The F3 phenomenon: Early‐career training breaks in medical training. A scoping review

Abstract

Background Since 2017, more than 50% of UK doctors have undertaken a ‘Foundation 3 (F3) Year’ training break after completing their foundation programme (the first two years following graduation), rather than immediately enter specialty training. The reasons for, and consequences of, the growing F3 trend are largely unknown. This scoping review presents the current evidence and identifies future research in this field. Methods Following Arksey and O’Malley's guidelines, 12 databases and three UK‐based national postgraduate organisation websites were searched for articles published in English (final searches January 2020). Multiple search terms were used to capture articles relating to the ‘F3’ time‐period, including ‘post‐foundation’ or ‘pre‐specialty’ training. Title, abstract and full‐paper screening selected articles reporting any aspect of F3, including within a wider context (eg postgraduate training breaks), and then underwent mixed‐methods analysis. Results Of 4766 articles identified, 45 were included. All articles were published after 2009; 14/45 (31.1%) were published in 2019. 27 articles reported research, and the remainder were opinion/commentaries. Specific personal (including demographic), professional and organisational factors, particularly the UK postgraduate training structure, are associated with undertaking an F3. The majority of F3 training breaks last 1 year and involve working (clinically or non‐clinically) and/or travel. The decision to undertake an F3 is made either prior to or during foundation training. Evidence regarding the impact of F3 on health care service provision was limited but evenly balanced. Conclusions In summarising the existing F3 evidence, this review has highlighted important issues including health care workforce equality and diversity, training pathway inflexibility and the effect of negative early‐career experiences on subsequent career decisions. More research is needed to understand the financial impact of training breaks on health care service provision, how training programmes must adapt to retain more trainees and the long‐term effects of training breaks, such as F3, on subsequent career progression.

Study protocol - Ascertaining the career Intentions of UK Medical Students (AIMS) post-graduation: a cross-sectional survey

“…While there have been: i) studies exploring which specialties junior doctors or medical students intend on pursuing (13,14,15,16,17,18), ii) studies which focused on career intentions of those pursuing one specialty or exploring factors that attract them to one speci c specialty (19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35), iii) studies speci cally focused on reasons why doctors are leaving the UK (36, 37,38,39,40), iv) studies exploring how medical students and junior doctors feel about speci c aspects of working within the NHS (41,42,43,44), v) studies investigating the desire for a career break post-foundation year 2 (also known as the 'F3') (45,46,47), there have been no recent, high-powered studies explicitly aimed at medical students, irrespective of current career ambitions or seniority, investigating overall career intentions and correlating it with demographic factors and medical student seniority. There has been one similar study, although focusing entirely on medical students and their intentions to leave the NHS, which is limited by its low power and lack of subanalysis regarding student seniority and demographic factor (48).…”

Study protocol - Ascertaining the career Intentions of UK Medical Students (AIMS) post-graduation: a cross-sectional survey

“…While there have been: i) studies exploring which specialties junior doctors or medical students intend on pursuing (13, 14, 15, 16, 17, 18), ii) studies which focused on career intentions of those pursuing one specialty or exploring factors that attract them to one specific specialty (19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35), iii) studies specifically focused on reasons why doctors are leaving the UK (36, 37, 38, 39, 40), iv) studies exploring how medical students and junior doctors feel about specific aspects of working within the NHS (41, 42, 43, 44), v) studies investigating the desire for a career break post-foundation year 2 (also known as the ‘F3’) (45, 46, 47), there have been no recent, high-powered studies explicitly aimed at medical students, irrespective of current career ambitions or seniority, investigating overall career intentions and correlating it with demographic factors and medical student seniority. There has been one similar study, although focusing entirely on medical students and their intentions to leave the NHS, which is limited by its low power and lack of subanalysis regarding student seniority and demographic factor (48).…”

‘A Unique opportunity to test things out’: a qualitative study of broad-based training in Scotland

“…As well as promoting the concept of generalism, an important additional benefit shown by our evaluation is that BBT can play a role in keeping trainees who might be lost to Scotland and lost to a training programme both in the country and in training. BBT provides an appealing alternative to an ‘F3’ year, providing another option alongside the staff grade or fellow posts many post-Foundation doctors undertake 27. The emergence of the F3 year as a phenomenon shows that opportunities to keep training broader for longer have a significant role to play in a world where trainees welcome more time to decide on their ultimate career.…”