Design and Implementation of Flexible Advanced Training in Rheumatology: Report of a pilot program

BACKGROUND Training in medicine is highly demanding and coincides with critical life tasks including relationship development, childbearing, and rearing. The rigid requirements of training programs risk precluding successful achievement of these extracurricular roles, forcing choices between work and other life commitments. Flexible employment structures that facilitate the development of high-quality physicians are needed. METHODS The clinical department, trainees and senior administration designed flexible, part-time advanced training positions in rheumatology. We sought to deliver excellent training, supervision and support whilst ensuring safe, efficient clinical service delivery within existing systems and cultures. Barriers to implementation were actively identified. We rejected job share arrangements in favour of independent part time positions anchored to departmental education, clinical and trainee needs. The outcomes of these positions have been determined through regular trainee meetings, clinic activity and costs. RESULTS Trainees achieved all training requirements, reported high levels of job satisfaction, strong professional development, improved work-life balance, and reduction of stress. Outpatient events increased and waiting times have decreased. We estimate that increased rebatable outpatient services have rendered the positions cost neutral. CONCLUSION Flexible training positions can enhance clinical departments whilst enabling high quality training for junior doctors. Further work should consider longer term outcomes and application to different clinical and training settings. This article is protected by copyright. All rights reserved.