Planning an “F3” year: opportunities and considerations for aspiring surgeonsBMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f7224 (Published 12 December 2013) Cite this as: BMJ 2013;347:f7224
- Matthew John Fell, senior house officer, general surgery 1,
- Matthew Robert Frederick Jaring, anatomy demonstrator 2, senior house officer, general surgery3,
- Kenneth Russell MacKenzie, senior house officer trust grade, urology4
- 1Ngwelezane Hospital, South Africa
- 2University of Cambridge, Cambridge, UK
- 3Cambridge University Hospitals NHS Foundation Trust, UK
- 4Weston Acute Health Trust, UK
Often termed an “F3,” a year away from the UK training pathway after the second year of foundation training is an increasingly popular option for doctors in training. Matthew Fell and colleagues look at the options available and discuss what aspiring surgeons should consider
The proportion of foundation year 2 doctors continuing straight into the first year of core training (CT1) or specialty training (ST1) has declined over recent years, from 83% in 2010, to 70% in 2011, 67% in 2012, and 64% in 2013.1 This means that in 2013 a third of junior doctors took time away from formal UK training.
The Joint Royal Colleges of Physicians’ Training Board believes that a gap year between foundation training and CT1/ST1—an “F3”—should be seen as a positive initiative, which benefits the trainee and the NHS. “The year allows trainees to gain new skills or consolidate existing skills, which are usually welcomed at CT/ST1 level,” Liz Berkin, deputy medical director of the board, has said.2
F3 for surgeons
Would this advice apply to those considering a career in surgery rather than medicine? Surgery is a practical profession and requires thousands of hours of training before proficiency is acquired. Gaining clinical and theatre experience is more important than ever for junior doctors. Does an F3 increase trainees’ experience and strengthen career prospects or could it undermine training continuity and jeopardise future career prospects (box 1)?
Box 1: Advice from the Royal College of Surgeons of England
We identified a lack of official advice about taking a year out before core surgical training and so contacted the Royal College of Surgeons of England directly to ask its opinion. Here is the response it provided in September 2013:
• “We [the royal college] do not provide definitive guidance on whether or not trainees should take time off between F2 and application to CST. If a trainee would like to gain more varied experiences before application or feels that he/she is lacking in a particular area of experience, it can be useful to take advantage of the natural break between foundation and core training.
• Applicants must ensure that they are able to meet all the requirements of the person specification. Trainees must have achieved their foundation competencies in the 3 years before the intended CST start date and have a maximum of 18 months’ post foundation year experience in surgery.
• The core surgical training application system does not have a formal list of specific requirements associated with time out of training after F2. However, candidates should be able to show that their career progression is consistent with their personal circumstances so they should think about how they will explain the time they have taken off, and what skills or experience they have gained from this.”
The decision to take an F3 will be linked to individual circumstances. Some doctors may be forced to take a year out if they have failed to obtain a training post. Others may be craving the freedom to travel without the restrictions associated with a UK training job. There is an argument, however, that it may be worth taking an F3 to increase your competitiveness at surgical selection.
The UK Foundation Programme aims to provide a broad range of experiences in a variety of medical areas before doctors start to specialise. A reduced surgical component and no specification for time in theatre in the curriculum, however, can leave trainees with limited experience of crucial aspects of surgical care.3
For the 2012-13 round of core surgical training applications, there were 1295 applicants for 692 jobs, making a competition ratio of 1.9:1.4 The portfolio forms an important element of the application system and crucially it is in this area that candidates can do the most preparation before the interview.
Candidates are given credit for their ability to display evidence of theatre experience, research, and teaching, all of which may be hard to bring together during foundation training. Of note, credit can be gained for attending courses, such as advanced trauma life support (ATLS) and care of the critically ill surgical patient (CCrISP), even though they are not judged to be suitable for foundation trainees.5
Interviews for core surgical training are tough, but the real hurdle is at the following stage for ST3 application. The average competition ratio for entry into any surgical specialty at ST3 in 2010 was 6:1, and most successful applicants had extra surgical experience in addition to that achieved during core surgical training.6 In this competitive environment, an F3 provides an opportunity for aspiring surgeons to gain experience and strengthen their portfolio in advance of core and specialty selection.
Opportunities for the year out
There are a range of potential opportunities during a year away that you might consider for an F3. These include surgical trust positions in the UK, anatomy demonstrating posts, working abroad, and academic work in research and teaching (see box 2).
Box 2: Potential opportunities
Surgical trust positions
A trust post in a UK hospital gives you the chance to spend an extended length of time in a post compared with time spent by doctors in training positions. You have a good chance of securing a position in the surgical specialty of your choice and developing a rapport with the senior members of the team. This may provide regular time allocated on operating lists and the opportunity to gain a degree of independence for simple procedures as the year progresses.7 One concern with trust posts is that, compared with core trainees who have the benefit of working in a structured system, it may be difficult to show progression. However, the intercollegiate surgical curriculum programme is accessible to doctors in trust jobs, so there is an opportunity to record procedural and clinical experiences. Also, study leave applies in a similar way to core trainees, allowing for participation in courses and conferences.
Anatomy demonstrating is one of the most traditional activities for aspiring surgeons taking a working gap year, but the number of these positions available in the UK has fallen.8 Anatomy demonstrating remains a worthwhile choice, as surgical consultants have criticised the inadequate anatomical knowledge of trainees.9 The advantage of this job is that you thoroughly learn your anatomy and gain a great deal of teaching experience within a supported university environment. It is important to investigate each demonstrating position carefully. Some are linked to surgical on-call rotas, but many are stand-alone anatomy posts and so clinical experience throughout the year may be harder to come by.
Historically, the favoured destinations for working abroad have been Australia or New Zealand, because of similarities in health systems, a common language, and a lack of requirement for additional exams.3 But, with a 62% increase in Australian graduates over the past five years and rising retention rates of overseas doctors in New Zealand, these countries may no longer be such an easy option.1011 Another possible destination is South Africa, which is becoming increasingly popular because the high burden of disease gives opportunities to develop important hands-on experience.12 During a year abroad, your experience will be broadened by working within a different healthcare system and by exposure to a unique workload of cases. You may be given a greater degree of independence and develop practical and management skills that would be harder to come by in the UK.13 A concern about working abroad after foundation year 2 is that you might pick up bad habits and be required to work in an environment beyond your skill level with a lack of supervision. It will be important, therefore, to choose your placement carefully and to ensure that the hospital and department you work in have a record of excellent training. Supervision and appropriate levels of progression can be documented via the surgical logbook, and continued engagement with the portfolio processes is recommended.
Research and teaching
Research and teaching experience is often hard to acquire during medical school or foundation years, so an F3 can be used to boost this area. Timing academic projects after foundation year 2 may allow you to focus on the practical side of surgery during core surgical training without attempting the difficult task of balancing academia and surgery. The options for acquiring a full time degree in research or teaching will be limited by the amount of time you choose to take away, but there are other opportunities for projects of varying lengths and complexities that do not fall into a structured degree programme.14 Funding and support for academic projects will vary according to your area of interest, but scholarships exist for short term projects from surgical societies and local NHS trusts.
A year out after the Foundation Programme provides a unique opportunity to develop professionally and personally, potentially making you a stronger candidate for a future career as a surgeon. Arguably there is a need for an F3 year to fill the evident gaps in surgical experience within the current junior doctor training programme.
Competing interests: We have read and understood the BMJ Group policy on declaration of interests and have no relevant interests to declare.