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

Date Published: 2023-05-18

Abstract:
Objectives A recent review recommended UK postgraduate medical education should produce doctors capable of providing general care in broad specialties across a range of different settings. Responding to this, broad-based training (BBT) was introduced in Scotland in 2018 to provide postgraduate trainees with a grounding in four specialties. Introduced as an option for trainees after initial postgraduate ‘Foundation’ training, it comprises 6?months in general medicine, general practice, paediatrics and psychiatry. This study addresses two key BBT outcomes. It examines how successful BBT is in developing trainees who perceive they are able to work beyond traditional specialty boundaries to care for patients with complex, multifactorial healthcare needs. Second, it explores how well BBT prepares trainees for their next stage in training. Design A longitudinal qualitative study using semistructured interviews to collect data from BBT trainees, trainers and ‘programme architects’. Fifty-one interviews were conducted, 31 with trainees (with up to three interviews per trainee across BBT and immediately afterwards (post-BBT)) and 20 with trainers. Data were subject to thematic analysis. Results Two overarching themes were identified: (1) trainees able to work beyond specialty boundaries and (2) preparation for the next stage in training. BBT trainees were able to see the links and overlap between different specialties and understand the interface between primary and secondary care. They did not perceive that BBT (as compared with single-specialty early-stage training) disadvantaged them, other than in terms of specialty examination preparation. BBT was seen as a way to keep career options open in a system where it is difficult to switch training pathway. Conclusions BBT has the capacity to create doctors who will carry on using their generalist skills to care for patients more holistically, even if they end up working in focused practice areas. BBT helps to keep options open for longer, which is beneficial in a highly structured training environment.

Introduction:
Between 2008 and 2013, the Shape of Training review examined the structure of UK postgraduate medical education and considered what reforms might be necessary to continue to provide the best care for the needs of a changing patient population, one in which many more patients have chronic illnesses and multiple comorbidities. 1 One of the key findings of the report was that ‘there was…a clear consensus about what change should deliver: greater flexibility, better preparation for working in multi-professional teams…

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