The Medical Council plans to restrict the working week and regulate the structured teaching of hospital interns.
According to proposals seen by The Irish Times, the most junior category of hospital doctor is to be guaranteed seven to 10 hours of structured teaching a week. This will represent about a quarter of the working week which is itself to be capped at 39 hours. Only one 24-hour period of on call will be allowed each week.
Compared to the findings of the National Joint Steering Group on the working hours of non-consultant hospital doctors, which recently reported an average 89-hour working week with only 4 per cent time spent training, the Medical Council proposals indicate a considerable increase in protected teaching time.
A provisionally registered doctor must have his medical actions supervised at all times. The Medical Council is responsible for issuing full professional registration to doctors who complete the intern or "pre-registration" year. It does this on the basis of a certificate of experience from the dean of the graduate's medical school.
The new proposals involve a strengthening of this process; interns will in future have to complete a logbook in order to be eligible for full registration. An intern co-ordinator will advise medical school deans on a candidate's suitability based on the new logbook.
Every hospital will have an intern tutor who will supervise the newly graduated doctors' continuing education. The logbook will contain feedback on the intern's performance based on entries by the intern tutor and supervising consultant.
Unlike current practice, largely based on ad-hoc experience and teaching, interns will have to demonstrate the ability to perform named clinical procedures. The junior doctor's level of competence will be recorded in the logbook.
According to the Medical Council, "the overall aim of the intern year is to provide an educationally sound experience that professionalises the new doctor with appropriate knowledge, skills and attitudes".
The newly qualified doctor will have to outline the details of cases he has seen in accident and emergency and the outpatient department; log details of cases in which he planned investigations and made therapeutic decisions; and record the details of critical learning incidents such as the need to break bad news unexpectedly to a patient. The intern will also have to demonstrate competence in dealing with medico-legal and ethical issues.
The proposals are to come into effect next July as part of a legally binding intern contract. Whether the restricted working week of 39 hours will conflict with EU proposals for a maximum non-consultant hospital doctor's working week of 48 hours, due to be implemented over a longer time-span, remains to be seen.
A review of undergraduate medical education in the Republic will be published following a series of visits to medical schools by the Medical Council this autumn.