Junior doctors’ learning and development in foundation year 1 posts in palliative medicine

Abstract

Background: The ability to provide good palliative care to patients is increasingly recognised as a core clinical skill that all doctors should possess. Few junior doctors, however, feel competent in breaking bad news, pain relief and the care of dying patients by the time they are fully registered to practice. Aim: The aim of this study was to explore doctors’ experiences in foundation year 1 (F1) palliative medicine posts. Design: Participants underwent semi-structured interviews and interview transcripts were analysed using Interpretative Phenomenological Analysis. Setting/participants: The study involved a purposive sample of six F1 doctors matched in 2005-2006 to rotations incorporating palliative medicine posts at two acute hospital National Health Service (NHS) Trusts and one NHS hospice in the UK. Results: F1 doctors were satisfied with the learning opportunities provided by the posts, which achieved the right balance between supported and autonomous working. They described learning through their day-to-day interactions with staff, including specialist nurses, and by practising their skills on the job. Some struggled, however, to make the transition to a more independent learning style in the clinical environment. Trainees felt the post helped them to develop generic skills, such as symptom control, diagnosing dying and breaking bad news. Whilst they found split posts and on-call rotas disrupted their palliative care learning, these offered important opportunities to learn additional F1 skills. Conclusions: F1 posts in palliative medicine in the UK have positive influences on perceived generic skills development and practice. These findings might encourage the development of more rotations incorporating palliative medicine in the future.