A mixed-methods study identifying and exploring medical students' views of the UKCAT.

BACKGROUND: The United Kingdom Clinical Aptitude Test (UKCAT) is used by 23 UK medical schools. Research to date has focused on validity and utility but it is also critical to examine selection processes from the applicant's perspective. METHODS: This was a mixed-methods study using a paper-based survey and focus groups with first year medical students in Scotland in 2009-2010. Questionnaire data were analysed using SPSS, focus group data using framework analysis. RESULTS: The survey return rate was 88% (883/1005). More than 99% of respondents had sat the UKCAT. Only 20% of respondents agreed the UKCAT was useful in the selection procedure. Nineteen students then took part in three focus groups held in three medical schools. These identified four themes related to views of the UKCAT: lack of face validity, concerns about fairness and cost, and the use of data by medical schools and influence of preparation. CONCLUSION: The UKCAT was viewed unfavourably by first year medical students completing it pre-admission. These negative views seem due to concern as to the use of UKCAT data, and the fairness of the test. More evidence as to validity and fairness of the UKCAT and how it is used in practice is required.

Consultants in nhs scotland: a survey of work commitments, remuneration, job satisfaction and retirement plans.

BACKGROUND AND AIMS: UK consultants have reported working long hours, increased stress and reduced morale. This study set out to elicit consultants' views on flexible working and to gather data on consultants' workloads, remuneration, job satisfaction and retirement plans. As such it is the first comprehensive study of consultants in NHS Scotland. METHODS: The Information and Statistics Division of the Scottish Executive Health Dept provided a list of consultants working in NHS Scotland Focus groups and interviews informed the design of a postal self-completion, questionnaire. RESULTS: The response ratewas 61%. Almost two-thirds (65%) of respondents felt their workloads were unreasonable and unsustainable and 67% were unable to provide their desired standards of patient care. Two-thirds (67%) did not normally take meal breaks, 63% had insufficient time for outside interests, whilst 44% felt their health was being adversely affected Many (84%) believed that some of their work could be delegated to someone less qualified but 79% agreed that there were insufficient staff to make this possible. The average planned retirement age was 60 years, with 23% describing their plans as definite and 70% as quite or very likely. When asked what might induce them to postpone retirement, 50% cited reduced workload/work intensity. CONCLUSIONS: In 2003, a majority of consultants in the UK voted in favour of the new consultant contract. This will improve consultant pay and introduce a standard 40-hour working week, including worked on-call. This should address tow of the main areas of consultant dissatisfaction in NHS Scotland. However, staff shortages will require to be addressed if the contract is to be successfully implemented.

Coping with the epidemic. The impact of proximal femoral fractures upon the acute orthopaedic services in northeast Scotland.

Increasing health care costs and an aging population have made hip fractures one of the most pressing concerns for developed nations in the latter half of the twentieth century. Using data collected in 1970 and in 1993, the extent of the hip fracture problem in the northeast of Scotland is assessed. The results demonstrate a 101% increase in the number of patients admitted with hip fractures, and an increase in the proportion of patients aged 75 years and over by 158%. Although there has been no change in the number of acute orthopaedic beds in the region, the increase in patient numbers have been managed by approximately halving the in-patient stay through the provision of rural convalescent/rehabilitation beds. Through this approach considerable savings can be made by the health service without reducing the standard of care that is required by the elderly patient later in the post-operative period. In addition, this approach will help focus local community services upon the long-term placement of the patient, in keeping with current government policy.

GP non-principals in north-east Scotland--a valuable pool of medical labour or second-class citizens? Results of a questionnaire survey.

OBJECTIVES: (1) To identify all general practitioner [GP] non-principals in the Grampian Health Board area (north-east Scotland), (2) To seek their views via a questionnaire survey, (3) to offer them the opportunity to meet individually with an Associate Adviser [GP Tutor]. DESIGN: All GP practices were contacted, requesting the names of non-principals. A questionnaire was sent, where possible, to all non-principals so identified. SETTING: The Grampian Health Board area in north-east Scotland. SUBJECTS: One hundred and nine names were obtained, 90 questionnaires were mailed and a final response rate of 67 per cent was achieved. RESULTS: Eighty-seven per cent of respondents were female (median age--35 years); 92 per cent were vocationally trained; 89 per cent had at least one postgraduate qualification; 32 per cent had been a principal; 68 per cent agreed to meet with an Associate Adviser. There was considerable confusion regarding entitlement to funding for continuing medical education [CME]. Advantages of working as a non-principal included the flexibility of working part-time and limited involvement in practice administration and out-of-hours work. However, many disliked their inferior conditions of employment, their inability to follow up patients and the negative attitudes displayed by some principals. Feelings of professional isolation, lack of involvement in practice decision-making and employment insecurity were also cited as disadvantages. Short-term career plans included maintaining the status quo (45 per cent); increasing work commitment (26 per cent) or becoming a principal (11 per cent), while in the longer term, 67 per cent of those intending to remain in general practice wished to do so on a part-time basis. The main factors determining career plans were family commitments and/or availability of suitable posts. CONCLUSIONS: Demand for part-time principal posts will undoubtedly increase. Regional databases of non-principals must be established and all GPs must have equal access to CME particularly in the light of the General Medical Council's [GMC] pronouncements on revalidation of all doctors.

Cost analysis of fracture of the neck of femur.

A detailed cost analysis of fractures of the neck of femur in elderly patients has been conducted at Aberdeen Royal Infirmary. The aims of this study were as follows: (1) to show that the use of average orthopaedic bed day costs can lead to an overestimation of costs; (2) to identify the key explanatory variables of hip fracture costs; and (3) to identify differences in resource consumption between patient groups. The care of 50 first and ten second (contralateral) hip fracture patients admitted to Aberdeen Royal Infirmary in 1993 was costed in considerable detail. Acute care, convalescence, rehabilitation and operations accounted for more than 90% of total costs in both groups. It was found that patients who were admitted from their own homes cost significantly more than patients who were admitted from long-term care (4018 pounds vs. 2069 pounds; p < 0.001). In order to validate the costed samples, additional data were collected on all hip fracture patients admitted to Aberdeen Royal Infirmary in 1993. The main factors in explaining cost variation were the number of days spent in acute care and convalescence or rehabilitation [r2 = 0.62; logcost = (0.009 x acute days) + (0.01 x rehabilitation days) + 3.213]. Age and place of residence prior to admission explained a further 2.8% of total costs but neither variable was statistically significant. When costing fractures of the neck of femur, we recommend the collection of a minimum data set of these four variables which account for 65% of the variation in total costs.