James Parkhouse

Career preferences of doctors who qualified in the United Kingdom in 1993 compared with those of doctors qualifying in 1974, 1977, 1980, and 1983

Abstract Objective: To report the career preferences of doctors who qualified in the United Kingdom in 1993 and to compare their choices with those of earlier cohorts of qualifiers. Design: Postal questionnaires with structured questions, including questions about choice of future long term career, were sent to doctors a year after qualification. Setting: United Kingdom. Subjects: All medical qualifiers of 1993, comparing their replies with those from earlier studies of the qualifiers of 1974, 1977, 1980, and 1983. Main outcome measures: Choice of future long term career and certainty of choice expressed at the end of the first year after qualification. Results: Questionnaires were sent to 3657 doctors. 2621 (71.7%) replied. Of the 2621 respondents, 70.5% (1849) stated that their first preference was for a career in hospital practice, 25.8% (677) specified general practice, 1.0% (25) specified public health medicine or community health, 1.4% (36) specified careers outside medicine, and 1.3% (34) did not state a choice. By contrast, 44.7% (1416/3168) of the doctors in the 1983 cohort had specified that their first preference was general practice. Among the 1993 qualifiers, general practice was the first career choice of 17.5% of men (227/1297) and 34.0% of women (450/1324). Only 7.4% of men (96/1297) stated that they definitely wanted to enter general practice. Only 7.8% (103/1324) of women qualifiers in 1993 expressed a career preference for surgical specialties. Within hospital practice, comparing 1993 with 1983, choices for the medical specialties and for accident and emergency medicine rose and those for pathology fell. Women were less definite than men about their choice of future long term career. Conclusions: If the 1993 cohort is typical of the current generation of young doctors, there has been a substantial shift away from general practice as a career choice expressed at the end of the preregistration year. General practice was much more popular among women than men. Few women opted for surgery. The sex imbalance in the percentage of doctors who choose different mainstreams of medical practice seems set to continue.

Doctors' careers : aims and experiences of medical graduates

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Graduate status and age at entry to medical school as predictors of doctors’ choice of long-term career

To determine whether graduate entry to medical school, taking an intercalated degree during medical school, and age at entry to medical school are related to choice of eventual career.

Clinical performance of the OMV inhaler

The Oxford Miniature Vaporizer (OMV) has been developed during the last four years by the Nuffield Department of Anaesthetics in conjunction with the Longworth Scientific Instrument Company. The purpose of this article is to describe some aspects of its clinical performance when used with halothane. Although inhalers for the volatile agents, such as the EMO ether inhaler, have found wide acceptance throughout the world one of the main difficulties with their use has always been the achievement of a smooth induction. This is particularly important when the administrator is likely to be a more-or-less unskilled anasthetist as in remote communities or in the handling of mass casualties. In recent years it has become increasingly apparent that halothane offers outstanding advantages over any other anresthetic drug for the purpose of introducing ether: there is a remarkable absence of coughing, laryngeal spasm or other disturbance and, indeed, it is unusual to see any evidence of an excitement stage. Clearly, a swift trouble-free induction of this kind, followed by maintenance with ether, with its known reliability and wide safety margin, has much to recommend it. Yet for the relatively inexperienced amsthetist the use of halothane a potent and potentially dangerous agent can only logically be defended if everything possible is done to ensure that inadvertent overdosage does not occur. The ideal apparatus for induction, therefore, is one which liniits both the concentration and the amount of halothane which can be delivered. The OMV was originally conceived as one of a number of such devices. It was intended to be simple, portable and fool-proof and to deliver fairly accurate concentrations, within defined limits, over a short period of time. During the last four years prototype models of the OMV have been used clinically in Oxford and in inany other parts of the worldl. From these early trials, and from laboratory tests, it became evident to Dr H. G. Epstein that, if certain design difficulties could be

Postoperative analgesia with ketamine and pethidine.

A double-blind trial compared ketamine with pethidine, pethidine alone at two dose levels and a placebo, in patients with postoperative pain. By assessment of pain intensity, observed relief and side-effects, the active drugs were clearly distinguishable from the placebo. With the doses used, however, the combination of ketamine with pethidine showed no advantage over pethidine alone.

