A national survey exploring UK trainees' perceptions, core training experience, and decisions to pursue advanced training in breast radiology
Introduction
Demand for the services of breast radiologists has never been higher. Breast cancer not only remains the most common cancer in the UK,1 but the annual number of newly diagnosed female breast cancers has risen continually for the last 20 years.2 With extension of the age range for the NHS Breast Screening Programme, and the requirement for all women presenting with breast symptoms to be assessed within 2 weeks,3 the workload of the breast radiologist continues to increase. Greater use of more complex imaging such as breast magnetic resonance imaging (MRI) for surgical treatment planning, high-risk cancer screening, and assessing response to neoadjuvant chemotherapy places further demand on breast radiologists’ time.
A critical problem in meeting this demand is the recognised shortage of breast radiologists in the UK, a situation that is expected to worsen significantly over the coming years. Although breast radiology is the largest area of special interest within general radiology, it faces the greatest workforce deficits.4 A survey of NHS Breast Screening Programme units and radiology departments carried out in 20155 confirmed significant understaffing issues, showing that 25% of NHS Breast Screening Programme units operate with just one or two consultant radiologists with no cover for sickness or absence. There were 60 vacant consultant breast radiologist posts across the UK, representing around 13% of all substantive posts. Less than half of these were expected to be filled within the following 12 months. Moreover, 21% of breast radiologists are expected to retire by 2020, increasing to 38% by 2025, and 53% by 2030, which will have a severe impact on breast cancer screening and diagnosis unless these positions are filled.
These problems are further compounded by the recognition that too few breast radiologists are being trained.5 The standard clinical radiology specialty training programme within the UK comprises 3 years of core radiology training (ST1–3) followed by 2 years (ST4-5) of advanced (special interest) radiology training, allowing trainees to develop higher competences in a specific area(s).6 The exception to this is training in interventional radiology, which is currently the only formally recognised subspecialty within radiology, lasting for 6 years (ST6) and leading to a separate Certificate of Completion of Training (CCT). During ST1–3, all trainees are required to gain experience and basic competences across the core components of radiology, including breast radiology. Summative assessment of the core curriculum in breast radiology occurs in both parts A and B of the final Fellowship of the Royal College of Radiologists (FRCR) exam. During ST4-5, trainees spend dedicated time in their chosen area(s) of special interest and develop higher competences in preparation for work as a consultant.
In order to inform potential improvements in recruitment of trainees to breast radiology at ST4-5 level, the present study was undertaken to survey all UK radiology trainees regarding their perceptions of breast radiology and the factors that influenced their decision whether or not to choose breast radiology as an area of special interest.
Section snippets
Materials and methods
The survey was compiled on SurveyMonkey (www.surveymonkey.net) and distributed to UK specialty trainees in clinical radiology via the Royal College of Radiologists Junior Radiologists’ Forum (JRF) regional representatives. There were 35 questions in total (Electronic Supplementary Material Appendix S1), but not all were applicable to each respondent. “Page logic” was applied, automatically directing respondents to the most appropriate next question based on their response to the previous
Response rate
Overall 275 trainees completed the survey. In March 2016, during the time the survey was “live”, there were a total of 1,270 clinical radiology trainees in the UK (figure obtained from an enquiry to the Royal College of Radiologists), giving a response rate of 22%.
Demographics and working patterns
There was at least one response from each training region in the UK (Table 1). Overall, years ST1 through to ST5 were well represented (Fig 1). As expected, far fewer responses were obtained from those in ST6 as only a small
Discussion
The aim of this survey was to ascertain the factors that influence trainees’ decisions whether or not to pursue breast radiology and to try and identify ways in which recruitment to breast radiology may be improved in the future. The precise reasons underlying these are inevitably complex, and a survey of this type cannot provide all the answers, but it is intended that the data gathered will give an overview to inform further discussion regarding resolving the current workforce crisis in
Acknowledgements
The authors thank the British Society of Breast Radiology Executive Committee for their input and for providing financial support for the survey prizes. S.L. was funded by a National Institute for Health Research Clinical Lectureship. R.S. is supported with research funding from the National Institute for Health Research Cambridge Biomedical Research Centre.
References (7)
- Cancer Research UK. Breast cancer statistics. Available at:...
- National Cancer Intelligence Network. Cancer e-Atlas. Available at:...
Cited by (1)
A national survey investigating the impact of the COVID-19 pandemic on core and higher breast radiology training in the UK
2022, Clinical RadiologyCitation Excerpt :Similarly, looking at things from a different viewpoint, the proportion of trainees who stated they had no intention of pursuing breast radiology prior to their core rotation and still did not want to pursue it after completing it increased 1.5-fold when their rotation took place during pandemic (41%) compared to before it (27%), again suggesting that trainees' core breast rotation experience has the potential to positively influence career decisions towards breast radiology. The notion of trainees' core rotation experience influencing their decision to pursue higher breast training was also addressed in a previous survey of UK radiology trainees, where 17% of respondents had said their core rotation positively changed their mind to pursue breast radiology when they had not previously considered it.9 In fact having had a “positive experience during [their] core rotation” was one of the top reasons why trainees pursuing higher breast training had chosen to do so, second only to having a “good level of patient contact” and being “interested in the subject”.9