Trainee doctors are experiencing a great deal of anxiety about how covid related absences will affect their progression in training, writes Rachel Pillai
At the end of every year that a doctor is in training, from foundation to consultant level, a decision is made on whether or not they can progress to the next stage—a process referred to as the annual review of competency progression (ARCP). Health Education England (HEE) stipulates that in order to pass, a trainee’s sick leave should not amount to more than 20 days unless there are extenuating circumstances.
In April 2020, with the covid-19 pandemic making the steady progression of doctors even more critical, the statutory education bodies set out changes to enable as many trainees as possible to advance to their next stage of training. However, crucially, any days that a doctor misses due to covid related isolation count towards their 20 day allowance of sick leave. Surpassing this figure means that trainees are automatically put before an ARCP panel, where a decision will be made as to whether they are allowed to progress. In October, a statement by the UK Foundation Programme Office (UKFPO) stated that the “20 day rule” is indicative only and if exceeded, “should trigger a review of progression by the foundation programme director.” Although some steps have been taken to mitigate this by allowing discretion regarding an individual’s progression, there is still a great deal of anxiety among trainees about how covid related absences will affect their advancement in training.
Following government guidance on self-isolating when exposed to a positive contact could amount to 10 days’ sick leave. Many of us are exposed to covid-19 though work and will contract it, which again also means 10 days of self-isolation. Unfortunately, in my experience, trusts are unwilling to allow trainees to use any of these days spent isolating for study days, even though many may be physically well enough to do so. This runs contrary to the aforementioned statement from the UKFPO, which suggests that remote working should be considered for those unable to carry out clinical duties due to covid related reasons but who are not on sick leave. In my view, unless you’re unwell, self-isolating should not be recorded as sick leave and trainees should be supported to work from home, thus minimising the impact on their training.
Until recently, many trusts were not regularly testing their staff, leaving workers who did not have the three recognised symptoms of covid-19 (a new, continuous cough, anosmia, and a high temperature) to determine whether any other symptoms should lead to self-isolation pending a PCR test and its result. The symptoms of covid-19 can manifest in a variety of ways, with even the exhaustion from working long shifts sometimes difficult to distinguish from virus induced fatigue. Trainee doctors who, upon balancing the potential risks, decided to self-isolate over undetermined symptoms while awaiting a test result are likely to be anxious about the impact of this on their progression. This situation has improved somewhat with the rollout of lateral flow testing, which gives a speedier turnaround, although, as has been noted, these tests have relatively low sensitivity.
In theory, the 20 day allowance gives trainees sufficient time in their training to develop the relevant skills and expertise that enable a successful transition to the next stage of their career. But by upholding this unsustainable stipulation during the pandemic, HEE is contributing to a culture of anxiety during an already fraught time. These anxieties could disproportionately impact doctors who have chronic health conditions and need to use their full allocation of sick leave, irrespective of covid related absences.
Establishing clearer guidance that allows trainees to use isolation time for study leave if they are well may be a solution, as well as excluding covid related absences from the allowable sick days.
More broadly, however, doctors’ anxieties about testing and isolating exposes a wider truth: adequate training for junior doctors has become secondary to essential service provision. Trainees working within stretched teams are missing crucial aspects of training, such as weekly in-department teaching and regular observation by seniors, and many may be worried about their training development and whether they’re acquiring the skills they need. Some doctors out of training may delay applying for the next stage due to uncertainty around fulfilling requirements and gaining adequate breadth of experience.
Of course, training as usual is hard to sustain in the middle of a pandemic. Yet trusts and statutory education bodies need to think now and longer term about how they can support these trainees, who are grappling not only with a deadly pandemic, but with worries about progressing safely and confidently to the next stage of their career.
Rachel Pillai is a foundation doctor working in the North, Central and East London deanery.
Competing interests: none declared.