Supporting trainees in difficulty: a new approach for Scotland.

National Health Service (NHS) Education for Scotland (NES) works with NHS and University employers, through the four Postgraduate Deaneries to provide education and training for medical trainees from graduation to completion of specialist and general practice training. Most trainees make good progress through the relevant curriculum supported by a managed system of supervision with regular appraisal and feedback. Similarly most trainees demonstrate their progression to Certificate of Completion of Training through the assessment process that is defined in each specialty curriculum. However a small number of trainees each year will experience difficulties sufficient to impact on their progress and when this occurs, a clear plan of investigation, support and management is required. These activities now have to be robust, and are subject to quality management locally and also external scrutiny by Postgraduate Medical Education and Training Board. Therefore, there is a need for the management process to be clear and consistent, and easily accessible to both trainees and their consultant supervisors. NES has introduced a new infrastructure for Scotland which is described in this paper. The paper also discusses training of educational supervisors, best use of national training and remediation resources and how a national advisory group might contribute.

Dependency rather than old age increases the risk of warfarin-related bleeding.

There is uncertainty about the safety of anticoagulation with warfarin in the elderly. This cohort study investigated the risk factors for warfarin-related bleeding in a primary care setting. In multiple regression analyses increased risk of bleeding was associated with domiciliary monitoring of international normalised ratio (INR), low proportion of INR tests in the target range, high intensity of anticoagulation, and male sex. Age was not associated with increased risk after adjustment. High levels of dependency, not old age, should raise concerns about the safety of anticoagulation with warfarin.