Is Foundation training producing competent doctors? What do Foundation trainees, educational supervisors and nurses in Scotland have to say?

Abstract

The aim of this paper is to examine perceptions of Foundation Year trainees, consultants and senior nurses about the introduction of the Foundation Programme. Specifically, to examine whether Foundation trainees acquire appropriate skills, experience and responsibility. Semi-structured interviews were conducted with 23 F1 doctors, 22 F2 doctors, 23 consultants and 25 nurses from across Scotland in a broad range of specialties. In the summer of 2007 trainees, consultants and nurses broadly agreed that Foundation offers good experience but some issues were highlighted. Certain specialties were seen as offering insufficiently generic experience and consultants, in particular, were concerned that four-month rotations are too short. Frequent moving around for trainees was seen as detrimental for seeing cases through and continuity of care was now perceived to be provided by nurses and consultants rather than junior doctors. Levels of responsibility could vary widely from post to post and tended to be specialty-dependent. As a result, some F2s reported frustration that they were not given sufficient responsibility for their stage of training. Nights were recognized as a valuable learning opportunity and most trainees were supportive of night work being made available in F1 and F2. In conclusion, in order to maximize the possibilities of the Foundation years and ensure that trainees can meet the required Foundation competencies, specialties that offer narrow experience need to be matched with ‘busy’ specialties that can offer broader experience. Night work should be retained, but perhaps not introduced right at the start of F1. Trainees feeling that they are being given insufficient experience, particularly in the F2 year, need to be proactive in addressing this if possible. There is a perception among some consultants and nurses that a process of ‘delayed skilling’ is taking place, attributable more to reduced hours than Foundation per se. There is a need to follow trainees through to specialty training to ascertain if Foundation has adequately prepared them for run-through training.