Of the 113 educational supervisors (68 physicians and 45 surgeons) proposed by the clinical tutors, 10 (9%) refused to take part and seven (6%) did not respond. Of the remaining 96 (85%), 75 agreed to take part, and 21 asked to see the work before deciding. Overall, we sent out 96 forms (60 physicians and 36 surgeons) in round 1. Two consultants withdrew and so we sent out 94 forms (59 physicians and 35 surgeons) in round 2.
Overall, 74 forms were returned in round 1 of which 64 (67%) were processed (42 physicians, 22 surgeons), and 72 forms were returned in round 2 of which 67 (71%) were processed (45 physicians, 22 surgeons). We did not process datasheets returned after 4 weeks. Forty physicians and 18 surgeons replied to both rounds.
Teaching versus non-teaching hospitals
Analysis of non-respondents in both rounds by employment showed no significant difference between teaching hospitals and non-teaching hospitals (6 of 20 (30%) v 26 of 93 (28%) respectively). Eighteen specialties were represented on the panel.
Tables – show the task statements from round 2 and those that achieved over 95% agreement in round 1. The items identified from the literature under section 7 (self management) were skills and not tasks. However, as the data from this section were dealt with by the same procedure as the others, we included them here (table ).
Section 1: communication tasks. Values are numbers (percentages) of panel accepting statement
Section 6: practical procedures. Values are numbers (percentages) of panel accepting statement
Section 7: self management skills. Values are numbers (percentages) of panel accepting statement
As round 1 of the Delphi technique was concerned principally with refinement of the task statements, we focus on the data from round 2.
In section 1 (communications), 13 (62%) statements achieved over 95% acceptance, and 16 (76%) achieved over 90% acceptance. Suggestions were given on how to alter three of the five tasks (1.18, 1.19, 1.20) that achieved less than 90% acceptance (table ).
Comments indicated that task 1.18 would have gained more acceptance if presented as “Giving simple health promotion advice to patients.” Comments on task 1.19 suggested that handling complaints, other than in limited instances, was not the duty of the house officer. No clear guidance for change was given for task 1.20 except that it needed to be made more “explicit.”
Section 2 (on call patient care) generated few comments from consultants, with over 95% acceptance for 7 (70%) task statements and over 90% acceptance for all but task 2.3b. One comment on task 2.3b was that it was not a house officer task.
In section 3 (routine patient care), 15 (75%) task items achieved over 95% acceptance with only three (15%) items under 90% acceptance. Consultants’ comments suggested that task 3.13 should be limited to hand written discharge letters and therefore supported task 3.10b “Completing hand-written discharge forms,” which was accepted in round 1. Comments suggested that altering task 3.15 to “Create a provisional problem list and management plan” might have made this task statement more acceptable.
Sections 4 and 5
For sections 4 and 5 (laboratory and clinical investigations respectively) venous blood sampling, electrocardiography, and simple respiratory function tests all achieved over 70% acceptance as unsupervised tasks whereas lumbar punctures and urinalysis achieved over 70% acceptance as supervised tasks. No investigation achieved over 95% acceptance in either unsupervised or supervised categories, although venous blood sampling came near. Those educational supervisors who accepted the task but did not indicate whether supervised or unsupervised are not included in the results.
For some investigations, acceptance and rejection rates were similar for both unsupervised and rejected categories—for example, urine sampling and sputum sampling. Some rejected a task because they considered it to be a nursing activity whereas others believed the house officer should be capable of performing it. There was parity in responses over all categories for some investigations, for example, Doppler arterial assessment. Comments by consultants stated that experience provided by a job influenced whether the house officer could perform the task independently or not, for example, “... depends on experience, for example, skin biopsy in dermatology ward, Doppler arterial assessment in vascular job, urine microscopy—renal job.”
Some investigations in tasks 4.2 and 5.2 were not seen as within the remit of the house officer. This was also true for tasks 5.3b (computed tomography scan) and 6.5c (injecting: intra-articularly).
Sections 6 and 7
For tasks 6.1 to 6.13 (practical procedures), 9 (47%) achieved over 95% acceptance and 4 (21%) under 90% acceptance. In section 7 (self management skills) of round 1, some of the panel were unhappy to accept some skills as “fully developed” by the end of the preregistration year. Therefore in round 2 for all newly submitted skills the panel were asked to decide whether the skill should still be developing or fully developed by the end of the preregistration year.