What counts as training capacity? Professional identity and educational readiness for postgraduate medical training expansion in Ireland: a qualitative multistakeholder case study
This qualitative multistakeholder case study reveals that professional identity significantly shapes how Irish stakeholders define and prioritize training capacity for postgraduate medical expansion, leading to the development of an Educational Readiness Framework that reconciles conflicting service, educational, and regulatory demands to ensure sustainable growth.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Hospitals around the world are facing a shortage of specialist doctors. As populations age and demand for care grows, health systems are trying to train more doctors faster. The logic seems straightforward: if there are not enough doctors, create more training spots. However, a critical gap exists between simply funding a job and actually teaching someone how to be a specialist. Medical training does not happen in a classroom; it happens while doctors treat patients. For a trainee to learn, they need to be watched by an experienced mentor, given time to reflect on their work, and allowed to take on responsibility gradually. If a hospital is already stretched thin, adding another trainee might fill a staffing gap but could overwhelm the very people meant to be teaching. The question is not just how many doctors are needed, but whether a specific hospital has the time, the staff, and the environment to turn a new hire into a competent specialist.
A recent study conducted in Ireland investigated exactly this problem. Researchers wanted to understand why different groups of people involved in medical training often disagree about whether a hospital is ready to take on more trainees. They spoke with thirty-five senior leaders, including government officials, hospital managers, medical regulators, and the doctors who teach and train others. These interviews took place over several years, from 2023 to 2025, and were combined with a review of official documents and maps drawn by the participants to show how they thought the system worked. The researchers found that the disagreements were not just about money or numbers. Instead, they stemmed from the different professional identities of the people involved. Each group looked at the same situation through a different lens, seeing different problems and different solutions.
The study revealed that how a person sees their role changes what they consider "ready" for expansion. Government officials and hospital managers, whose primary job is to ensure there are enough doctors to keep the hospital running, tend to focus on numbers. They look at vacancies and how quickly a new doctor can be put to work. For them, a training post is ready if it is funded and filled. In contrast, the doctors who teach and the trainees themselves focus on the quality of the learning experience. They ask whether there is a supervisor available to watch the trainee, whether the trainee will see a wide enough variety of cases, and whether there is protected time for teaching and feedback. A third group, the regulators, focuses on safety and standards, asking if the system can guarantee that the training meets strict rules to protect the public. The researchers found that when these groups try to make a decision, they often talk past each other because they are prioritizing different things. A site might look ready to a manager because it has a vacant job, but look unready to a teacher because the senior staff are too busy to supervise.
The most striking finding was that the hospitals under the most pressure to hire more doctors were often the least capable of providing a good education. These busy sites have a strong argument for needing more staff to handle the patient load, but that same pressure means senior doctors have less time to teach. If a new trainee is added without extra support, they might end up doing more work for the service rather than learning how to be a specialist. The study showed that simply counting the number of funded jobs is not enough to measure capacity. A job is only a training post if the environment around it supports learning. Without enough time for teaching, enough supervisors, and a safe environment for the trainee to make mistakes and learn, the expansion fails its educational purpose, even if it succeeds in filling a roster.
To solve this, the researchers developed a practical framework called the "Educational Readiness Framework." This is not a rigid checklist but a set of six areas that must be considered together before adding more trainees. First, there must be enough trained supervisors who are actually available to watch and guide the trainee. Second, the trainee needs access to a wide variety of patients and procedures, not just repetitive work. Third, there must be protected time set aside specifically for learning, separate from the rush of patient care. Fourth, the hospital needs enough staff to handle the extra work of assessing and grading the trainees. Fifth, the system must support the wellbeing of the trainee, ensuring they are not burned out by excessive workload. Finally, all the different organizations involved must agree on their roles and how they will monitor the success of the expansion.
The study suggests that for training to expand successfully, leaders must stop treating a funded job as the same thing as a learning opportunity. They need to recognize that different groups have valid concerns and that a decision is only sound when it addresses the needs of the patient, the trainee, the teacher, and the regulator all at once. The researchers found that consensus is possible when these groups stop trying to replace each other's priorities and instead connect them. For example, a hospital might agree to take on a new trainee only if it also secures extra time for teaching and a plan to monitor the trainee's stress levels. This approach ensures that the system does not just produce more doctors, but produces doctors who are truly ready to care for patients. The findings indicate that without this careful, multi-sided planning, expanding training could actually lower the quality of education and put both trainees and patients at risk.
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