Doctors who qualified in the UK between 1974 and 1993: age, gender, nationality, marital status and family formation.

We report on some demographic characteristics of junior doctors in the United Kingdom, studied in six national cohorts of qualifiers between 1974 and 1993. Over the 20 years covered by the data, the percentage of qualifiers who were women increased substantially (from 27% in 1974 to 47% in 1993). Between 1983 and 1993, the number of women qualifiers rose by 242 (a 17% rise) and the number of men fell by 430 (a fall of 18%). Of all doctors, 52% were aged 23 years or less when they qualified and there was no increase over time in mature qualifiers. We report on increases in the percentage of doctors who qualified in the UK but who were born outside it (from 11% to 16%). The percentage of respondents who were married at the end of the first year after qualification declined from 45% in 1974 to 15% in 1993. At 25 years of age, 2% of the women doctors who qualified in 1983 had children compared with 45% of women aged 25 in the general population. Two‐thirds of the women doctors had children by their mid‐30s.

Intentions of newly qualified doctors to practise in the United Kingdom

In a series of cohort studies of newly qualified British medical graduates, respondents were asked about intentions to practise in the United Kingdom.1 2 We compared the intentions of those who qualified in 1993 with the intentions and subsequent employment of earlier cohorts. The studies were undertaken by mailed questionnaires. Members of each cohort was asked in their preregistration year, “Apart from temporary visits abroad, do you intend to practise in the United Kingdom for the foreseeable future?” There were five possible responses: “yes–definitely,” “yes–probably,” “undecided,” “no–probably not,” and “no–definitely not.” For this report, these five categories were reduced to three by combining the “yes” and the “no” categories. Of those qualifying in 1993, 75.7% (1969/2600) definitely or probably intended to practise …

Home, training and work: mobility of British doctors

This study examines the locations of family homes, medical schools and places of specialist training, and work of doctors qualifying from UK medical schools in 5 calendar years between 1974 and 1993. The contribution of each UK region to the medical workforce relative to its population is assessed and trends over time are examined. The relationship between place of family home and medical school attended is examined for 14,108 doctors. Career appointment location and its relationship to medical school and family home loc‐ation are examined for over 4000 doctors. For the qualifiers of 1983, an additional analysis incorporating place of training is included. Large differences were found in the percentage of medical students from local family homes attending each regional medical school. In some cases differences reflected local populations but other cases had no obvious cause. Over all cohorts studied, 38% of respondents attended a medical school in the region of their family home (32% of 1993 qualifiers), 42% held a career post in the same region as their medical school, and 38% held a career post in the same region as their family home. Among the qualifiers of 1983, 65% had a career post in the same region as their postgraduate training, 34% also attended medical school in the same region, and 19% also came from family homes in the same region. More women than men took up a career post in the same region as their postgraduate training. The relationships to family home and medical school did not differ by gender. Consultants appeared slightly less likely than GPs to have stayed within a region, but this difference was not statistically significant.

Allocation of preregistration posts1

Not every graduate easily finds a suitable combination of preregistration posts. This problem might be expected to grow if the number of British graduates increases at the expected rate during the next 10 years. More posts and a more efficient system of allocation perhaps on a national basis will be needed. Several medical schools and regional boards are developing effective allocation systems, but in the country as a whole preregistration posts still sometimes stand vacant, unbeknown to graduates who are in need of places. Postgraduate Deans are concerned about this problem, and the Central Committee on postgraduate Education has set up a central clearing house; this, at first, will merely supplement regional schemes, which do place most graduates fairly satisfactorily. The present difficulties and the anticipated needs of the future have combined to encourage the creation of additional preregistration posts. This must not be done at the expense of standards. Many currently recognized posts require critical examination; if each region were to be surveyed with a view to eliminating unsuitable posts as well as creating new ones, the country might finish up with a smaller total number of preregistration posts than at present. Considerations of ‘quality’ apply also to the occupants of posts, While the undergraduate course is fixed in length, there will always be some new graduates who are more capable of assuming responsibility than others. Should the preregistration year, then, be regarded as a prolongation of the medical school course during which the weakest students are placed in the jobs which offer them the most supervision and support, or should it be seen as a time when the student receives his

General Anaesthesia as an Aid to Therapeutic Hypothermia

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