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How to continue learning on foundation

Lifelong learning is a core aspect of becoming a competent doctor. During your foundation years, it can be difficult to find time outside work or your clinical duties to continue learning. Being motivated to learn is essential, and this guide outlines some of the opportunities available for learning.

On-the-job learning

Most foundation doctors will develop their own knowledge and skills through learning on the job. The ward round is a perfect opportunity for you to learn from registrars and consultants and:

  • ask plenty of questions about the diagnosis and management of patients
  • write down topics to read about after rounds or in your own time
  • make a note of particular cases for presentations and case reports, to enhance the learning experience
  • see patients in outpatient clinics, as the management of chronic disease in this setting differs markedly from patient management on the ward.

Being on call can be stressful at times, and you will often feel out of your depth. Tackling a problem by yourself can boost your confidence. However, asking for help from senior doctors, at least in the first few months of your training, is advisable and will ensure that you are managing patients correctly. Make a note of common problems that you encounter, and discuss these with your supervisors or look up management guidelines yourself. When you see a patient on call and set a management plan, go back the next day to see whether what you did made a difference and whether it was the right way of managing that particular situation. This will improve your confidence in your clinical decision making.

As a foundation doctor, it is essential to become competent in core practical procedures such as urethral catheterisation. It is also an excellent time to start learning about more invasive practical procedures. Never be afraid to ask whether you can perform procedures such as pleural aspiration or lumbar puncture. Be proactive and take every opportunity that arises; the more you do, the more comfortable you’ll become with performing practical procedures. In the future, when you approach another invasive procedure, such as central line insertion, it will be much easier to prepare equipment and create a sterile field. Reading about a procedure before trying it, such as the use of local anaesthetics, is recommended.

Your portfolio

Use your portfolio to structure your learning by documenting your learning needs and which parts of the foundation curriculum you need to cover. Reflective practice is a popular and effective learning method; document any cases or incidents that you could analyse and learn lessons from. This can help to guide your future practice based on your experience.

Workplace-based assessments form the basis of every portfolio and are a more formal method of learning on the job. Choose cases wisely, to cover a wide part of the foundation curriculum. Make sure a senior doctor watches you perform an examination or explanation to a patient, and then gather feedback from them and the patient, to really develop your skills.

Meetings and courses

Your trust will often have formal weekly teaching sessions, and most hospitals will have lunchtime meetings or grand rounds. Try to attend these, as you will learn useful snippets of information and knowledge.

There are many courses available that focus on particular areas, from managing critically ill patients to developing practical skills such as ultrasound-guided vascular access. Make sure you also attend courses that have a personal and professional developmental aspect, such as teaching, communication or leadership skills. Choose the courses you attend wisely, as many are expensive. Some may not incur a charge and can be as good as commercialised courses. The Royal College of Physicians has many courses and updates about particular areas of medicine that may interest you.

Attending courses in specialties that you hope to specialise in can be an excellent addition to your portfolio. Most courses pack a lot of information into little time. Consolidate your learning by reading around the topics and applying what you’ve learnt when you review patients. E-learning modules or online courses can be extremely useful if you do not want to go on too many courses in person.

Research and audit

Carrying out a research or audit project will help further your understanding of a particular specialty. By the end of the project, you should know this topic very well and develop generic skills such as organisational and management skills. Present your findings at conferences to see how your project compares with others. Even if you don’t have anything to present, attending conferences can be an excellent way to see the latest research developments. It is also a good way to learn about medical statistics and research methods, which will be invaluable not only during your foundation years but also in your future medical career.

Further education

There are many other ways that you can formalise your learning as a postgraduate. For example, part-time distance learning postgraduate certificates or MSc programmes are available, but they require a significant amount of commitment to studying around your working hours. Foundation year 2 doctors are permitted to sit the MRCP(UK) exam, but be forewarned – sitting these exams requires a lot of hard work and preparation.


Dr Clement Lau

BMedSci (Hons) MBChB (Hons)