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      How do workplaces, working practices and colleagues affect UK doctors’ career decisions? A qualitative study of junior doctors’ career decision making in the UK

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          Abstract

          Objectives

          This study draws on an in-depth investigation of factors that influenced the career decisions of junior doctors.

          Setting

          Junior doctors in the UK can choose to enter specialty training (ST) programmes within 2 years of becoming doctors. Their specialty choices contribute to shaping the balance of the future medical workforce, with views on general practice (GP) careers of particular interest because of current recruitment difficulties. This paper examines how experiences of medical work and perceptions about specialty training shape junior doctors’ career decisions.

          Participants

          Twenty doctors in the second year of a Foundation Training Programme in England were recruited. Purposive sampling was used to achieve a diverse sample from respondents to an online survey.

          Results

          Narrative interviewing techniques encouraged doctors to reflect on how experiences during medical school and in medical workplaces had influenced their preferences and perceptions of different specialties. They also spoke about personal aspirations, work priorities and their wider future.

          Junior doctors’ decisions were informed by knowledge about the requirements of ST programmes and direct observation of the pressures under which ST doctors worked. When they encountered negative attitudes towards a specialty they had intended to choose, some became defensive while others kept silent. Achievement of an acceptable work-life balance was a central objective that could override other preferences.

          Events linked with specific specialties influenced doctors’ attitudes towards them. For example, findings confirmed that while early, positive experiences of GP work could increase its attractiveness, negative experiences in GP settings had the opposite effect.

          Conclusions

          Junior doctors’ preferences and perceptions about medical work are influenced by multiple intrinsic and extrinsic factors and experiences. This paper highlights the importance of understanding how perceptions are formed and preferences are developed, as a basis for generating learning and working environments that nurture students and motivate their professional careers.

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          Most cited references31

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          Imbalance in the health workforce

          Imbalance in the health workforce is a major concern in both developed and developing countries. It is a complex issue that encompasses a wide range of possible situations. This paper aims to contribute not only to a better understanding of the issues related to imbalance through a critical review of its definition and nature, but also to the development of an analytical framework. The framework emphasizes the number and types of factors affecting health workforce imbalances, and facilitates the development of policy tools and their assessment. Moreover, to facilitate comparisons between health workforce imbalances, a typology of imbalances is proposed that differentiates between profession/specialty imbalances, geographical imbalances, institutional and services imbalances and gender imbalances.
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            Addressing the crisis of GP recruitment and retention: a systematic review.

            The numbers of GPs and training places in general practice are declining, and retaining GPs in their practices is an increasing problem.
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              Preparedness is not enough: understanding transitions as critically intensive learning periods.

              Doctors make many transitions whilst they are training and throughout their ensuing careers. Despite studies showing that transitions in other high-risk professions such as aviation have been linked to increased risk in the form of adverse outcomes, the effects of changes on doctors' performance and consequent implications for patient safety have been under-researched. The purpose of this project was to investigate the effects of transitions upon medical performance. The project sought to focus on the inter-relationships between doctors and the complex work settings into which they transition. To this end, a 'collective' case study of doctors was designed. Key transitions for foundation year and specialist trainee doctors were studied. Four levels of the case were examined, pertaining to: the regulatory and policy context; employer requirements; the clinical teams in which doctors worked, and the doctors themselves. Data collection methods included interviews, observations and desk-based research. A number of problems with doctors' transitions that can all adversely affect performance were identified. (i) Transitions are regulated but not systematically monitored. (ii) Actual practice (as observed and reported) was determined much more by situational and contextual factors than by the formal (regulatory and management) frameworks. (iii) Trainees' and health professionals' accounts of their actual experiences of work showed how performance is dependent on the local learning environment. (iv) The increased regulation of clinical activity through protocols and care pathways helps to improve trainees' performance, whereas the less regulated aspects of work, such as rotas, induction and the making of multiple transitions within rotations, can impede performance during a period of transition. Transitions may be reframed as critically intensive learning periods (CILPs) in which doctors engage with the particularities of the setting and establish working relationships with other doctors and other professionals. Institutions and wards have their own learning cultures which may or may not recognise that transitions are CILPS. The extent to which these cultures take account of transitions as CILPs will contribute to the performance of new doctors. Thus, these findings have implications for practice and for policy, regulation and research. © Blackwell Publishing Ltd 2011.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2017
                25 October 2017
                : 7
                : 10
                : e018462
                Affiliations
                [1 ] departmentDivision of Population Health, Health Services Research and Primary Care , School of Health Sciences, University of Manchester , Manchester, UK
                [2 ] departmentDepartment of Psychology , Edge Hill University , Ormskirk, Lancashire, UK
                [3 ] departmentDivision of Population Health, Health Services Research and Primary Care , Centre for Health Economics, University of Manchester , Manchester, UK
                Author notes
                [Correspondence to ] Dr Sharon Spooner; sharon.spooner@ 123456manchester.ac.uk
                Author information
                http://orcid.org/0000-0001-6965-3673
                Article
                bmjopen-2017-018462
                10.1136/bmjopen-2017-018462
                5665284
                29074517
                9a58a233-58de-45b9-8581-384ad598989e
                © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                : 30 June 2017
                : 07 September 2017
                : 11 September 2017
                Funding
                Funded by: National Institute for Health Research through the School for Primary Care Research;
                Categories
                Medical Education and Training
                Research
                1506
                1709
                Custom metadata
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                Medicine
                medical education & training
                Medicine
                medical education & training

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