included honorary contract holders, mainly university staff in St Mary's and Charing Cross and Westminster Hospital Medical Schools, who carry out a substantial amount of the consultant work in inner London.

Methods

The sample was drawn from the regional file of consultant staff. Each consultant has a number; from these a 1 in 5 sample was chosen by using random numbers. No stratification was used.

The questionnaire was designed in house and tested on members of staff in the directorate and, in its penultimate form, on regional advisers, who were asked to criticise it. The final version sought factual information about the consultant's use of study leave over the past two years (one year in the case of three consultants between one and two years in post); the local arrangements for obtaining study leave and expenses and any ceiling on reimbursement; and their future intended use of study leave. Consultants were asked to give their view of the main purposes of study leave before being cued by direct questions; to list the other methods they used to keep up to date; to rank the importance of arguments in favour of retaining and protecting study leave. Copies of the questionnaire are available on request from the authors.

Results

THE RESPONSE …