The transition from medical student to junior doctor is a demanding and stressful period for many graduates [1]. The pressures of being new to a job, heavy workloads, intense emotional burdens, fear of litigation, and general feelings of ‘unpreparedness’ can lower morale and job satisfaction [2]. Research shows that job satisfaction is associated with employee retention rates in numerous work sectors [3, 4], including in health care [2]. More importantly, research shows that initial experiences within the first few months of starting work strongly influence career decisions [3]. Indeed, a British Medical Association study revealed that junior doctors’ desires to continue practising medicine fall in the first year of training [5]. Hence, for government agencies tasked with providing an efficient public health care service, it is vital to identify factors that improve the job satisfaction of first year doctors and facilitate a smooth transition from student to doctor.
The bulk of research conducted to date suggests that the transition from student to doctor may be eased by implementing strategic changes to medical school curricula and more effective induction processes at the onset of work [6–8]. In the UK, following directives for learning and competencies outlined in the General Medical Council’s Tomorrow’s Doctors reports [9, 10], undergraduate medical school curricula were revised to incorporate more integrated clinical learning and greater opportunities to experience relevant tasks (e.g. via student assistantships and ‘shadowing’ – that is, working for a time alongside a qualified postgraduate doctor as a learning experience prior to qualification). Some studies have reported that these changes improved the proficiency and the performance of new doctors [7, 11–13]. However, other studies have revealed continued shortfalls in skills and ‘preparedness’ for work, from the perspective of both graduates and their supervisors [8, 13–17].
Currently in the UK, all new medical graduates must complete a structured two-year Foundation Training Programme (termed the F1 and F2 years) prior to entering a core, specialty or general practice training programme. In the F1 year, medical graduates begin to take supervised responsibility for patient care and consolidate skills learned at medical school. In the F2 year, doctors continue to develop their core generic skills under clinical supervision but take on increasing responsibility for patient care. In particular, F2 doctors begin to make management decisions as part of their progress towards independent practice and contribute to the education and training of nurses, medical students and less experienced doctors.
The provision of posts and training during the Foundation Programme is coordinated at a regional level by ‘virtual’ bodies called Foundation Schools, which comprise the doctors’ employers (known as Health Boards in Scotland and Medical Trusts elsewhere in the UK, and which we refer to as Trusts throughout) and the educational providers (known as local education training boards [LETBs] in England and Deaneries elsewhere in the UK). New F1 doctors undertake short (typically 2–4 days) generic educational inductions from their LETB/Deanery prior to the commencement of work, designed to familiarise them with the clinical and non-clinical practices of their first job and involving a period of ‘shadowing’ (which became mandatory in 2013; [18]). In addition, junior doctors receive short (typically ≤1 day,) practical inductions from their respective Trusts (hospitals and departments) focusing on the information needed for working in their particular location [18, 19]. These short inductions have been criticised for being both insufficient and inefficient [20, 21]. While there is some indication that longer, more structured induction processes can offer greater improvements in clinical skills, competence and preparedness among new doctors [6, 8, 22], it is not clear whether such gains correlate with greater job satisfaction or increased morale.
In addition to curriculum changes at medical school and an effective and comprehensive induction process, support more broadly for graduate doctors in their work environment is also likely to ease their transition. In the UK, day to day, this responsibility for trainees feeling well-supported lies with the employing Trust. Trusts are tasked with ensuring new doctors understand the practicalities and logistics of working in that location (e.g. providing information on safety drills and procedures, how to request tests and obtain results, how to obtain a bleeper or pager), and ensuring that new doctors know their chain of supervision and how to access advice and resolve problems. They may also provide additional support for new doctors by offering mentoring schemes, ensuring that graduates receive good support from management, senior doctors and colleagues, and facilitating access to help and learning opportunities (but are not obliged to do so). As studies have shown that new doctors are often ill-prepared for the practicalities of clinical work [13, 17], the implementation of effective initial institutional support in these areas would be expected to ease these difficulties [23, 24]. Indeed, this was true for newly appointed hospital consultants [25]. Such support would also be expected to improve morale and job satisfaction amongst new staff.
Surprisingly, despite considerable interest in easing the student-doctor transition and enhancing morale across the health profession [23, 24, 26], few studies have yet examined whether the extent of overall institutional support that new doctors receive influences their enjoyment of and attitude to work [27]. In this study, we examine the evidence to support the hypothesis that self-reported job enjoyment and attitude to work of F1 doctors, including their level of intention to work long term in medicine in the UK, are positively associated with how much initial support the doctors reported receiving from their employing Trust.
