The F3 phenomenon: Early-career training breaks in medical training. A scoping review.

Church, Helen R; Agius, Stevie

BACKGROUND Since 2017 more than 50% of UK doctors have undertaken a 'Foundation 3 (F3) Year' training break after completing their Foundation Programme (the first two years following graduation), rather than immediately enter specialty training. The reasons for, and consequences of, the growing F3 trend are largely unknown. This scoping review presents the current evidence and identifies future research in this field. METHODS Following Arksey and O'Malley's guidelines, 12 databases and three UK-based national post-graduate organisation websites were searched for articles published in English (final searches January 2020). Multiple search terms were used to capture articles relating to the 'F3' time-period, including 'post-foundation' or 'pre-specialty' training. Title, abstract and full-paper screening selected articles reporting any aspect of F3, including within a wider context (e.g., postgraduate training breaks), and then underwent mixed methods analysis . RESULTS Of 4766 articles identified, 45 were included. All articles were published after 2009; 14/45 (31.1%) were published in 2019. 27 articles reported research, the remainder were opinion/commentaries. Specific personal (including demographic), professional and organisational factors, particularly the UK post-graduate training structure, are associated with undertaking an F3. The majority of F3 training breaks last 1 year and involve working (clinically or non-clinically) and/or travel. The decision to undertake an F3 is made either prior to, or during, foundation training. Evidence regarding the impact of F3 on healthcare service provision was limited but evenly balanced. CONCLUSIONS In summarising the existing F3 evidence, this review has highlighted important issues including healthcare workforce equality and diversity, training pathway inflexibility and the effect of negative early-career experiences on subsequent career decisions. More research is needed to understand the financial impact of training-breaks on healthcare service provision, how training programmes must adapt to retain more trainees, and the long-term effects of training breaks, such as F3, on subsequent career progression.