What today's workplaces are teaching tomorrow's physicians

We spend a great deal of time designing how doctors are trained – defining competencies, refining curricula and setting standards for what good training looks like. But alongside the formal curriculum runs another, often more powerful one: the curriculum of the workplace.

A recent study of general practice argues that working conditions are not simply the backdrop to training – they are a central part of what doctors learn. While the research focuses on general practice, its implications extend across physician training. In postgraduate education, learning happens through experience. Resident doctors absorb lessons from what they see around them: how care is delivered, how decisions are made, and what is considered realistic in day-to-day practice.

The study describes workplaces characterised by rising demand, increasing administrative burden, limited consultation time and reduced autonomy. These conditions do more than create pressure. They shape expectations. Over time, resident doctors learn to see such constraints not as temporary challenges but as normal features of medical practice.

One of the most striking findings is that full-time work is widely viewed as unsustainable. GPs described reducing their hours and, in some cases, actively discouraging resident doctors from working full-time. The dominant response is not to change the system, but to limit exposure to it. This example of the hidden curriculum of training (the lessons resident doctors absorb from the behaviours, norms and expectations modelled around them) is reflected in the rapid rise of less than full time and portfolio working of both resident doctors and consultant physicians, which may signal that sustaining a career in medicine increasingly depends on reducing exposure to pressure, rather than changing the conditions that make that pressure unsustainable.

For resident doctors, the message is clear: sustaining a career may require reducing workload, working less than full time, or pursuing alternative ways of practising. Applied more broadly, the risk is that we shape a generation of physicians whose expectations of their careers are defined by managing pressure rather than tackling its causes.

The study also highlights how doctors respond to workplace pressures. The most common approaches are individual – reducing sessions, developing portfolio careers or seeking employment models that offer greater control. There is far less evidence of collective or systemic responses being modelled. This, too, teaches an important lesson. Resident doctors may come to view responsibility for managing workload as an individual challenge, while seeing the wider system as difficult to influence. Adaptation becomes the expected response, rather than challenge or improvement.

For physician training, this raises concerns about professional identity. It risks promoting a view of the doctor as someone who works around constraints rather than helping to reshape the systems in which they work. Participants in the study repeatedly described feeling unable to influence key aspects of their work, from appointment length to the broader organisation of care. This matters because autonomy has long been central to professional identity. Yet resident doctors are learning that many of the decisions affecting their practice are made elsewhere.

Over time, this could reduce confidence in influencing systems, discourage engagement in leadership or service improvement, and reshape expectations about what it means to practise as a physician.

The study’s findings also resonate with the phase 1 diagnostic report of the medical education and training review, which argued that training reform must go beyond curricula and assessment. A central theme of the review was the need for a more flexible, supportive and sustainable training system that reflects the realities of modern medical careers. Workplace culture and working conditions can shape professional identity just as powerfully as formal educational structures.

They also echo the priorities identified through the RCP's next generation campaign. Resident doctors told us they need protected learning time, better supervision, greater flexibility, improved work–life balance, supportive working environments and workforce planning that prioritises retention. These reforms are often discussed as workforce issues, but this research suggests they are educational issues too. If resident doctors are learning that excessive workload, limited autonomy and compromises in care are unavoidable, workplace conditions risk undermining the ambitions of training reform before those reforms have a chance to take effect.

Workplace pressures affect clinical practice itself. Under conditions of limited time and increasing workload, doctors often cannot deliver care in the way they would ideally wish. Resident doctors learn to work within tight constraints, prioritise efficiency and accept compromises as part of everyday practice. This is not a criticism of individual doctors. Rather, it reflects the environments in which training takes place. But it does raise important questions about how standards of care are shaped over time and what lessons future doctors take from their experiences.

Formal training programmes continue to emphasise resilience and coping with pressure. Yet the workplace may be teaching a different lesson: that the pressures themselves are unsustainable. This creates a disconnect between what is taught and what is experienced. The key insight from Dr Leonard Grant’s research is simple but significant: resident doctors are always learning from the systems in which they train. Working conditions shape expectations before careers are fully formed, professional identity is influenced by experience as much as education, and long-term workforce patterns may be rooted in lessons learned early in training.

If we want to influence the future of the profession, we cannot focus on curriculum alone. We must also pay attention to what the workplace is teaching. Because whether we intend it or not, it is already shaping the next generation of physicians.