SPECIALTY TRAINEE SURVEY REPORT 2020 Introduction: In November 2020 the British Thoracic Society (BTS) conducted a survey of trainee members. The intention was to gather data on: Trainee demographics Trainee intentions regarding their future career Information on sub-specialty choices - - - - Working patterns, including Less Than Full Time (LTFT)/flexible modes of working - Experience of support during the consultant recruitment process Method: The survey was developed by trainee members of the BTS Workforce and Service Development Committee (BTS WSDC) and comments were sought from the BTS Trainee Advisory Group (BTS STAG). BTS had 715 Specialty trainee members in November 2020, at various stages of training. All were emailed inviting them to complete the survey. The survey was conducted over a four week period from the beginning of November to the beginning December 2020. A reminder was sent out. No question was mandatory. For some questions it was possible to check more than one answer. The initial results were presented to the open meeting of the BTS STAG in December 2020. Response rate: 144 trainees responded, a response rate of 20%. BTS has surveyed Specialty trainee members in the past, but this survey returned the highest response rate. 74 respondents (51%) identified as male. 67 respondents (47%) identified as female. 2 respondents preferred not to say. 1 respondent left this question blank. Responses were received from the majority of the deaneries (figure 1): 1 s e i r e n a e D Yorkshire & Humber Wessex Wales South West Scotland West Scotland South East Scotland East Oxford Northern Ireland North West North Midlands West Mersey London South London North West London North East KSS East of England East Midlands South East Midlands North 3 2 2 2 4 4 6 6 5 9 9 9 8 8 8 11 10 11 15 12 0 2 4 6 8 10 12 14 16 Figure 1 Response total Responses were also received from trainees at each Specialty stage (figure 2). BTS has a slightly smaller proportion of members who are ST3, and the survey questions may not have felt as relevant to this cohort. Figure 2 Planning for a consultant post A key aim of the survey was to gain information on the number of trainees who were planning to apply for a consultant post within the UK, remain in respiratory medicine, and/or continue with GIM work 2 142 completed this question (figure 3) and the majority (79, 56%) of respondents do plan to apply for a consultant job within the specialty. Yes – with a subspecialty interest and with GIM in the UK 19 Yes with GIM in the UK 79 Yes – a clinical academic post Undecided Yes – without GIM in the UK Yes - but I intend to undertake a post CCT fellowship first Yes – with intensive care medicine in the UK Yes – with a subspecialty interest without GIM in the UK Yes - with GIM outside of the UK Yes - without GIM outside of the UK Yes – with a subspecialty interest outside of the UK Figure 3 9 7 6 5 5 4 3 2 3 0 50 100 No respondents reported an intention to: - Apply for a consultant job outside of Respiratory Medicine - - - - - apply for another medical job (e.g. Critical Care, Acute Medicine) in the UK apply for another medical job (e.g. Critical Care, Acute Medicine) outside of the UK leave clinical practice but remain within healthcare (e.g. research, teaching) leave medicine completely (e.g. Finance) take time out Sub-specialty interests 144 respondents provided information on the sub-specialty areas that were of most interest (figure 4). Respondents were able to select more than one option and it was clear that trainees have a wide range of sub-specialty interests. 3 55 51 51 41 41 40 33 31 29 26 Pleural Lung cancer ILD Infection – TB/NTM/Bronchiectasis COPD Asthma Non-clinical – research Sleep and ventilation Non-clinical – education Interventional bronchoscopy Non-clinical – management Critical Care Infection – Fungal Integrated care Cystic fibrosis Lung transplant medicine Pulmonary hypertension Immunology Allergy Occupational Lung Disease Exercise physiology Palliative and chronic disease management Non clinical sustainability and Green transformation 17 17 13 10 8 7 6 5 4 1 1 1 1 Figure 4 0 10 20 30 40 50 60 When choosing a sub-specialty a large number of influences will play a part and trainees were asked to rank each factor across four domains from ‘very influential’ to ‘not influential’ (figure 5). 142 respondents provided an insight into the factors that had drawn them to a particular area of respiratory medicine. When combining “very influential” and “influential”, the following factors were most significant: - Clinical attachment/experience (131/142, 92%) - Mentoring/support from a respiratory colleague (107/141, 76%) - Interest in practical procedures (90/142, 63%) - Research interest in the field(s) (87/140, 62%) Interest from medical school and national widespread vacancies were least influential. 