Gillespie Hannah, Brown Megan E L, Brennan Nicola, Burford Bryan, Vance Gillian
School of Medicine, Newcastle University, Newcastle Upon Tyne, UK
School of Medicine, Newcastle University, Newcastle Upon Tyne, UK.
BMJ Open. 2025 Apr 2;15(4):e097190. doi: 10.1136/bmjopen-2024-097190.
The healthcare workforce is in crisis. Despite a competitive selection process, a substantial number of doctors leave specialty training (ST) programmes prematurely. This attrition causes increased costs for the National Health Service, exacerbates workforce shortages and threatens quality and safety of care. It also increases pressure on trainees who remain, further compounding the risk of attrition. There is an urgent need to understand why doctors leave ST in order to find ways to maintain the training pipeline from ST to consultant.
We aimed to understand what is known about why doctors choose to leave ST programmes in secondary care, to map current knowledge and identify avenues for future research.
All studies which investigated why doctors leave ST programmes in secondary care were included.
Ovid Medline, Web of Science, SCOPUS and EMBASE were searched until January 2024. Descriptive codes were assigned to the findings of each study. These descriptive codes were reviewed and grouped together in broader categories.
Data was extracted and charted, and a qualitative content approach was used to synthesise data.
A total of 6079 potentially relevant abstracts were retrieved, of which 23 were included in the final analysis. This included the experience of 1896 doctors who have left training and 454 programme directors. Doctors chose to leave training programmes because (1) they felt unsupported and underappreciated, (2) training was associated with unacceptable personal costs and (3) career prospects were unattractive.
There is a mismatch between trainees' expectations of ST and the reality of being a trainee in ST. Understanding the issues which drive attrition and developing evidence-based solutions, has the potential to both reduce attrition, and improve the training experience for doctors in training more widely.
医疗保健劳动力正处于危机之中。尽管选拔过程具有竞争性，但仍有相当数量的医生过早地退出专科培训（ST）项目。这种人员流失给国民医疗服务体系带来了更高的成本，加剧了劳动力短缺，并威胁到医疗服务的质量和安全。这也给留下来的实习生增加了压力，进一步加剧了人员流失的风险。迫切需要了解医生离开ST项目的原因，以便找到维持从ST到顾问的培训渠道的方法。
我们旨在了解关于医生选择离开二级医疗保健ST项目的已知情况，梳理当前的知识，并确定未来研究的方向。
纳入所有调查医生离开二级医疗保健ST项目原因的研究。
检索了Ovid Medline、科学引文索引、Scopus和Embase数据库，截至2024年1月。对每项研究的结果进行描述性编码。对这些描述性编码进行审查，并归为更广泛的类别。
提取数据并绘制图表，采用定性内容分析法对数据进行综合分析。
共检索到6079篇潜在相关摘要，其中23篇纳入最终分析。这包括1896名已离开培训的医生和454名项目主任的经历。医生选择离开培训项目的原因是：（1）他们感到没有得到支持和赏识；（2）培训带来了难以承受的个人代价；（3）职业前景不具吸引力。
实习生对ST的期望与ST实习生的现实情况存在差距。了解导致人员流失的问题并制定基于证据的解决方案，有可能减少人员流失，并更广泛地改善实习医生的培训体验。
