Locum doctor working: A qualitative exploration of the implications for learning and professional development.

backgroundIn the English National Health Service, and other health care systems internationally, there have been growing numbers of doctors working on a short- or long-term temporary basis as 'locums'. Social environments and professional relationships are fundamental to learning in clinical contexts; however, locums are often positioned at the periphery of the organisation and the clinical team. An examination of locum learning and continuing professional development is vital to understanding the implications of temporary working for the growing numbers of mobile doctors, often working at the margins of the medical workforce, and whose career trajectories may diverge from traditional models.

methodsQualitative interview and focus group data were collected from 130 participants, including 88 professionals and 42 patients, between March 2021 and April 2022 in primary and secondary health care organisations in the English NHS. Participants included locums, patients, permanently employed doctors, nurses and other health care professionals with governance and recruitment responsibilities for locums. Data were analysed using reflexive thematic analysis and abductive analysis.

resultsFour themes were developed from the data: (1) exclusion from formal and informal learning opportunities; (2) self-directed learning and workarounds; (3) decline in knowledge and clinical skills; (4) effects on the professional development of the wider team. Locums were frequently excluded from feedback and learning opportunities because they were considered expensive and not the responsibility of the organisation and there to work, not to train. This meant that professional development was often the responsibility of the locum, self-directed and divorced from context. Locums often did not take on educational supervision roles for the wider team, meaning wider learning and development were disrupted or paused.

conclusionTo address the challenges locum working might bring for learning and professional development, professional bodies should provide guidance for locum doctors highlighting the risks associated with taking on locum work before medical knowledge and experience are established. To improve quality and safety, organisational leaders should include locums in developmental opportunities. Finally, policy makers need to strike a balance between using locums to address short-term workforce quotas and the long-term impact on the knowledge and development of the workforce and patient safety.