The Post-Foundation Training Break (‘F3’): evaluating its impact on postgraduate medical training

Why did we commission this research?

An increasing number of doctors are taking a training break between Foundation Year 2 (FY2) and the start of core/specialty training (C/ST). The research aimed to understand how this break is managed and perceived, and its impact on career progression, including any equality, diversity and inclusion issues. 

The researchers advocate using ‘Post Foundation Training Break’ (PFTB), to replace the colloquial term ‘F3’ currently in use.

What did the research involve?

• A national survey of 4,046 doctors undertaking or who had completed a PFTB in the past ten years. This data was linked to the UKMED database for consenting doctors.
• 16 semi-structured interviews with Foundation Programme directors or heads of Foundation Schools in this role within the past five years.
• 21 semi-structured interviews with core/specialty training programme recruiters at C/ST1 level within the past five years.

What are the key findings?

The research focused on three main questions:

How does taking a PFTB affect subsequent career progression?

• 95% of doctors would recommend such a break to peers and colleagues and the majority reported positive effects on career progression. 
• Personal fulfilment, improving health and wellbeing, and taking a break from training were more prominent motivators for taking a PFTB than career exploration. 
• Of the 72% of doctors who agreed that the PFTB had influenced their career progression, 70% stated that it had confirmed their career choice and almost 25% that it had deterred them from certain specialties. 
• Almost 70% reported that the PFTB made a positive contribution to the way they viewed their work. Over 50% considered it to have prevented burnout.
• Most doctors who continued working clinically post-PFTB have returned to the traditional training pathway. 

What are medical educators’ perceptions of doctors undertaking a PFTB?

• Educators understood the increasing trend of PFTB but highlighted the challenge of providing advice considering the wide range of possible activities PFTB can involve. 
• Most PFTB-focused advice was from peers and healthcare professionals who had completed a PFTB, given in informal settings, rather than from supervisors during mandatory FP careers sessions.
• Medical educators correctly said that some doctors are motivated to take a PFTB due to ‘burnout’.
• Educators recognised the positive contribution of PFTB doctors working clinically, including workforce stability through providing clinical services and contributing to teaching.

Is the increasing number of doctors undertaking a PFTB year affecting subsequent training post applications? 

• There were conflicting findings on whether a PFTB gives an advantage at C/STP application stage. Almost 60% of doctors stated that their PFTB influenced their career progression by enhancing their CV and job applications. 
• Recruiters indicated that in specialities which used interviews at recruitment, there may be opportunities for PFTB candidates to obtain an advantage over their F2 counterparts. These included being more able to demonstrate specialty-specific insights, as well as increased maturity and breadth of experience.
• However, recruiters emphasised that PFTB is in no way required to secure a C/ST post and that formally PFTB doctors’ achievements should not give them an advantage over their F2 counterparts. Further, as not all C/STPs use interviews for recruitment - with some purely based on exams - the possible advantages afforded to PFTP candidates differ by specialty.
• Being male, privately educated, a school-leaver on entering medical school and having parents educated to degree level were associated with taking a PFTB. 
• Overall, non-white doctors were 32% less likely to undertake a PFTB than white doctors, although there were some differences within ethnicities. This has implications for specialties more heavily populated by doctors who have taken a PFTB, for example, anaesthetics and emergency medicine.

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The Post-Foundation Training Break (‘F3’): evaluating its impact on postgraduate medical training