As a participant in the survey by Child and Old1 I have some concerns about their paper. I don’t recall at any time being told there was an intention to publish these results and I suspect people would have answered differently if that was known. In fact, my impression was that the purpose of the survey was to illustrate the utility for hospital grand rounds of the keypad system being demonstrated. The information that was collected in the survey was therefore not used for the purpose that (at least some of) the audience thought it was being collected for. If the original intention was to publish the results, this survey would constitute “research” and as such ethical approval probably should have been sought.

The survey was conducted at a Physicians’ grand round and by its design could only produce biased results. It was an advertised event so volunteer bias is likely to have occurred. Dr Child presented a summary of background issues for both sides of the debate, but he is an SMO, and this may have influenced his presentation of the issues. He also drew conclusions from the responses as the rounds progressed, and both his summary, and merely seeing the results, may have influenced the way people answered later questions. The questions and allowed answers were limited and so responses may not have reflected the views of the attendees accurately. In addition, the time for considering the questions was limited.

Due to the highly selected groups surveyed, and the problems with the survey design, the results gathered are heavily biased and essentially meaningless. The many conclusions drawn in the paper are therefore not valid and not generalisable. This survey was an entertaining and stimulating grand round, but the hypotheses generated should only have formed the basis of future research.

We thank Dr Bolland for his letter. The key purpose of publishing this survey was to stimulate debate and discussion on the topics raised and hence we thank Dr Bolland sincerely for his letter and interest in the article. We fully accept Dr Bolland’s criticism of the validity of the results and have even acknowledged these views in the discussion.

If one reads the discussion, they will note that we drew two primary conclusions:

Due to the limitations described by Dr Bolland, we did not attempt to make specific conclusions about the individual issues raised. We would strongly encourage further discussion and research on the issues of junior doctor working conditions and believe that it is vital to include the senior doctors opinions in these discussions.