Less than full time training: Being a parent and an orthopaedic trainee

Anh Nguyen is an Orthopaedic Registrar and a Black, Asian, Minority and Ethnic (BAME) recruitment panel representative at St George’s University Hospitals NHS Foundation Trust. She is a Clinical Teaching Fellow and Post graduate student representative for the St George’s University of London.

Caroline Hing is an Orthopaedic Surgeon and Honorary Reader at St George’s University Hospitals NHS Foundation Trust. She is a member of the BOA Equality and Diversity Working Group and BOA Education and Careers Committee.

Alex Trompeter is a full-time orthopaedic Trauma Surgeon specialising in fracture surgery and the management of post fracture complications. He is an Academic and Educational Supervisor and Training Programme Director for the South West London Orthopaedic rotation, and is passionate about education.

Anh T V Nguyen, Caroline B Hing and Alex Trompeter

A number of female doctors in the United Kingdom (UK) report orthopaedic training being incompatible with family life 1 . This perception may stem from a lack of awareness and understanding around less than full time (LTFT) training in orthopaedics. We outline how LTFT training operates and the support available to LTFT trainees in orthopaedics.

LTFT refers to specialty training with a reduced number of hours (usually not less than 50% of full-time). Although more female trainees are taking part in LTFT training than their male counterparts; this option is available to both genders. Rationale for LTFT training requests are grouped into categories based on need, with childcare a prioritised reason for acceptance. Within the South West London rotation, in addition to support provided by the Training Programme Director (TPD) and Academic and Educational Supervisor (AES), the trainee can be connected with a mentor who has LTFT experience for additional guidance. Communication with the AES, TPD and mentor is crucial to a positive LTFT training experience, throughout all stages from pregnancy, parental leave and on return to work. During pregnancy, an agreement can usually be made between the trainee, their AES and the local occupational health department as to which clinical activities are safe – such as on call, manual handling, and exposure to ionising radiation. During this stage, the parental leave application is made. During leave, the trainee can remain engaged with the training programme. For example, keep-in-touch (KIT) days are a paid facility of up to 10 supernumerary days that the trainee can take to attend teaching or supervised clinical sessions to build confidence prior to their return to work date. Towards the end of the parental leave period, trainees have a meeting with their AES and TPD to facilitate a supervised return to work period. Specific

details of training policies and resources can be found in the national training reference guide or the ‘Gold Guide’ 2

and the ‘Supported Return to Training’ (SuppoRTT) guidance document 3

. In addition to local support, there is an increasing network of support nationally. The British Medical Association has set up a LTFT forum 4

that hosts regular conferences and provides pay and rostering guidance via a dedicated regional representative. The Joint Committee on Surgical Training are working to improve the LTFT training experience for trainees based on the recommendations from various trainee organisations.

Despite the above initiatives, there is scope for improvement. Firstly, the current guidelines could provide clearer guidance regarding the length of recommended parental leave. Stack et al. 5

reported that trainees with at least two months of maternity leave were less likely than peers to suffer post-partum depression and burn out. Secondly, it is suggested that on-site lactation and child care facilities can help more women to stay in full time work in orthopaedics 6 .

LTFT training is likely going to be a popular option amongst future trainees. Initiatives to improve LTFT trainee’s experience will increase career satisfaction of our surgeons and attract more female applicants into orthopaedics. n

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