More doctors are taking a break from training after foundation programme
BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l842 (Published 27 February 2019) Cite this as: BMJ 2019;364:l842
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The figure included in the article beautifully represents the trend in the pathway undertaken by clinicians after foundation training. It clearly demonstrates an increasing reluctance to enter speciality training immediately - but also invites a longitudinal observational study to look at the pros & cons of such a delay.
This natural experiment could highlight whether there was a significant positive outcome in taking a break for their long-term job opportunities, mental health, resilience and resistance to burnout, lifestyle balance and overall happiness.
Competing interests: No competing interests
Dear Editor,
In reference to ‘More doctors are taking a break from training after foundation training’ and as a doctor who has recently completed foundation training, I have seen a large amount of my colleagues choose to take up non-training medical roles in the UK and abroad and as such am not at all surprised by the continued downward trend in junior doctors choosing to go directly into speciality training following the foundation programme. This creates more rota gaps, leading struggling trusts towards the creation of lucrative trust grade positions to meet service demand. These positions can not only offer financial incentives but often offer tailored training opportunities not available to those in training posts. These can include the ability for doctors to develop personal portfolios with increased clinic times, specialty interest days and chances to have enhanced experiences such as dedicated research time or even sub-specialty exposure rarely afforded to those at junior level.
If there is the option to have more work flexibility, better pay and better training experiences, is it a surprise that more and more people are choosing to take up non-training medical roles in the UK?
These jobs are in stark contrast to inflexible speciality training programmes which have a high service provision requirement often with limited chances for genuine training opportunities. If the aim is to increase the percentage of foundation year doctors going directly into speciality training, should we not be altering the approaches of speciality training itself to incorporate some of the tailored and flexible approach that makes the non-training medical roles so attractive to a junior doctor.
Competing interests: No competing interests
Re: More doctors are taking a break from training after foundation programme
While there may have been a stigma attached with taking time out, it's becoming increasingly more popular to do so. As other commentators have mentioned, burnout is a key factor - maybe this burnout might be due to the political turmoil surrounding the NHS and feeling the burden of this at a junior stage. Furthermore, given the rigid structure of training posts and the idea of providing service provision in the next stage post FY2, it's easy to see why many candidates feel the need to take time out.
I took 2 years out of training following my FY2 year (not related to burnout at all, but rather circumstances required it), but I found the flexibility to be highly satisfactory. I entered a clinical teaching fellowship post (which I am currently finishing up and going back into training incidentally), which I felt was very rewarding and gave me a chance to develop skill sets including (but not limited to) teaching, leadership, assessment and more. Many of these were not as readily available or as substantive during my foundation posts. This opportunity I felt helped with improving my own portfolio - something I don't think would have been anywhere near as substantive (particularly in teaching).
I do think however more can be done in exploring what a "FY3" year can entail as this can often feel a bit haphazard without the safety net of a training structure and regular rotations/progression. Whether that is on the HEE website, however that may encourage further reductions in the number of trainees applying.
Competing interests: No competing interests