Improving Resident Doctors' Preparedness for General Medical On-Call Shifts Through Structured Induction Resources: A Quality Improvement Project at a Large UK Teaching Hospital

Resident doctors frequently report feeling underprepared when commencing general medical on-call duties. This is important as poor preparedness contributes to anxiety, inefficiency, and potential risks to patient safety. It has been found that preparedness is strongly influenced by the quality of local induction. This quality improvement project aimed to improve resident doctors' self-reported preparedness for their first general medical on-call shift at Salford Royal Hospital through the introduction of structured induction resources. Two Plan-Do-Study-Act (PDSA) cycles were undertaken between October 2024 and March 2025. Preparedness was assessed using questionnaires distributed to FY1 to ST7 grades before and after interventions. The first comprised an optional in-person hospital tour, and the second involved the development and dissemination of a structured induction booklet addressing on-call roles, escalation pathways, handover arrangements, and hospital logistics. At baseline, four of 31 doctors (12.9%) reported feeling prepared for their first on‑call shift. PDSA cycle 1 had minimal impact due to low uptake and was not felt relevant to the group of doctors rotating. However, following the introduction of the induction booklet in PDSA cycle 2, 18 of 30 doctors (60%) reported feeling prepared (p<0.001). Improvements were also seen in the understanding of on‑call roles, the acute medical take, and escalation processes. However, hospital orientation remained suboptimal. Structured induction resources improve resident doctors' perceived preparedness for general medical on-call duties. While written induction materials are low-cost and scalable, our findings suggest that a variety of structured induction materials are required to ensure adequate preparation. Furthermore, ensuring induction materials within a timely manner is crucial and an area for further improvement. This project did not assess clinical outcomes, but it is of interest whether improving preparedness improves clinical performance.