What was the impact of COVID-19 on the foundation training programme in north Wales?

Methodology

We conducted a survey of foundation trainees across the three hospitals in north Wales, using an online survey system in June 2020. The survey was disseminated through their hospital email and social media.

Results

29 out of 134 trainees responded, of which 21 were foundation year 2 trainees. Only one trainee rotated in April as planned, and two were redeployed to an area different from their current or intended placement. Two trainees were rotated once the perceived first local peak of COVID-19 had passed and 24 did not move remained in their second rotation for 8 months.

80% of the trainees felt that the decisions taken due to the COVID-19 pandemic had negatively affected their learning. 43% felt that alteration to their training programme would negatively affect their progression to speciality training. Involvement of trainees in the decision making varied between the hospitals surveyed ranging from 55%, 20%, and 0%. Discussion with educational supervisors revealed that none of them were involved in these decisions.

Discussion

The decision to cancel or postpone the rotation had a significant negative impact on the foundation trainees' perception and experience towards training. Many were unhappy that they had missed out on adequate clinical exposure in different specialities. Because the foundation programme ended in August 2020, there will be no time to restructure future placements and the missed placements would always remain missed. Some specialities (for example general practice) do not offer stand-alone short-term employment at the foundation trainee level. Therefore, it would be impossible for trainees who had missed the opportunity to rotate to gain any experience in those specialities at a later date.

Some trainees were aggrieved by perceived unfairness between colleagues, with some rotating as planned while others could not because they were either redeployed to COVID-19 wards or asked to remain in the same placement for 8 months. In total, 70% of the trainees felt there was lack of involvement regarding alterations to their rotations. This is a major concern because it gives the impression that they were undervalued and their opinions did not count.

Many trainees shared the view that rotation would have been possible, and that their services were never so busy so as to make that unsafe.

A similar survey was undertaken in the East of England and East Midlands. Although not directly associated, similar enough questions were asked to allow comparisons to be drawn. Rotation into third placement was similar at 90% in north Wales compared to 89% in east England. A marked difference was noted in re-deployment rates, with just 7% of north Wales trainees redeployed compared to 59% in east England.² This could partially be explained by differing demands geographically. Similar themes were identified in both areas. Missing out on specialty experience is a common complaint, as are the adverse effects on future opportunities and progression to further training.