The prevalence and effects of on-call stepdown on orthopaedic registrar training: the North West trainees'...

Safe staffing levels are increasingly being threatened by gaps in rotas. When a gap occurs in junior grade on-call rotas the orthopaedic registrar needs to step down and undertake the role of both junior and middle-grade doctor. This increased responsibility could compromise the safety and wellbeing of patients and doctors. This study quantifies the prevalence and effects for trainees of stepdown while on call.

An anonymous online and paper survey of trainees was conducted. The primary outcomes were the prevalence of stepdown in trainees' experience, the effects of stepdown on trainees and patients, and the overall impact on training and morale.

The response rate was 93% (n = 51). Of the total, 55% of trainees had experienced stepdown, which occurred a minimum of 84 times, statistically more frequently for expected absences rather than unexpected absences (p = 0.002). Of the trainees who stepped down, 64% felt pressure to do so from seniors and 79% from hospital management. Some 50% of trainees felt that step down was managed in an unsafe manner; 40% of trainees stated that stepdown impacted on their own personal safety and 50% of trainees lost a training opportunity. Overall, 57% of trainees considered that stepdown and rota gaps affected their morale negatively. In 85% of cases there were no issues that resulted in patient harm.

The survey results suggest that stepdown is common and it does impact negatively upon registrar training, safety and morale. Patient safety overall seems to be well protected.