The F3 phenomenon: Early-career training breaks in medical training. A scoping review.

BACKGROUND: Since 2017, more than 50% of UK doctors have undertaken a 'Foundation 3 (F3) Year' training break after completing their foundation programme (the first two years following graduation), rather than immediately enter specialty training. The reasons for, and consequences of, the growing F3 trend are largely unknown. This scoping review presents the current evidence and identifies future research in this field. METHODS: Following Arksey and O'Malley's guidelines, 12 databases and three UK-based national postgraduate organisation websites were searched for articles published in English (final searches January 2020). Multiple search terms were used to capture articles relating to the 'F3' time-period, including 'post-foundation' or 'pre-specialty' training. Title, abstract and full-paper screening selected articles reporting any aspect of F3, including within a wider context (eg postgraduate training breaks), and then underwent mixed-methods analysis. RESULTS: Of 4766 articles identified, 45 were included. All articles were published after 2009; 14/45 (31.1%) were published in 2019. 27 articles reported research, and the remainder were opinion/commentaries. Specific personal (including demographic), professional and organisational factors, particularly the UK postgraduate training structure, are associated with undertaking an F3. The majority of F3 training breaks last 1 year and involve working (clinically or non-clinically) and/or travel. The decision to undertake an F3 is made either prior to or during foundation training. Evidence regarding the impact of F3 on health care service provision was limited but evenly balanced. CONCLUSIONS: In summarising the existing F3 evidence, this review has highlighted important issues including health care workforce equality and diversity, training pathway inflexibility and the effect of negative early-career experiences on subsequent career decisions. More research is needed to understand the financial impact of training breaks on health care service provision, how training programmes must adapt to retain more trainees and the long-term effects of training breaks, such as F3, on subsequent career progression.

The impact of an integrated medical leadership programme.

PURPOSE: The purpose of this paper is to determine the impact of an integrated Medical Leadership Programme (MLP) on a cohort of participating specialty doctors and the NHS services with which they were engaged. DESIGN/METHODOLOGY/APPROACH: This was a qualitative study designed to obtain rich textual data on a novel training intervention. Semi-structured interviews were conducted with participating MLP trainees at fixed points throughout the programme in order to capture their experiences. Resulting data were triangulated with data from extant documentation, including trainees' progress reports and summaries of achievements. Recurring discourses and themes were identified using a framework thematic analysis. FINDINGS: Evidence of the positive impact upon trainees and NHS services was identified, along with challenges. Evidence of impact across all the domains within the national Medical Leadership Competency Framework was also identified, including demonstrating personal qualities, working with others, managing services, improving services and setting direction. RESEARCH LIMITATIONS/IMPLICATIONS: Data were drawn from interviews with a small population of trainees undertaking a pilot MLP in a single deanery, so there are inevitable limitations for generalisability in the quantitative sense. Whilst the pilot trainees were a self-selected group, it was a group of mixed origin and ability. PRACTICAL IMPLICATIONS: The study has provided valuable lessons for the design of future leadership programmes aimed at doctors in training. ORIGINALITY/VALUE: Identifying the effectiveness of an innovative model of delivery with regard to the Medical Leadership Curriculum may assist with medical staff engagement and support health service improvements to benefit patient care.

Why do medical trainees take time out of their specialty training programmes?

Postgraduate medical trainees may take time out of programme for personal or professional reasons which can delay completion of training. This survey of out of programme trainees in England explores a phenomenon that impacts significantly upon medical careers and workforce planning.

Managing change in postgraduate medical education: still unfreezing?

BACKGROUND: Modernizing Medical Careers (MMC) is an ambitious project to change the training of UK doctors. A key to its successful implementation is the ways that MMC is perceived and operationalized by senior doctors who act as local educational leaders and supervisors. AIMS: To analyse hospital consultants' perceptions of the modernization process and its impact on their role as the primary educators of Senior House Officers (SHOs), using Schein's extended model to explain their stage in the process of change. METHODS: We interviewed medical directors, College and clinical tutors and education supervisors at 6 Trusts. The transcripts were analysed using Schein's change model to explore the perceptions and assumptions of senior medical staff and to determine their stage in the process of change. RESULTS: 12 tutors, 12 supervisors, and 4/6 medical directors approached agreed to participate (28/30). Nine themes emerged from transcript analysis. These were related to the three-stage model of change. Most participants were at the stage of 'unfreezing', expressing views around disconfirmation of expectations, guilt and anxiety and feelings of some psychological safety. A smaller number were at the stage of 'moving to a new position'. There were limited examples of 'refreezing'. CONCLUSIONS: At the local delivery level, most senior doctors were aware of the need to review their current position and alter their approaches and assumptions about postgraduate medical education. Yet only a minority were moving forward. Considerable work remains for successful implementation of MMC.