Innovative recruitment and clinical orientation programme to manage NHS junior doctor shortfall: A district hospital experience

Abstract

Background: International medical graduates (IMGs) contribute significantly towards the NHS care provision. No standardised clinical orientation programme (COP) for IMGs new to the NHS exists.

Objective: Our objective was to describe recruitment and retention strategies for junior doctors (JDs) in general medicine and develop a framework to anticipate outcomes of these interventions using the realist evaluation methodology.

Methods: We performed quality improvement interventions of recruitment and COP for new entrant IMGs in our organisation employed between December 2017 and April 2019.

Results: Twenty-three IMGs were recruited, 96% successfully completed the COP with a mean contract duration of 13±5 months. From the academic year 2017/18 to 2018/19, mean JD post occupancy increased from 54±3 to 73±4 JDs (p<0.001) and JD locum spend fell by £1.9 million.

Conclusion: Our structured COP provides a stable, trained and financially sustainable JD workforce. Application in broader NHS settings is recommended.

Keywords: Health service research; clinical orientation programme; medical education; quality improvement; realist theory.

Fig 1.

Clinical orientation programme pathway and assessment for senior house officer (foundation year-2 doctor: 6 weeks’ duration) and registrar (specialty training year-3 doctor: 12 weeks’ duration) grade doctors. *Assessment targets for senior house officers and registrars include competency in using trust IT systems; familiarity and understanding of local policies, guidelines and safe prescribing as well as ward round documentation standards; clerking and presenting patients to consultants on the acute medical unselected take; review of management of top acute medical conditions; knowledge and communication of personalised treatment escalation planning, do not attempt resuscitation policy and end-of-life care pathways; management of frail elderly patients with multiple comorbidities (including dementia and delirium assessment); performance of core bedside procedures (those expected at the end of the UK Foundation Programme); and mandatory trust induction and modules, consultant feedback report, registrar feedback report, completion of the orientation on-call as per rota, satisfactory attendance in departmental teaching, satisfactory interim educational supervisors report and advance life support provider (for registrars only). CS = clinical supervisor; ES = educational supervisor; SHO = senior house officer; TPD = training programme director.

Fig 2.

Participant cohort of recruited international medical graduate junior doctors. EGH = Epsom General Hospital; MTI = Medical Training Initiative; SHO = senior house officer; STH = St Helier and Queen Mary's Hospital for Children.