Junior doctors need flexibility in specialist training

Medical training in the UK should be more flexible to ensure doctors make the right choices about how they specialise, a study suggests.

Changes to postgraduate medical training that have meant doctors have to decide earlier how to specialise may be forcing some to make decisions earlier than they would like, researchers believe.

A team from the University of Oxford compared 15,759 doctors’ early career choices with their eventual career destinations, surveying them one, three, five and 10 years after graduation.

The team found that, a decade after graduating, almost half of doctors were working in a specialty different from the one chosen in their first year after graduation. A quarter of doctors were working in a specialty different from their choices at three years after graduation.

Large differences existed between specialities, with only half of GPs choosing their speciality in year one after graduation, compared with 90 per cent of surgeons.

The researchers concluded that one to three years after graduation was a key period for the formation of young doctors’ career plans.

They said increased flexibility in medical training would allow a later choice for graduates to choose a speciality.

‘Some [doctors] expressed concerns about having only one lifetime opportunity to succeed in getting on to a training programme for their chosen specialty,' wrote the researchers.

‘We suggest that at least two possible entry points should be available for most specialties - the first after one or perhaps two years of foundation training and the other at (say) three years.’

In an accompanying editorial, Jeremy Brown, a senior lecturer at Edge Hill University in Lancashire, warned that ‘specialty programmes need to identify ways of supporting those trainees who need time and experience in the postgraduate setting to make a firm commitment that will match their eventual career destination.’

He concluded: ‘These findings may strengthen the argument that the existing two year foundation programme, followed by two or three years of core specialist training, may provide the necessary flexibility to match and underpin the natural variation in career aspirations for many postgraduate doctors.’

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