Make specialist training more flexible, study says

20 July 2010

MEDICAL training in the UK should be more flexible to help doctors choose the right specialty, a study suggests.

Doctors in training are forced to choose a specialty earlier than those in previous years due to changes to postgraduate training. Concerns have been raised that trainees are having to make decisions without knowing enough about their options. The 2008 Tooke report suggested junior doctors were being encouraged to make career choices before they were ready.

Researchers from the University of Oxford have called for a system shake-up to allow two entry points into the specialties, after the end of foundation training and again around a year later.

The Oxford team compared the early career choices of more than 15,700 doctors with the career they eventually ended up in. They checked in with them one, three, five and 10 years after graduation. The results showed that 10 years after graduating, almost half the doctors were working in a specialty different to what they chose after three years.

There was wide variation amongst the specialties with only half of GPs choosing their field one year after graduation compared to 90 per cent of surgeons. The researchers concluded that years one to three following graduation was a key period for the formation of young doctors’ career plans. They said that making medical training more flexible would let doctors choose their specialty later in their careers.

Some trainees who responded to the study highlighted an increasing lack of flexibility in applying for specialty training, while some were concerned about having only one lifetime opportunity to get on to a training programme for their choice of specialty.

The study suggested “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 acknowledges that the career advice service provided by medical schools and deaneries has improved greatly, but warns 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 concludes: "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."