4 80 70 60 50 40 30 20 10 0 Figure 5 Very influential Influential Neutral Not influential Attracting trainees Important factors A number of NHS Trusts have consultant vacancies and respondents were asked how important a range of factors were when considering a consultant post (figure 6). Combining the “very important” and “important” options, the top five considerations were: Type of hospital (129/141, (91%) Location (118/119, 99%) Keen to work with a specific team or department (117/143, 82%) Previously worked with the department (116/142, 82%) - - - - - Vacancy for your subspecialty (116/143, 81%) 5 90 80 70 60 50 40 30 20 10 0 Figure 6 Very important Important Neutral Not important N.B. When reading this graph please note that the data for “Location” was drawn from a smaller number of respondents n=119). Encouraging factors There were various considerations that appear to influence the respondents when they consider applying to a certain hospital (figure 7), but hearing good feedback from previous and current employees was the most encouraging factor for this group of trainees (116/143, 81%). Looking at where respondents were “neutral”, or “not encouraging”, the data indicated the least important factors were: - No on call responsibility (100/142, 70%) - None or little GIM (68/142, 48%) - Taking up a locum post first (60/143, 42%) 6 140 120 100 80 60 40 20 0 Hearing good feedback Offering me the subspecialty choices I want Flexible working hrs A hospital approaching me None or little GIM responsibility Incentives Taking up a locum post first No on call responsibility Figure 7 Very encouraging Encouraging Neutral Not encouraging Communication 144 responded to the question asking about how they hear about consultant vacancies (figure 8). The majority of respondents found out about consultant jobs via word of mouth (106/144,74%). Word of mouth 106 Approached by the team advertising and I have worked there NHS Jobs 61 58 I approached the team I want to work with 41 Deanery/ TPD BMJ 19 18 BTS recruitment hub Approached by the team advertising and I have not worked there 10 7 Have not started looking yet 12 RCP 5 Involvement with BTS 1 Figure 8 0 20 40 60 80 100 120 7 Support and advice Only 17/141 (12%) felt they have enough support and advice about the consultant process (figure 9). Yes, 17, (12%) No, 52, (37%) Some but not enough, 72, (51%) Figure 9 A number of free text comments suggested that some trainees are given information and support in their final year rather than throughout their specialty training, and there was a suggestion that this information should form part of the training curriculum. Trainees reported finding the process difficult to navigate, and one described the process as “a bit of a minefield and hidden behind a curtain I am yet to peer behind”. From the free text a couple of trainees saw the process as favouring those who work where the vacancies are, or have more access to informal support from colleagues. A number of specific questions were asked to understand more about the support trainees receive and indeed would like to receive. This included formal mentoring and more informal or ad hoc support from colleagues. Overwhelmingly, respondents reported that they would like to receive more support during their trainee journey. Figure 10 indicates that the vast majority are interested in receiving a wide range of support, and it appeared that few trainees had received support to date. Most viewed support positively, with very few feeling that it did not or would not help. The free text responses also supported the view that organisations, including BTS, could provide more help in this area. 8 120 100 80 60 40 20 0 112 111 111 109 105 101 87 76 58 48 32 5 3 4 Support via Royal College Informal mentoring Support from BMA 14 14 13 15 8 18 16 13 13 21 Formal mentoring Support via BTS Online information Support from local hospital or the local trust/board Information gained from attending a Consultant application course Figure 10 I received support I would like to receive support I do not think support did/will help Working patterns Many respondents indicated the intention to work LTFT, or in a flexible pattern, if not straight away then in the future (figure 11). Only 21/143 (15%) had no intention of working LTFT. Two respondents provided additional information about issues to do with inflexibility and support in relation to LTFT working. One described “zero help for those who want to work LTFT”, and another noted that lack of flexibility for LTFT makes working in the UK less attractive. Figure 11 9 Free text comments 15 respondents provided additional comments and the full responses can be seen at Annex 2. Comments focussed on the need for more information and support, highlighting how this can often focus on informal routes of communication. There was also concern that there was very little support for those working LTFT. Conclusion In 2019 an estimated 50% of consultant respiratory jobs were unfilled, and many are often not advertised due to a lack of candidates1. Our survey highlights that trainees value working in teams that they have worked with before (82% found this very “influential” and “influential”) and are also strongly swayed by the location of jobs (99%). Trainees also value hearing good feedback on a job/department but only 12% felt they had enough support regarding career progression. The need for support was highlighted by the overwhelming proportion of respondents who would like to receive support, both formal and informal, with consultant applications and career progression. Trainees have expressed enthusiasm for pursuing a wide range of sub-specialties in the future and there is interest in important non-clinical aspects of respiratory medicine including research, education and management. We are delighted that the majority of trainees intend to stay working within respiratory medicine in the UK and that none of the 144 surveyed intended to leave their career in medicine. The vast majority (85%) of respondents are currently, or would like to consider, working LTFT. This suggests a shift in working practices and