Chapter 82 Life as a trainee doctor

Introduction

From the UK to Australia, postgraduate medical training is undergoing considerable reform (Grant, 2007, van Der Weyden, 2007; www.mmc.nhs.uk/). Consequently, some of what is written here will have changed by the time you read this. What is certain is that you will be working fewer hours than previous generations of young doctors. What has not changed is the steep learning curve required at the beginning of your first post. However, shadowing the previous trainee, a good induction and support from senior medical and nursing colleagues will all help to make this particular transition easier than it might otherwise be. This is the time when you really start to put all the theory you have learned as a medical student into practice.

Foundation programmes

In the UK, final-year medical students may apply for a place on a 2-year foundation programme via a national electronic application system (www.foundationprogramme.nhs.uk/pages/home). Most foundation programmes consist of 4 months in six different posts. The programme aims to help medical graduates to build upon what they have learned at medical school and to increase their confidence and competence as doctors. There is a national curriculum and attendance at formal teaching is compulsory throughout the 2 years. Successful completion of the first year, together with a minimum of 4 months spent in general medicine and 4 months in general surgery, is required to gain full General Medical Council registration.

The emphasis of foundation training is on acquiring generic rather than specialty-specific knowledge and skills, and time spent in a specialty is not a prerequisite for acceptance into training in that specialty. However, some trainees are convinced that they might be disadvantaged at interview by lack of experience in their chosen specialty (French et al., 2007), and it is generally held that it is important to do over and above the minimum assessment requirements if an applicant wishes to stand out when it comes to competitive entry to specialty training.

How do you think you will react to your first job? Can you predict what will give you satisfaction, and what you will find most difficult? Although medical students may be aware that the first postgraduate year can be difficult, many of them seem surprised by the demands of the early years.

Specialty training

During their second year, foundation doctors may apply for entry to specialty training. In 2007, a national electronic recruitment system was introduced, the Medical Training Application System (MTAS: www.mtas.nhs.uk/). There were considerable problems in its first year and these received wide publicity. The government set up an independent inquiry, led by Professor Sir John Tooke. The inquiry reported in January 2008 (www.mmcinquiry.org.uk/index.htm) and made 47 recommendations. One of these was to separate the first and second foundation years and to make the second year into the first year of core specialty training. However, at the time of writing, no definite decision has been made.