Table 2

A summary of the main themes regarding the challenges of training in a tertiary setting

ThemeSubthemesExample quotes from interviewees
Mismatch of expectations between trainees and trainersExpectations of baseline knowledge/feeling stupid‘I think when people are really senior it can be difficult remembering what it’s like when you have never heard about (these very complex) conditions’. (Participant (P) 3)
High stakes attachment/chose all 3 years for this
Important to want to come here
Different teams and specialties working in ‘Silos’Not much work with other specialties‘It’s a shame that you don’t get to see any of the patients or specialities within the hospital and you don’t get exposure to any of the expertise within the hospital’. (P7)
Very specialised care means less opportunity for traineesReduced opportunity for step-up/taking a step backwards‘For those about to become registrars they can’t step up as it’s specialised’. (P7)
‘The workload is very high and I feel stupid asking basic questions as they are on a much higher level. Lots of the cases are too complex for us to deal with so it’s mostly senior led’. (P8)
Not enough involvement in sick children
Very specialised care
Pastoral care not always prioritisedAnonymity in training/not nurtured‘Consultants see you as a nameless faceless SHO’. (P9)
Culture of learning not universalCulture/ethos of learning‘As an institution it sometimes feels too big to train or teach’. (P2)
OtherDifferentiation between specialist and generalist trainees‘It is hard work when you are doing lots of the service provision and other people are getting the training opportunities’. (P6)
‘There is a lot of learning through diffusion and osmosis but it is hard…everyone is so stretched for time’. (P1)
Tick box educational supervision
Difficult to get involved in projects
Practical issues, for example, busy job and rota issues