Learning Experiences Abroad for Residents in National Training (LEARN): 
Results From a Scottish Training Programme Director Survey.

Introduction Resident doctors (RDs) in UK training programmes are contractually entitled to take study leave (SL) to pursue activity related to progression of training. In 2024, NHS Education for Scotland (NES) announced a temporary change to SL policy, indicating international attendance at educational events would no longer be supported. NES is also responsible for administration of the RD study budget (SB) in Scotland - one of the lowest in the UK. There is little data regarding Training Program Director (TPD) views on RD use of SL to pursue professional development (particularly internationally) and appropriateness of SB. Here, we present TPD views on international SL and SB with an aim to contribute to wider policy discussions. Methods A cross-sectional survey consisting of closed and open responses was developed by the authors to evaluate a range of TPD opinions related to international SL and current SB. The survey was published in Microsoft Office Forms. Initial pilot testing was carried out by the authors before survey review by a Scotland TPD for content validity. The authors conducted a final re-test before distribution via TPD email addresses available via public domain. All TPDs in Scotland were eligible to respond, which was confirmed via survey response. No incentive or prize was offered. Responses were anonymised before review. Response percentage and chi-square analysis were undertaken using Microsoft Excel. Qualitative analysis of free text comments was conducted with assistance from Google Gemini AI Software, with prompts to assist "thematic analysis" before review by the authors to identify trends in response. Results In total, responses were obtained from 16% of invited TPDs (N=26) across a variety of medical specialties. International SL had been approved by 65% (N=17) of TPDs in the last 12 months. International SL was actively encouraged by 77% (N=20). TPDs were significantly more likely to encourage international SL if they had approved international leave requests within the last 12 months. SB was not considered appropriate to cover mandatory training costs by 85% (N=22) of respondents. Personal costs to trainees were estimated to be at least £1000 per annum in 88.5% (N=23) of training programmes. Annual SB was felt to be adequate for trainees by 12% of respondents (N=3). TPDs indicated overall support for international SL with regard to international collaboration, networking, research opportunity and access to learning opportunity not available in the UK. Responses highlighted concern that removing international SL could reduce the quality of medical training in Scotland and affect recruitment and retention of medical trainees. Conclusion There is relative consensus from Scottish TPDs on the importance of international learning during medical training, highlighting benefits for professional development, collaboration and education. The majority of TPDs view SB provided to trainees by NES as inadequate. Opportunity for suitable use of international SL could benefit RDs in Scottish training programmes with appropriate TPD oversight. Insights gathered from these responses could help inform policies to enhance international engagement in medical training programs within Scotland and the UK. Further exploration of differences in TPD opinion between specialties could highlight potential benefits of a level of autonomy in decisions made around resident doctor study budget funding and learning opportunities.