The case for reform of rotational training
BMJ 2024; 384 doi: https://doi.org/10.1136/bmj.q410 (Published 29 February 2024) Cite this as: BMJ 2024;384:q410
- Jo Best, freelance writer and doctor
- Brighton, UK
- jo{at}jobest.online
Calls for reform of rotational training have been growing. Grassroots movements, junior doctors’ committees, and others have been calling for updates to a system that they say brings little benefit and much disadvantage to doctors in training.
Under the current system (see box 1) trainees rotate to new jobs—often spread over a wide geographical area—every few months for anything up to a decade (or longer if working less than full time) before achieving their certificate of completion of training. Supporters of the system argue that doctors are thus exposed to different hospitals, patient populations, and ways of working, bringing a breadth of knowledge to their practice.
How does rotational training work?
The current rotational training system requires doctors to move between jobs regularly.
Medical graduates apply to the UK Foundation Programme for the first two years (foundation years 1 and 2) of their postgraduate training, ranking their preference for 18 foundation schools across the country. A foundation school is not a single institution but a group, including medical schools and NHS trusts, in a single geographical area.
Successful applicants are allocated to a foundation school and then a series of six jobs across the two year programme, each lasting four months, in six different departments. All six could be in one hospital, or they could be spread across two hospitals, potentially in different counties, in the foundation school area. Foundation doctors will typically know the types and locations of their jobs at the start of the programme.
For specialty training (core and specialty trainees), doctors again apply nationally, stating their preference for geographical locations known as deaneries (12 in England, plus one each …
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