A number of trainee doctors became disenchanted with practising medicine in their first year of training, known as foundation year 1, a BMA study shows. It found that the number who said they strongly wished to practise medicine nearly halved between graduation from medical school and the end of foundation year 1.
The 10 year BMA cohort study is following the career paths of 435 doctors who graduated in 2006, to help with future workforce planning. The second report, published on 7 July, gives information about their work and experiences in their first foundation year of training along with their thoughts on their future careers.
The study found that on completing foundation year 1 just 30% of the 397 trainees who responded to the second questionnaire said they had a very strong desire to practise medicine. When they graduated 54% of the cohort had rated their enthusiasm for a medical career as very strong.
More worrying perhaps was the increase from 15% to 26% in the percentage of trainees who rated their desire to practise as either lukewarm or weak. Furthermore, 2% of respondents said they regretted becoming a doctor after foundation year 1, whereas a year earlier none had regrets.
The response of most doctors to their foundation year 1 posts was positive. Most doctors (92%) got their first choice of deanery or foundation school, and nearly half (43%) of those who didn’t got their second choice. And four in five doctors thought that their foundation year 1 placements provided them with the confidence and ability to practise medicine independently.
However, more than a third of the trainees in the cohort considered that they had been asked to perform tasks during the year that were beyond their capabilities. And three quarters thought that some tasks, such as taking bloods, could be done more appropriately by other health professionals, such as appropriately trained nurses.
At the end of foundation year 1 around half of the trainees wanted to practise hospital medicine, a quarter wished to enter general practice, and almost a fifth were undecided. The most popular choice of specialty was general practice, followed by general medicine and surgery.
Around two thirds of the trainees had ambitions to become a consultant or a GP principal. Female trainees, however, were more likely than their male colleaguesto plan a career in the associate specialist or staff grade or as a salaried GP.
Findings from the study also indicate that for these new graduates the future holds a number of uncertainties that perhaps were not present a generation ago. Just 8% of the respondents were confident of automatically getting a job after completing their training; a year earlier the percentage was 16%. The percentage who envisaged working outside the NHS rose from 66% at graduation to 75% a year later. And three out of five trainees expressed a desire to practise medicine outside Britain at some point, either temporarily or permanently.
Respondents had mixed feelings as to how well their undergraduate degree had prepared them for work in hospital. Many trainees thought there was too much emphasis on communication at the expense of time spent on learning clinical and practical skills. A third of the trainees also thought that part of their undergraduate course was irrelevant, naming laboratory based topics, anthropology, history of medicine, and biochemistry as being of little practical use.
The BMA’s cohort study of 2006 graduates can be seen at www.bma.org.uk.
Cite this as: BMJ 2008;337:a704