Objectives: To describe working conditions for senior house officers in medicine in Scotland and to relate these to the quality of clinical training they receive. Design: Postal questionnaire survey. Subjects: All senior house officers in medicine and related specialties in past in Scotland in October 1995 (n=437); 252 (58%) respondents. Main outcome measures: Questionnaires covered hours, working patterns, measures of workload, an attitudes to work scale, and experience of education and training. Results: In the week before the questionnaire, doctors on rotas had worked a mean of 7.4 (95% confidence interval 5.8 to 9.0) hours in excess of their contracts, compared with 3.7 (2.0 to 5.5) hours for those on partial shifts. The most common reason for this was ''the needs of the patients or the service.'' Those on partial shifts reported significantly less continuity of care with patients than those on rotas (Mann-Whitney U test, z=-4.2, P<0.0001) or full shifts (z=-2.08, P=0.03). Doctors in general medicine reported significantly higher measures of workload (number of acute admissions, number of times called out, and fewest hours' uninterrupted sleep) than those in subspecialties. Consultants' clinical teaching and style of conducting a ward round were significantly related to factors extracted from the attitudes to work scale. Conclusions: The quality of senior house officers' training is detrimentally affected by a variety of conditions, especially the need for closer support and supervision, the need for greater feedback, and the lack of time that consultants have to dedicate to clinical training. Efforts should be made to improve these conditions and to reinforce a dose working relationship between trainee and supervising consultant.
