Enhance Explore contains both clinical and educational elements. Enhance is a modular development programme taking you through your early years of postgraduate training.  Through the Enhance programme you will be offered unique opportunities to work with subject specialists (via both enhance experiences and the GLIC placement), lead on change projects and build an exciting CV.  

The educational aspects of the Enhance programme are themed around the six modules and four cross cutting themes of Enhance:

These modules should be completed across your 2-year foundation programme. 

For each module you should expect to spend approximately 3-4 hours engaging with online material, and attend the associated learning event (please note that attendance at learning events are mandatory for those who are placed in enhance explore posts).  Completion of these core elements allow the doctor in training to develop as a skilled practitioner with knowledge and expertise in a broad range of disciplines that will stand them in good stead to work within the 21st century NHS.  Each module offers triggers for deeper learning, reflective practice and for the opportunity of activism and quality improvement experience.  There may also be opportunities to write (and potentially publish) material. 

Experience from Harvard Medical School shows that learners going through Longitudinal Clerkships perform to a higher standard than learners going through traditional blocks. Doing clinical attachments in blocks has created many good clinicians “The question is not whether blocks are good and fine. They are… There’s something better beyond blocks, and it’s streams.” Dr David Hirsh, Harvard Medical School.

The rationale is related to how people learn. At school, we didn’t learn four months of maths, then four months of English, then four months of history etc. Mixing up different types of problems improves learning, and learning is more durable when stretched out over longer periods.

When applied to clinical rotations people learn more adaptability and that learning “sticks” better if it is drawn out over a longer period for part of the week, rather than doing a 4-month block. Trainees become more embedded into team cultures, and having one foot in the community and one in the hospital helps keep a mindset of examining patient problems form more than one perspective to create a whole-system approach.

There is a steep learning curve to begin with and some additional organisational challenges around moving to more than one workplace, but learners going through those pathways report that they’ve preferred it by the end of those rotations because of what they’ve learned (Hirsh et al., 2014).

There is a further potential learning opportunity for trainees. When clinical areas align, they will be able to follow patient journeys through different parts of the system. For example, an F2 looking after a child in hospital may be reviewing them in a community paediatric clinic a couple of weeks later. That patient journey perspective is one that is extremely powerful for learning about person-centred practice and about systems. Thinking about people in a holistic way rather than as “the diabetic foot in bay 2”. These opportunities, they can be extremely helpful for trainees to demonstrate Foundation Professional Competencies (FPCs) on which they’ll be assessed as foundation doctors.

The GLIC is helpful to train generalists, but there is also increasing evidence that a grounding in generalism makes better specialists. Trainees learn how to make better decisions with their patient in the context of the wider healthcare team and increasingly complex environment, and that’s what gives Enhance its impact on their future careers.

Reference: Hirsh DA, Holmboe ES, ten Cate O. Time to trust: longitudinal integrated clerkships and entrustable professional activities. Acad Med. 2014 Feb;89(2):201-4. doi: 10.1097/ACM.0000000000000111. PMID: 24362396.