How resident doctors’ personal and professional development can benefit from a pause in training

INTRODUCTION: Residency training is a demanding period marked by long hours, emotional strain, and ongoing assessments. Burnout and poor wellbeing among residents have become global concerns, affecting both patient care and workforce sustainability. Consequently, educators and researchers are seeking ways to foster sustainable learning, wellbeing, and professional growth in residency programmes. AIMS: To explore resident doctors' perspectives on the Out-of-Programme-Pause (OOP-P). Specifically, it asks what are resident doctors motivations for pursuing an OOP-P and what are their experiences in terms of personal benefits and benefits to the service? METHODS: The study adopted a qualitative research design situated with an interpretivist paradigm. Twenty-nine residents taking time out of programme in England were interviewed. Through a lens of self-determination theory, we created four ideal types to encompass how an out-of-programme model could meet the basic needs of residents and promote their autonomous motivation. RESULTS: Four resident ideal types were constructed based on the needs of respondents: residents sought (1) gain clinical exposure (2); solidify capabilities (3); manage burnout; and (4) consolidate specialty choice. For each ideal type, one or more basic needs were unmet at the point of deciding to take time out. Each ideal type used their time differently to regain autonomous motivation before returning to the programme. TPDs felt that residents taking time out of programme while continuing to work in patient-facing roles disrupted service less than the alternatives - moving to non-clinical posts, taking long-term sick leave or leaving medicine entirely. They were also optimistic about the long-term impact on resident retention. CONCLUSION: A model permitting residents to step out of training while remaining in a patient-facing role can mitigate short-term detriment and, theoretically, offer long-term benefits to service provision. Recommendations are provided for each ideal type on how residents with diverse needs can be supported to prevent disaffection.