Objectives: The number of doctors directly entering UK specialty training after their foundation year 2 (F2) has steadily declined from 83% in 2010 to 42.6% in 2017. The year following F2, outside the UK training pathway, is informally termed an 'F3' year. There is a paucity of qualitative research exploring why increasingly doctors are taking F3s. The aim of this study is to explore the reasons why F2 doctors are choosing to take a year out of training and the impact upon future career choices. Design: This is an exploratory qualitative study, using indepth interviews and content analysis. Setting: UK. Participants: Fourteen participants were interviewed from one foundation school. Participants included five doctors who commenced their F3 in 2015, five who started in 2016 and finally four recently starting this in 2017. Main outcome measures: Content analysis was conducted to distill the themes which exemplified the totality of the experience of the three groups. Results: There were four predominant themes arising within the data set which can be framed as 'unmet needs' arising within foundation years, sought to be fulfilled by the F3 year. First, doctors describe exhaustion and stress resulting in a need for a 'break'. Second, doctors required more time to make decisions surrounding specialty applications and prepare competitive portfolios. Third, participants felt a loss of control which was (partially) regained during their F3s. The final theme was the impact of taking time out upon return to training (for those participants who had completed their F3 year). When doctors returned to NHS posts they brought valuable experience. Conclusions:This study provides evidence to support the important ongoing initiatives from Health Education England and other postgraduate bodies, exploring approaches to further engage, retain and support the junior doctor workforce.

It is inevitable that an individual with a remit for change entering an established social group will experience difficulties in establishing their role. It is also clear that an individual who changes their role within a group to reflect behaviours not congruent with the primary activity in that setting will experience dimensions of social exclusion. Further work needs to address how educational roles can make a significant impact on the everyday lives of students and nurses working in practice. The findings of this study are as relevant for the new roles of practice educator, clinical facilitator and practice placement co-ordinator as they are for link teachers and lecturer practitioners. Several suggestions are made to improve links with practice.

2 IntroductionCompassion is not a new concept. It has been described and debated as a religious and secular value and virtue, as an emotion, a psychological process, a political phenomenon, a core value in health professional practice and as a topic of empirical research for some time. The word 'compassion' comes from the Latin 'co-suffering' or 'to suffer together with ' (Austin et al. 2013). We ensure that compassion is central to the care we provide and respond with humanity and kindness to each person's pain, distress, anxiety or need. We search for the things we can do, however small, to give comfort and relieve suffering. We find time for patients, their families and carers, as well as those we work alongside. We do not wait to be asked, because we care. (DH 2015:5) The impetus for the call was in response to the Francis reports (Francis 2010(Francis , 2013) which detailed numerous care failures that resulted in the avoidable distress, neglect and deaths of patients. These reports indicate that the values of the NHS Constitution are not always enacted.In the call for bids, HEKSS highlighted the fact that the Secretary of State had issued a mandate to Health Education England (HEE) to deliver 'high quality, effective, compassionate care: Developing the right people with the right skills and the right values' (DH 2013).A research team from two universities, one medical school, four NHS organisations and service users collaborated together to design, implement and evaluate the project. The project built on previous research, practice and educational expertise in the areas of professionalism and ethics in healthcare practice. The project had funding for one year and it aimed to develop a sustainable programme of 'compassion awareness training' that engaged with diverse healthcare staff within the partner organisations across the region, building on existing compassion initiatives. The nature and purpose of the research element of the project was to generate an evidence base for the implementation and evaluation of the compassion training programme. Literature ReviewCompassion is recognised as a core value within the NHS Constitution, in professional codes, 3 several policy documents relating to high quality service delivery, and in the Prime Minister's Commission Report on the Future of Nursing and Midwifery (NMC 2015, DH 2015, DH 2013, DH 2012, DH 2010. A significant number of empirical and philosophical studies on compassion have been published in the nursing, care and ethics literature. These papers were identified through online professional databases and included if they demonstrated rigour as well as relevance to the development and maintenance of compassion for people accessing healthcare services and for a variety of health professionals, students and support staff. Research from many countries and using different methodologies were included in the review. For example, Torjuul et al (2007) conducted a qualitative study of nurses and physicians regarding compassion and responsibility in surgical ca...

Purpose – The purpose of this paper is to enhance understanding of the experience of qualified nurses managing the process of learning through work when enrolled on a work-based learning module. Design/methodology/approach – The study was based on constructivist grounded theory using semi-structured interviews with purposive and theoretical sampling of 13 health professionals across acute and community settings. Constant comparative method of data analysis used. Findings – A core category revealed a social process of learning to learn through work as the nurse shifted from a relatively passive view of the self in the workplace to one that actively constructed an environment that facilitated the realisation of learning objectives. The outcome was the development of metacognition skills of learning to learn promoting intentional learning behaviour towards a lifelong learning attitude. Research limitations/implications – If knowledge generated from work-based learning is to nourish the organisation, there needs to be opportunities for knowledge exchange in the workplace, consistent mentor support, protective time and a positive attitude to learning in work from colleagues. The study did not include master's students. Originality/value – While studies have highlighted the influence and impact of organisations on the quality and scope of learning through work, less is known about how health care professionals, in particular qualified nurses, learn to learn in the workplace. This study is of value to those investigating and supporting individuals learning through work-based learning. Threshold concepts and troublesome knowledge introduce a creative perspective to explore the meaning of learning through work

This paper is offered as an introduction to qualitative research, with the hope that it informs and stimulates osteopaths and researchers who are unfamiliar with this area of research. This paper discusses the potential contribution of qualitative research in exploring the complex and multiple aspects of osteopathy and how the fi of qualitative studies may contribute to the knowledge base of osteopathy. A defi ion of qualitative research is provided, and a number of different methodologies are discussed. Finally it suggests examples of how the findings of qualitative research could potentially help inform osteopathic practice.