Identifying the work activities performed by doctors in the Foundation Programme

What were the key findings?

  • Foundation Programme doctors are expected to fulfil different functions and perform different activities in different settings. For example, GP placements involve activities quite distinct from hospital-based placements.
  • There are tensions between the three main roles of a Foundation Programme doctor: as a ‘support’ who keeps the ward functioning; as an ‘independent practitioner’; and as a ‘learner’.
  • Some common activities of Foundation Programme doctors are not set out, or not set out in detail, in our curricular requirements. These include some practical procedures (notably arterial blood gases and nasogastric tube placement), end of life discussions with patients, and ‘professional skills’ that are seen as integral to routine work (task prioritisation and making a ‘job list’).
  • Nearly one quarter of activities specified in our curricular requirements are 'rare': that is performed regularly by less than 25% of Foundation Programme doctors. Many of these are practical procedures, such as taking basic observations or giving intramuscular injections.
  • These activities are rare for Foundation Programme doctors largely because they are routinely undertaken by nurses or because they are seldom needed at all.
  • However, it may still be important that Foundation Programme doctors are able to carry out at least some of these activities, eg in emergencies.
  • Acknowledging the variability of the Foundation Programme year 1 role may help to make graduates more able to adapt to a fluid role when they begin practice.

Why did we commission this research?

The Foundation Programme is a two-year (full time equivalent) generic training programme for doctors after successfully completing undergraduate education. By exploring how the current requirements for curricular outcomes and practical procedures listed in our guidance relate to the activities performed by Foundation Programme doctors, the research aimed to provide an evidence base for determining whether the competencies previously set are appropriate for the needs of Foundation Programme doctors today.

The research will be important for the next review and revision of our required outcomes and practical procedures and will supplement the research and evidence we have already obtained through the preparedness for practice of UK graduates research.

What did the research involve?

They researchers used a mixture of methods to gather the information including questionnaires, focus groups, and telephone interviews with Foundation Programme doctors, nurses, supervisors, senior clinicians, and senior non-medical Trust management.

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