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Patient safety and junior doctors: are we missing the obvious?
  1. Claire Lemer,
  2. Fiona Moss
  1. Correspondence to Dr Claire Lemer, London Deanery; clairelemer{at}

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Doctors in postgraduate training posts are essential for delivery of acute care in the NHS. Arguably, amongst the most engaged and energetic in the health care workforce, they occupy an organisational space that lets them see good and bad practice and experience first hand both what happens when an organisation works well and the failings that all too often line up to cause harm to patients. And yet, these doctors are only marginally involved in the running of the organisations in which they work. Failure to involve such a key sector of the health care workforce in quality improvement initiatives does a disservice to doctors in training and the patients they care for so ubiquitously.

Leading quality improvement therefore requires not only clinical knowledge of effective interventions but also a clearly defined set of organisational skills and an understanding of organisational behaviours. Sir Donald Berwick articulated these skills two decades ago1 ,2 and the NHS institute for Innovation and Improvement now includes some of them in its Medical Leadership Competency Framework: demonstrating personal qualities, working with others, managing services, improving services, setting direction and demonstrating personal qualities.3 The Medical Royal Colleges and the General Medical Council, who set and approve speciality curriculums, recognise the importance of these skills which are referenced within curriculums and within guidance for practice.4

Most doctors in postgraduate training programmes do not formally acquire these skills as part of their clinical experience and training. A few work with clinical supervisors who are also clinical managers and so do learn about the skills for organisational change. For many, learning about this aspect of medical practice is concentrated within a single ‘management courses’ set apart from their clinical work and …

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