The impact of service change on doctors' training

What were the key findings?

  • Service change is any process that affects what NHS services are delivered, including where they are delivered. Service change can be planned or unplanned. 
  • The implementation of service change was typically perceived of as a ‘top-down’ process and hard to influence, either nationally or locally.
  • Although there was an ambition to improve training through reconfiguration, and to develop practical benefits such as new learning opportunities, the majority view was that training wasn’t fully considered during service change.
  • In all types of service change, there was a lack of communication about how it would affect doctors’ training.
  • Where trainees were actively involved in the service change, both trainees and supervisors felt it had led to better training experiences and better service provision.
  • All types of service change impacted both positively and negatively on doctors in training with wide ranging ramifications on professional, educational, interpersonal, and personal challenges. Many of these changes are unanticipated and emerge during the change.
  • The impacts and risks associated with service change vary by training grade, speciality, Trust/Health Board site and the type of service change. There are short-term risks on the educational experience of trainees and long-term risks for the recruitment and retention of permanent medical staff.
  • The research sets out implications for practice, the way service change is devised, implemented, communicated, and evaluated.

Why did we undertake this research?

We commissioned this research to:

  • gain a deeper understanding about how service change impacts on doctors’ training
  • to understand if specific types of service change pose a risk to the training experience
  • and to learn more about best practice when implementing service change to protect doctors’ training.

The findings of the research will help us to work with the system to ensure that doctors’ training is considered and protected within the planning and implementation of service change, so training environments continue to meet our standards.

What did the research involve?

The research was undertaken by UCL Research Department of Medical Education. Phase 1 involved expert interviews with senior leads responsible for service change across the four countries of the UK. Phase 2 involved an in-depth examination of three case studies who were undergoing service change. At these sites researchers interviewed doctors in training, clinical and educational supervisors and trust leadership.

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Impact of service change research - summary

Impact of service change research - full report