tunity for study; lack of study skills, examination skills, and skill in career planning; or the reason may be individual to each senior house officer. The need for careers advice for senior house officers is already widely recognised,"" "" and postgraduate deans are recommended to be aware of any senior house officers who have been in the grade for more than three years.' Our data indicate the scale of the problem; 39 senior house officers within a 62% sample may be projected to a total of 63 senior house officers in the region who are in need of careers advice because of problems of progression. If pro-active careers advice is to be provided earlier the logistics of providing it on such a wide scale require consideration and careful planning. Another study being done in South East Thames and Merseyside indicates that not all junior doctors require much more than library sources of accurate careers information, one or two lectures early in their post- graduate years, and an informal talk with their consul- tant (J Grant, unpublished). Whether this is sufficient for all senior house officers remains to be evaluated. EDUCATIONAL PROGRAMMES One of the most important factors disclosed by the survey is the wide variety of qualifications that senior house officers have and are pursuing. Planning improvements in senior house officer training must therefore encompass many curricula. There is a widely held view,' however, that there is an identifiable common core of learning for all senior house officers; the identification of a rational training programme must involve not only the region but also the royal colleges and their regional representatives.' That some senior house officers are doctors from overseas should also be taken into account; their methods of learning and their educational environ- ments may well differ from those of their British peers. Examination technique, approaches to learning, and acquisition of appropriate study skills may well form an important part of the training programme. Designating time for study is also central to educa- tional planning, meaning more than providing lectures and meetings, but also ensuring that the senior house officers can attend. Recognition of the value and indispensability of individual study as an obligatory and legitimate part of a senior house officer post is possibly more difficult to attain. The transition from student to practising doctor is not straightforward. Senior house officers seem to be regarded as doctors in the hospital-therefore there primarily for the service -and as students when off duty-and therefore expected to study. This expectation is no longer tenable, and this point will be taken up in the subsequent paper. 1 Council for Postgraduate Medical Education in England and Wales, I'he problems of the senior house officer. London: CPME, 1987. 2 Hsu H, Miarshall V. Prevalence of depression and distress in a large sample of' Canadian residents, interns and fellows. A.mI7 Psvchiatrv 1987;144: 1516-66. 3 Council for Postgraduate Medical Education in England and Wales. A proposal for a district medical education structure. Lonidon: CPME, 1987. 4 Department of Health and Social Sersices, Joint Consultants Committee, Chairmen of Regional Health Authorities. Hospital medical staffing: achieV- ing a balance. London: DHSS, 1986. S Coles CR, Mountford B. Interview surveys in medical and health-care education. Dundee: ASME, 1988. (ASME Medical Education Research Booklet No 3.) 6 Woodward CA. Questionnaire construction and question wnriting for research in medical educatton. Dundee: ASME, 1988. (ASME Medical Education Booklet No 4., 7 Coles CR, Gale-Grant J. Cumculum evaluation tn medical and health-care education. Dundee: ASME, 1985. (ASME Medical Education Booklet No 1.) 8 Siegel S. Nonparametric statistics. New York: McGraw-Hill, 1956. 9 Review Body on Dsctors' and Dentists' Remuneration. Seventeenth report. London: HMSO, 1987. 10 General Medical Council. Recommendations on general clinical training. l ondon: GMNIC, 1987. 11 General Medical Council. Recommendations ont the training ofJ specialists. London: GMC, 1987. Accepted I September 1989) II. Perceptions of service and training Abstract Aspects of teaching and learning at senior house officer level in South East Thames region were investigated by analysis of the responses of con- sultants, senior registrars, registrars, and senior house officers to a postal questionnaire. Responses to sections about who teaches senior house officers, how senior house officers learn, and the relation between the service and training elements of these posts varied significantly, according to the status of the respondents; certain grades commonly overestimated their own contribution when com- pared with the estimates of the other grades. Although the replies of senior house officers showed that they were taught by various grades, 47% of this group did not regard the consultant as their main teacher. Senior registrars and registrars rather than consultants were regarded by senior house officers as best at teaching (63% v 48% respectively). Consultants and registrars were considered to require more commitment to training, personal educational training, and to be more approachable. Inquiry about teaching methods used most by senior house officers showed absence of a systematic approach to training. Only about half of senior house officers cited ward rounds with consultants. Views on the relation between training and service were significantly different among grades, but there was general dissatisfaction. Overall, the findings disclosed the ineffectiveness of senior house officer training posts. This arises from lack of a clear distinction between training and service elements, of educational training for teachers, of a clear contractual obligation to teach in the consultant grade, and of allotted time for training and study for the teachers and senior house officers respectively. Reversal of these current trends is needed for senior house officer posts to fulfil their main training function. Introduction This paper describes teaching and learning at senior house officer level and, in particular, considers the uneasy relation between training and service, which is reflected in the incompatibility of the views of senior house officers compared with those of registrars, senior registrars, and consultants. The paper deals with training; specifically, who teaches senior house officers, how senior house officers learn, and the relation between service and training. Subjects and methods The subjects and methods are described above. From the postal questionnaire of 282 closed and open ended questions completed by 608 doctors of consultant to senior house officer status in South East Thames region we report the findings of three of the 16 sections. Results of frequency counts, cross BMJ VOLUME 299 18 NOVEMBER 1989 1265 on 13 June 2020 by guest. Protected by copyright. http://www.bmj.com/ BMJ: first published as 10.1136/bmj.299.6710.1265 on 18 November 1989. Downloaded from