That SHO’s not dead – he’s only resting…..

I’ve recently been forced to consider the longevity of the SHO grade. This is not an idle pursuit but a requirement as over the last few years there have been a number of patient safety reports highlighting the difficulties in the use of the term SHO, or ‘senior house officer’. The title has not existed as a training grade for many years (2005?? if I remember rightly), but the term remains in common parlance.

Is this a problem?

Well, if usage is anything to go by, then to some it isn’t. It appears to be widely used by a variety of different staff perhaps having become one of those terms that is difficult to define, but seemingly everyone knows what it means….

Or do they?

We have pretty much disbanded the term house-officer in favour of foundation doctor (although some die-hards do remain), but SHO seems more sticky. It is an all encompassing term that links years 1-3 core/specialist training posts. FY2 docs, clinical fellows, trust fellows and a bunch of other trainees into one amorphous mass which belies the variability in experience and skill within. There is clearly a significant difference in experience (and ability) between an FY2 and an ST3 so it is disingenuous and potentially dangerous to consider them to be all the same….., a nurse (for example) requesting an ‘SHO’ to see a patient may get a doctor with wildly different levels of experience and that can’t be good. So why does the term continue? I think it is a mixture of convenience and history. SHO rolls off the tongue in a way that ‘core trainee, year 1, Acute Common Care Stem (Emergency Medicine)’ does not. It just does. and there is little we can do about this, but that does not mean that it is unimportant. The question has been raised as a patient safety concern by the deanery and by national bodies for good reason, so we must do what we can to change the current custom and practice. Here at CMFT we are going to try the following.

• Stop the issue of ID cards with ‘SHO’ on them.
• Stop doctors from trying to choose their own titles for ID cards.
• Don’t advertise any job as an SHO post.
• Change rotas to reflect true grade and not ‘HO’ or ‘SHO’
• Use alternative grading systems. For example In the ED and medicine we use different coloured lanyards to designate roles and responsibilities (so the whole team can see who is operating at whichever level in the clinical setting).

Will this work? We hope so as we’d like to think that the term ‘SHO’ is dead….., my concern is that it might only be resting unless we take steps to make sure that he not just (as Monty Python might say) pining for the Fjords……

httpv://www.youtube.com/watch?v=4vuW6tQ0218‎