More than burnout: qualitative study on understanding attrition among senior Obstetrics and Gynaecology UK-based trainees

OBJECTIVES: Workforce retention among UK-based Obstetrics and Gynaecology (O&G) trainees has been a particular concern for a number of years, with 30% trainees reportedly leaving specialty training. With specialty focused research being limited and tending to analyse the training programme as a whole. The aim of this study was to explain why senior O&G trainees within reach of completing training were leaving the specialty. DESIGN: Qualitative study based on Constructivist Grounded Theory methodology using semi-structured interviews. Data collection and analysis continued until theoretical saturation was achieved. The key themes were used to build an explanatory model, in the form of a concept map for attrition. SETTING: London. PARTICIPANTS: Nine senior O&G trainees (ST5-7) of which six were committed to the specialty, two were not going to pursue a consultancy post once training was complete and one ex-trainee. RESULTS: Five major themes emerged from the study, of which four; ‘Just get on with it’, ‘Just a number’, ‘Tick-box exercise’ and ‘It has not happened to me but…’ were described by all participants. However, the final theme, relating to the lack of professional identity, ‘I did not see myself as an Obstetrician and Gynaecologist’ was only demonstrated among those who had left or were not going to pursue a consultancy post once training was complete. Potential strategies for facilitating professional identity development were focused into three areas; establishing meaningful connections, adequate support mechanisms and regional initiatives. CONCLUSION: Previous research on attrition in the medical profession have suggested burnout and the lack of resilience as being the key factors for leaving training. However, based on this study’s findings, an alternative pathway related to the lack of professional identity has been proposed for senior O&G trainees. ETHICS: This study was registered at King’s College London, Kings Reference: LRU-18/19-10632 and was awarded ethical approval through the Research Ethics Committee (REMAs)