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Cardiology in focus
Less than full-time training in cardiology
  1. Rebecca Dobson1,
  2. Abhishek Joshi2,
  3. Christopher Allen3,
  4. Hannah C Sinclair4
  1. 1 Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
  2. 2 Bart’s Heart Centre, Barts Health NHS Trust, London, UK
  3. 3 Guy’s & St Thomas' Hospital, Kings College, Rayne Institute, London, UK
  4. 4 University Hospital Southampton NHS Foundation Trust, Southampton, UK
  1. Correspondence to Dr Rebecca Dobson, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool L14 3PE, UK; rebecca.dobson{at}lhch.nhs.uk

https://doi.org/10.1136/heartjnl-2019-315226

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    Introduction

    In the UK, 15% of physician trainees are less than full time (LTFT) (25% of female and 3% of male trainees).1 The 2018 British Junior Cardiologists’ Association (BJCA) annual survey identified that approximately 4% of cardiology trainees work LTFT. To explore this further, a survey was sent to LTFT cardiology trainees to identify the challenges they face.

    Demographics

    Of the estimated 24 LTFT cardiology trainees in the UK, 70% completed the survey. Thirty-one per cent were male, much higher than the proportion of physician LTFT trainees who are male (9%).1 The majority of LTFT trainees are 31–40 years old and are training LTFT in a full-time post (88%). Nearly half of LTFT trainees work 80% of full time. Childcare responsibility is the most common reason for working LTFT (82%).

    Results

    The subspecialty interests of LTFT trainees in comparison with full-time trainees are shown in figure 1. Notably no LTFT trainees specified electrophysiology and only 10.5% chose intervention, dramatically different to the choices of full-time trainees.2

    Figure 1
    Figure 1

    ‘What is your first choice advanced module?’ Data taken from the 2018 BJCA Trainees’ National Survey and the 2018 LTFT BJCA Trainees’ National Survey. BJCA, British Junior Cardiologists’ Association; LTFT, less than full time.

    Almost 30% of LTFT trainees feel that they do not get the same training opportunities as full-time colleagues. Sixty per cent of LTFT trainees have no regular administrative or research sessions. Seventy-one per cent feel that they have been treated differently due to working LTFT (figure 2). Similar to full-time trainees, LTFT trainees frequently work over their rostered hours, and in 24% of cases, this is 5+ hours per week.

    Figure 2
    Figure 2

    Percentage of less than full-time trainees who feel that they have been treated differently as a result of working less than full time.

    There is a general impression that LTFT training is difficult in the more practical subspecialties, evidenced by the low proportion of LTFT trainees in these areas. In some instances, rota coordinators are unsure of the distribution of ‘zero’ days and study leave for LTFT trainees, which can lead to inequity and missed training opportunities. There is variability in the understanding of LTFT rotas by human resource departments, and this has led to errors with pay and unfair allocation of on-call commitments. Eighteen per cent of LTFT trainees report that they have been bullied or discriminated against for working LTFT (figure 2). The small number of current LTFT trainees makes them easily identifiable in otherwise anonymous surveys. This has prevented us and others reporting narrative accounts from trainees to training bodies.

    When asked about their positive experiences, many trainees report better work–life balance. Working LTFT has enabled some trainees to continue a job they love, despite health or personal problems, when the alternative would have been a different career. Many trainees mention excellent support from their supervisors and training programme directors. Several LTFT trainees report that their stress levels have declined since working LTFT.

    The future

    It is essential that all cardiology trainees receive appropriate support to enable equitable LTFT training. Several trainees report an excellent experience of training LTFT and sharing good practice could improve the experience for others. Consolidation of practical skills remains challenging for all trainees, but for those who are LTFT, it is particularly difficult and ways to improve this should be considered. It is clear that in some areas, a change in mindset is required and a LTFT cardiology working group could help drive the innovation that is required to address these challenges.

    The BJCA is working to produce an LTFT guideline to assist in the development of equitable rotas and to increase awareness of LTFT rights. The guide will consolidate information and signpost trainees to key resources. Similar challenges for LTFT training exist outside cardiology, and collaboration with other specialties will help to make LTFT training better for all.

    References

    1. 1.↵
      Royal College of Physicians. Census of consultant physicians and higher specialty trainees 2017–18. https://www.rcplondon.ac.uk/projects/outputs/focus-physicians-2017-18-census-uk-consultants-and-higher-specialty-trainees (Accessed 11 Apr 2019).
    2. 2.↵
      British Junior Cardiologists' Association Trainees' Survey 2018. http://bjca.co/ (Accessed 09 Jan 2019).

    Footnotes

    • Contributors RD and HCS designed survey, drafted and reviewed article. CA and AJ disseminated the survey and reviewed article.

    • Competing interests None declared.

    • Provenance and peer review Commissioned; internally peer reviewed.

    • Patient consent for publication Not required.