But whether or not there truly is an effect on patient care has always been difficult to ascertain.

Now a study from Imperial College London has added some facts to the debate. In their retrospective analysis of hospital mortality they found that in 2007 and 2008, when the system for junior doctors' job applications changed, patients who were admitted on Wednesday August 1st had 8% higher adjusted odds of death than those admitted the previous Wednesday. However their findings did not achieve statistical significance. Their study is the largest of its kind.

Common sense would suggest that staggering the changeover of medical staff would be sensible, and that patient care would be best served by phasing these changeovers over a period of months. Such common sense must have eluded the planners of MMC, for reasons we find hard to understand. Perhaps they underestimated the clinical significance of the changeover date. Or perhaps they were so fixated on their goal of shortening medical training to the barest minimum time that they couldn't let this trifle stand in their way.

We now find ourselves in a bit of a quandary. If the 8% increase in mortality is a genuine figure then we would expect an immediate change to the way training programmes are organised. Yet the findings did not achieve statistical significance, and only future larger studies could do so.

Remedy believes that this 'experimenting' needs to be stopped. We would like to see the changeover dates staggered throughout the year as soon as possible. A by-product of this change would be to lengthen the period of training for some doctors - something we also think would be very welcome.