Article Text
Abstract
Introduction There has been an exponential growth in Community COPD care delivered by respiratory consultants in the last 5 years. Despite this rapid expansion, little is known about trainees’ exposure to these services even though a proportion of them will go on to work in or set up such posts after completing their training.
Methods We conducted a national survey of respiratory trainees to assess their views and experience of Community COPD, including the commissioning process which forms an integral part of establishing such services.
Results We obtained 59 responses from trainees in 12 different regions (including all four home nations): 17% less than full time (LTFT), 81% ST5+, and 53% female. Despite the majority (64%) being aware of an expansion in services locally over 86% had no experience of Community COPD and most (75%) had no direct involvement in the commissioning process. Unsurprisingly, over three quarters felt their exposure to Community COPD services during specialty training was inadequate.
Of 8 who had attended Community COPD clinics, 7 had to organise ad hoc sessions themselves. Some trainees perceived a reluctance to facilitate formal training opportunities due to hospital service delivery requirements or a concern that community services were commissioned to be consultant-delivered.
While over 22% of respondents stated that they would not apply for a consultant post that included any community COPD sessions, this did not include any LTFT trainees and this group were also more likely to consider a job wholly based in the community [50% vs. 27%].
Discussion This survey suggests that most respiratory trainees, especially those in LTFT, would be willing to work in Community COPD roles as consultants, but are struggling to obtain adequate experience during training. It is envisaged that there will be further expansion of community respiratory services to improve patient access and to facilitate integration between primary and secondary care in the future. We suggest that training programme directors consider making experience of Community COPD a formal requirement and that the curriculum is updated to better reflect the needs of trainees.