The impact of Longitudinal Integrated Foundation Training: preliminary experiences in the United Kingdom

Abstract

Background: The United Kingdom health system is challenged with retaining doctors entering specialty training directly after their second foundation year. Improving doctors' training experience during the foundation programme may aid such retention. The Longitudinal Integrated Foundation Training (LIFT) pilot scheme aimed to provide a programme that improves the quality of their foundation training experience, advance patient-centred care and provide doctors with more experience in the primary care settings.

Methods: During this pilot study, three methods were employed to evaluate and compare doctors' experiences across their 2-year foundation training programme: Horus ePortfolio assessment of six domains for good medical practice analysed using a T-test, online survey assessments analysed using a 2-tailed chi-square test, and focus group feedback sessions with thematic analysis.

Results: Doctors completing LIFT (n = 47) scored a higher but non-significant mean score on all six domains for good medical practice versus doctors completing traditional foundation training (n = 94). By the end of foundation training, 100% of LIFT doctors rated their understanding of how primary and secondary care work together as high versus 78.7% of traditional doctors (p < 0.05). Improvements in wellbeing were observed among LIFT doctors, along with a reduction in the proportion of doctors considering leaving medical training. A significantly greater number of LIFT doctors versus traditional doctors rated their compassion for patients as high (100% versus 86.8%; p < 0.05), intended to become general practitioners (23.1% versus 13.5%; p < 0.05) and rated the extent to which they felt well informed and able to consider a general practice career rather than a hospital career as high (91.7% versus 72.3%, respectively; p < 0.05). Some LIFT doctors felt they had reduced exposure to secondary care, received less on-call experience and considered working a half-day to be problematic; challenges ameliorated by the end of the 2-year foundation programme.

Conclusion: The LIFT programme enhanced the quality of foundation training and improved doctors' experiences and competencies, generating valuable insights for the future of education and healthcare delivery. Applying the principles of LIFT to foundation training helps doctors to be more compassionate and patient-centred, leading to enhanced individualised patient care.

Keywords: Doctors; Foundation programme; General practice; Longitudinal Integrated Foundation Training.

Fig. 1

LIFT versus traditional doctors’ mean scores for each domain for good medical practice in F2 F2, Foundation Year 2; LIFT, Longitudinal Integrated Foundation Training; NHS, National Health Service

Fig. 2

Proportion of LIFT doctors, traditional doctors and their supervisors who rated their experiences of foundation training as good or high in F2 ^aThe number of LIFT supervisors responding ranged from 9 to 13 ^bThe number of traditional supervisors responding ranged from 191 to 199 F2, Foundation Year 2; LIFT, Longitudinal Integrated Foundation Training; NHS, National Health Service

Fig. 3

Proportion of LIFT and traditional doctors rating themselves as high for parameters of wellbeing, across F1 and F2 F1, Foundation Year 1; F2, Foundation Year 2; LIFT, Longitudinal Integrated Foundation Training