Out-patient management by junior staff: the value of consultant supervision

The effect of consultant supervision on management of patients by junior staff was assessed. Supervision was exercised by pre-reading the notes with the consultant at the start of the clinic. The principle finding was that less patients were brought back for another appointment. For new patients, the proportion fell from 40% to 19%, and for follow-up patients it fell from 49.5% to 29%. The overall rate fell from 46% to 23.5%. This has major implications with respect to use of resources and, in the unit studied, this change would make available 38 extra clinic appointments for each registrar per month. The study also raises issues regarding the use of out-patient clinics for post-graduate training and consultant supervision of patient management in general.