has an implication for workforce planning. It also suggests that it will be important for Trusts planning recruitment to ensure that where there are options for LTFT working, these are clearly stated. We will also work to make career information more accessible, building on our online resources which includes information for those wanting to work LTFT. It is also hoped that by gathering information on what matters to trainees we may be able to help our more experienced members to provide informal mentoring support to trainees during their training. BTS will continue to survey members to monitor any trends in career intentions of trainees in order to support them in their future careers. October 2021 BTS Workforce and Service Development Committee British Thoracic Society www.brit-thoracic.org.uk 1 British Thoracic Society Respiratory Medicine Workforce Survey Report 2019 https://www.brit- thoracic.org.uk/workforce/ 10 Annex 1: Survey questions: Q1. Please state your gender (n=143) Q2. Current training deanery Q3. Year of training at October 2020 Q4. Do you plan to apply for a consultant job in respiratory medicine? Q5. What sub-specialty areas interest you? Q6. What has influenced your interest in the above areas? Q.7 Please identify how important each of the following are when considering a consultant job Q8. Where do you hear/find out about consultant jobs? Q9. Please let us know what factors, if any, would encourage you to apply to a certain hospital? Q10. Please identify the support you received, or would like to receive. Q11. Do you feel you currently have enough support and advice in the consultant application process? Q12. Do you intend to work less than full time as a consultant? Q13. What are your thoughts on the information for trainees on the BTS website? Q14. Please provide any other comments on the consultant application process Annex 2: Data tables: Q4. Do you plan to apply for a consultant job in respiratory medicine? 79 (56%) 3 (2%) 6 (4%) 2(1%) 5 (4%) 0 19 (13%) Yes with GIM in the UK Yes - with GIM outside of the UK Yes – without GIM in the UK Yes - without GIM outside of the UK Yes – with intensive care medicine in the UK Yes – with intensive care medicine outside of the UK Yes – with a subspecialty interest and with GIM in the UK Yes – with a subspecialty interest and with GIM outside of the UK 2 (1%) 4 (3%) Yes – with a subspecialty interest without GIM in the UK 1 (1%) Yes – with a subspecialty interest without GIM outside of the UK 5 (4%) Yes - but I intend to undertake a post CCT fellowship first 9 (6%) Yes – a clinical academic post 7 (5%) Undecided 0 No – but I will apply for another medical job(e.g. Critical Care, Acute Medicine) in the UK No – but I will apply for another medical job(e.g. Critical Care, Acute Medicine) outside of the UK No – I am leaving clinical practice but remaining within healthcare (e.g.research, teaching) No – I am leaving Medicine completely(e.g. Finance) No – I am planning to take time out 0 0 0 0 Q6. What has influenced your interest in the above areas? 11 Interest from medical school Clinical attachment/experience Interest in practical procedures Research interest in the field(s) Opportunity to develop an academic career Preferred department job prospect National widespread vacancies Opportunity to develop teaching role Opportunity to develop leadership and management role Mentoring/support Respiratory Medicine colleague within from a Location Type of hospital (DGH/tertiary/teaching) Previously worked with the department Keen to work with a specific team or department Opportunity to make changes in the department Vacancy for your subspecialty Research opportunities Teaching opportunities Number of vacancies in the hospital GIM commitment Respiratory on call commitment Ability to work less than full time Flexible working (e.g. compressed hours) Department size Hearing good feedback from previous and current employees Incentives for me to join (e.g. help with moving, upfront golden handshake, etc.) Flexible working hours A hospital offering me the subspecialty choices I want None or little GIM responsibility No on call responsibility Taking up a locum post at the hospital before deciding if I want a substantive post at the same place Very influential 7 (5%) 55 (39%) 45 (32%) 51 (36%) 37 (26%) 27 (19%) 2 (1%) 15 (11%) 11 (8%) Influential Neutral Not influential 28 (20%) 76 (54%) 45 (32%) 36 (26%) 37 (26%) 59 (42%) 18 (13%) 60 (43%) 55 (39%) 4 (3%) 44 (31%) 63 (44%) 7 (5%) 33 (23%) 19 (13%) 32 (23%) 21 (15%) 31 (22%) 36 (26%) 43 (31%) 12 (9%) 61 (43%) 60 (43%) 49 (35%) 17 (12%) 51 (36%) 23 (16%) 47 (33%) 60 (43%) 25 (18%) 9 (6%) Very influential 81 59 35 49 33 32 28 21 12 13 23 31 29 12 Very encouraging 116 30 52 91 34 21 22 Influential Neutral 37 70 81 68 66 84 56 71 54 68 75 51 58 70 1 10 21 25 37 25 43 48 69 55 41 32 39 50 Not influential 0 1 5 1 6 2 16 3 8 8 4 30 17 11 Encouraging Neutral Not 27 61 66 47 40 21 61 0 46 21 4 52 72 46 encouraging 0 6 3 0 16 28 14 12 A hospital approaching me 47 67 27 1 Q10. Please identify the support you received, or would like to receive. Formal mentoring Informal mentoring Support from local hospital or the local trust/board Information gained from attending a Consultant application course Online information Support via BTS Support via Royal College Support from BMA received I support I would like to receive support 13 48 13 14 13 8 5 4 111 87 105 112 109 111 101 76 I do not think support did/will help 15 3 21 14 16 18 32 58 13