FORGE: Future-Oriented Reform of Generalist Education Evaluation

Background: Health systems are facing increasing demand from ageing populations, rising multimorbidity, and widening health inequalities. These trends require clinicians who can manage complex conditions across specialties and care settings. Within the NHS, however, postgraduate medical training has traditionally emphasised narrow specialisation. Standalone General Internal Medicine (GIM) training was introduced in England to strengthen generalist capability in secondary care and prepare physicians to deliver coordinated, system-aware care. Although the programme is expanding nationally, there has been limited independent evaluation of its implementation, workforce impact, or organisational integration. Aim: The FORGE (Future-Oriented Reform of Generalist Education) study evaluates the implementation and early outcomes of the standalone GIM training pathway and examines how training and employment systems support the development and deployment of standalone generalist physicians in the NHS. Methods: FORGE is a mixed-methods evaluation conducted over 36 months and embedded within the NIHR Workforce Voices Partnership. The study is structured in three phases. Phase 1 examines early implementation and resident experience through national surveys, qualitative interviews with residents and educators, analysis of workforce data, and a realist review of generalist training models. Phase 2 explores early career outcomes and organisational readiness through multi-site case studies involving interviews, focus groups and workforce data analysis. Phase 3 integrates findings through cross-site synthesis and participatory workshops with residents, educators, employers, and policy stakeholders to refine programme theory and develop recommendations for scaling and implementation. Results: The study will generate evidence on how standalone GIM training is implemented across diverse NHS contexts, how residents and educators experience the programme, and how organisations design and support posts for standalone GIM graduates. It will also identify organisational and workforce conditions associated with successful integration of generalist roles. Conclusion: FORGE will provide the first comprehensive evaluation of standalone GIM training in England. Findings will inform workforce policy, training design, and service planning by identifying how standalone generalist training can contribute to workforce sustainability and coordinated care, particularly in underserved areas of the NHS.