Recent changes in the workload and clinical experience of pre-registration house officers: experiences over four years in south-west England.

We aimed to measure changes in the training and workload of pre-registration house officers using a postal questionnaire. Two hundred and six pre-registration house officers in the south-western region of England were surveyed and asked to report on the education, training and workload of their posts. Results were compared with a survey conducted four years earlier. Since the previous survey, the number of hours on duty had reduced from a median of 80 h week-1 in 1992/3 to 72 h week-1 in 1996/7 (P < 0.0001). There were no statistically significant changes in the number of patients admitted or clerked in an average week, but house officers' clinical experience had fallen. All but five of 26 marker conditions showed a decline, which was statistically significant in seven cases. House officers were keener to include four months of general practice in the pre-registration year and were less adverse to extending the pre-registration year to two years. The reduction in hours of work for house officers has been accompanied by a decline in their clinical exposure to common medical and surgical emergencies. The long-term effects of these changes are unknown.