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The new cultural norm: reasons why UK foundation doctors are choosing not to go straight into speciality training

  • Hollis, Alexander Conor1, 2
  • Streeter, Jack3
  • Van Hamel, Clare1
  • Milburn, Louise3
  • Alberti, Hugh3
  • 1 UK Foundation Programme Office St Chad’s Court, 213 Hagley Road, Edgbaston, Birmingham, B16 9RG, UK , Birmingham (United Kingdom)
  • 2 2 , Birmingham (United Kingdom)
  • 3 Newcastle University, Medical School, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK , Newcastle upon Tyne (United Kingdom)
Published Article
BMC Medical Education
Springer (Biomed Central Ltd.)
Publication Date
Aug 27, 2020
DOI: 10.1186/s12909-020-02157-7
Springer Nature


BackgroundThe number of UK foundation doctors choosing to go straight into speciality training has fallen drastically over the last 10 years: We sought to explore and understand the reasons for this change.MethodsWe undertook semi-structured interviews with 16 foundation year two doctors, who had not applied to speciality training, from two regional foundation schools. Transcripts were thematically analysed.ResultsThe reasons that foundation doctors are choosing not to go straight into speciality training centre around the themes of feeling undervalued, career uncertainty and a new cultural norm. They report major feelings of uncertainty regarding career choice at such an early stage of their profession and this challenge was magnified by a perceived lack of flexibility of training and the growing normality of taking time out from training. Trainees feel a lack of support in planning and undertaking an “FY3” year and being helped back into the workforce.Trainees overwhelmingly reported that they feel undervalued by their employers. Importantly, however, not going into training directly was not always a reflection of dissatisfaction with training. Many trainees spoke very positively about their planned activities and often saw a break in training as an excellent way to recharge, develop skills and prepare for the rest of their careers in medicine.ConclusionsTaking a year or more out of training after foundation years has become the new cultural norm for UK junior doctors and reasons for this include feeling undervalued, career uncertainty and the perception that this is now “normal”. Exploring these factors with participants has generated a number of recommendations related to improving the workplace environment, allowing more flexibility in training and supporting those who chose to take an FY3.

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