Anaesthetics and intensive care medicine barely feature in the medical school curriculum, and foundation jobs in the specialties are few and far between. Interesting when you consider that anaesthesia is the largest hospital based specialty. Then, early on in foundation year 2, junior doctors are expected to apply for core training, meaning some may be making decisions about their future career based on little more than a taster week. For this reason amongst others, so-called ‘F3’ posts are gaining traction.  Each year the ‘F3’ becomes increasingly popular with more F2s choosing not to enter training (table 1). There are a number of options for those opting to take some time out following foundation training, including locuming and travelling, however the F3 year also presents a great opportunity for those wishing to gain further experience in a speciality to do so. We are an F3 and an F4 who chose this route, both currently working at Colchester Hospital in anaesthetics and critical care, and we wanted to share our experiences of the post so far.

Table 1: Percentage of F2s entering UK speciality training by year  

Year  
2019 34.9 
2018 37.7 
2017 42.6 

UK Foundation Programme Office (UKFPO). (2019). 

What is the post?

The F3 post at Colchester is 12 months long, divided between 6 months in anaesthetics and 6 months in critical care. There is a critical care on-call commitment throughout the year however this is well supported as all shifts are doubled up with a senior trainee. There is also non clinical time built into the rota to allow work on other aspects of the portfolio including teaching, research and quality improvement. This work pattern mirrors that of the core trainees, giving a real taste of life as a trainee.  Supervision and training is the same as for new anaesthetics trainees – initially all work is directly supervised however over time there is the opportunity to take increasing responsibility, particularly within critical care. With the support of the department, we were both able to join the Royal College of Anaesthetists and gain access to the Lifelong Learning Platform, using this to record workplace-based assessments the same as anaesthetic trainees. We’re encouraged to take part in audit, teaching and research providing many opportunities to build a healthy portfolio. 

Benefits of the post?

One of the main benefits of this post is the ability to try out a speciality in much more depth than would normally be possible prior to applying to a training programme. For anaesthetics in particular, it is rare to have the opportunity to spend a prolonged time in a department as without the initial assessment of competence (a sign off gained within the first few months of core training showing competence to give an anaesthetic independently), all work is supernumerary. Anaesthetics is a world apart from the usual foundation jobs and there is a steep learning curve to embark upon. Starting this without the pressure of exams or progression through training allows time to just enjoy learning and gaining new skills. We have access to the same e-learning as the trainees to supplement this and are encouraged to attend the local novice anaesthetics teaching programme. Having more of a grounding in the speciality before starting should make the transition into core training smoother. 

The post at Colchester focuses on training and portfolio development rather than service provision with plenty of opportunities and guidance through this. The inclusive, encouraging and friendly atmosphere of the anaesthetic/critical care team is a great place to foster an interest in training in anaesthetics. The experience gained provides an abundance of interview material to fall back on and hopefully will show that we have a firm idea about the good, the bad, and the ugly aspects of the specialities. Additionally, there are points for experience in speciality upon application to core training so simply doing the job is a bonus when it comes to applications.

However, anaesthetics is not for everyone, and in spending more time in the speciality some may realise it is not the right fit for them (although we are both enjoying the post and intend to pursue anaesthetics further!). The advantage of an F3 is the opportunity to realise this before committing to a training programme. For those who don’t go on to train in anaesthetics or critical care, the experience gained is still invaluable. The job allows development of many transferable skills useful to anyone working in medicine or surgery, including practical skills, knowledge of what critical care can offer and when to escalate, and importantly, when escalation may not be appropriate. Ceilings of care have become even more relevant than before during the covid pandemic, and understanding the limits of what critical care can achieve is vital in the delivery of holistic patient care. 

Particular advantages of the job at Colchester include the opportunity to spend 6 months in anaesthetics, while many similar F3 jobs are based largely or entirely in critical care. During the anaesthetics block we are encouraged to work towards the initial assessment of competence alongside core trainees – an opportunity that is rare for a non training post. The critical care department is a general ICU meaning it offers exposure to a good case mix and experience in the management of many common presentations. Essentially we gain a lot of useful experience whilst the trust gains some extra man power for the on call rota. Win-win. 

We believe that this role is invaluable and hope to see more pop up in the future. Anyone unsure about where to go in core training should certainly give an F3 a chance to explore where their interests may lie. 

References 

UK Foundation Programme Office (UKFPO) . (2019 ). 2019 F2 Careers Destination Survey . Available: https://foundationprogramme.nhs.uk/resources/reports/. Last accessed 19 October 2020

Article written by Dr. Melissa Hartley and Dr. Paige Mitson