Applying for preregistration posts in Scotland Amina Hussain reports on a new preregistration house officer allocation scheme that has just completed its first year of operation in Scotland. Traditionally, Scottish medical students were left to make their own arrangements for preregistration posts with the individual consultants they had come to know, or they were entered into regional matching schemes. Postgraduate departments often had little to do with the allocation of places and merely dispatched contracts once informed to do so by consultants.

Problems of previous allocation methods

There has always been a mismatch in the supply of and demand for medical graduates within the various regions of Scotland. Traditionally, this would result in the most popular posts in a region being filled by the local medical graduates who knew the consultants, while the least popular were filled by the "overflow" of students from regions where there weren't enough posts for the local graduates. Increasingly, panic stricken students were approaching consultants earlier and earlier in their academic careers to negotiate their preferred house officer posts. Consultants felt under strain at having to conduct so many exploratory discussions and to remember preliminary "deals" made as long ago as when students were only in their third year of medical school.

The problem was most acute in regions where there were not enough posts for local graduates, like the north east of Scotland. It has always been a "net exporter" of graduates, whereas the west coast has always been a "net importer." Overall, there are enough house officer posts in Scotland to match the number of Scottish medical graduates. In some instances, however, medical graduates from other EU countries were filling remaining posts, usually in the west coast, before their Scottish counterparts even knew that the vacancies existed. This meant that some Scottish graduates, especially from the north east, were left unplaced.

Consequently, some medical schools felt the need to develop their own matching schemes, to safeguard posts for their own students. But this did not fully ameliorate the difficulties. So in 1999-2000 the Scottish Council for Postgraduate Medical and Dental Education (SCPGMDE) started up a nationwide matching scheme. In theory, the new scheme gives equal access to all Scottish, and other UK, graduates who seek posts within Scotland, regardless of which medical school they come from.

Stages in new allocation system

There are several key stages in this two round scheme. First is registration, which takes place before the end of September in the final year of medical school. Following this, students submit applications, in the form of a three page curriculum vitae, for their preferred house posts. From October to mid-December there is a consultation period, when consultants shortlist candidates on the basis of the circulated applications they receive. Similarly, students take this time to decide how they will rank, in order of preference, the posts that they have applied for.

This information is entered into a national database, and the first round of matching takes place in late January. The results are known almost immediately and are published on postgraduate centre notice boards within a few days. Students who remain unplaced after this first round are contacted via the West of Scotland Postgraduate Office (the biggest in Scotland), with details of posts still remaining. The second round of matching takes place two months later, in March. The computer program used gives due regard to order of preference, but also prioritises placement. The benefit of this is that there is less chance of students who have prioritised popular posts finding that they are left unplaced. In the event that a student remains unplaced after the second run, postgraduate departments help to place students in suitable vacancies throughout Britain.

Problems encountered so far

Graduates under the new scheme have yet to take up their posts, but lessons have already been learnt and alterations implemented for next year's graduates. The first major hitch occurred when Dundee medical school refused to join the scheme in its first year of running, because the proposed timetable clashed too much with their university course plans. They were given a year's grace to get into line with the other medical schools. Other students begrudged Dundee graduates having the best of both worlds. Not only did they have priority in securing local jobs through their own matching scheme, but any unplaced Dundee students were then allowed to enter the national matching scheme on an equal footing with other Scottish students.

Another bone of contention noted during this first year of running the scheme is the differing selection processes that seemed to kick in during the consultation period. Consultants were told to base their choices solely on the information contained in the students' curricula vitae. But many found this an impossible task and flouted rules by inviting students to interview. Other consultants stuck to the rules rigidly and even turned away students who approached them for exploratory discussions. In future, consultants will have to complete a tear-off slip after receiving a student's application, to say whether they would welcome further inquiries by the student, whether they would like to interview the student, and whether they would welcome a visit from the student.

Tips on playing the new system to your advantage Applicants are required to sign a form attesting that they will accept any posts that are allocated to them. So, in essence, once a post has been allocated the student has entered into a binding agreement. Some students were concerned that this limited them to the Scottish scheme alone. This was compounded by advice given to students wishing to apply for English posts that they could not remain in the Scottish scheme at the same time as applying for other UK posts. This was despite the fact that some of their English counterparts were allowed to enter the Scottish scheme in addition to being a part of their own regional matching scheme in England.

Although these rules have not changed, a loophole may help future Scottish medical students wishing to apply to posts elsewhere in Britain. Although registration for the Scottish matching process takes place in early September, students do not have to return "ranking" forms until mid-December. Students should try to ensure that they secure their preferred UK posts by early December in their final year because the Scottish system allows students to veto posts they are no longer interested in by marking an "X" on the form. If a student secures a job outside Scotland since registering with the scheme, then they could still legitimately exempt themselves from any commitment by marking an "X" beside all posts detailed on the forms instead of ranking them.

Students could legitimately continue to be a part of the scheme beyond midDecember by vetoing all posts, and thus fail to secure a job in the first round. This would then technically make them eligible for entry into the second round. So they would have up until March to await confirmation of a favoured UK post before committing to any Scottish posts. Alternatively, if students find out in the interim that they have not secured their favoured posts then, in theory, they can enter into the second round for vacant Scottish posts. This scenario did not occur during 1999-2000, and it is not known how postgraduate departments would view such "strategic" applications.

Advice on ranking posts

Postgraduate departments advise that students rank the posts purely on the basis of personal preference and that they apply for as many posts as is allowed. During the first year of the scheme, some students said that they had undertaken "tactical ranking" in the hope that it would increase their chances of securing at least one of their desired posts. Students were wary of applying for posts in popular units, thinking they would not stand a chance of getting them. Because of this, some of the top units, which previously had no problem in filling their posts, actually found that they had vacancies at the end of the first run.

The emphasis of the new scheme, as was definitely borne out by this year's results, is that it is based on what the students want, not what the consultants want. Where else in life does it happen that the candidate's choice takes precedence over their potential employer's? The outcome of this first year shows that 90% of students secured one of their top three ranked posts. Because of this, the number of posts that a student can apply for in the first run, originally five for each specialty, has been decreased to three. The number of applications for rotational posts remains unchanged at two.

Seasonal preferences

More students want to pursue a career in hospital medicine and general practice than in surgery. Consequently, there has been a traditional preference for undertaking medical posts first, so that references can be secured from medical consultants in time for submitting applications for senior house officer posts. This has always tended to result in a glut of applicants for surgical posts in February, for whom there are not enough vacancies. The new system still allows students to indicate seasonal preferences, but, as with the old systems, postgraduate deans still advise that, wherever possible, students should try not to indicate a seasonal preference, since doing so inevitably limits their overall chances of securing their favoured posts. Exceptions to this advice include students who secure a six month post elsewhere in Britain, and thus only want to apply for one six month post in the Scottish system. They can use the seasonal preference form to indicate which period they would not be available for.

Within a UK setting

The scheme is open to all UK medical students in their final year of study. Interested students from English, Welsh, and Northern Irish medical schools should contact the West of Scotland Deanery for Postgraduate Medical Education for an application pack. This year, 30 packs were sent out to UK students outside Scotland, although most of them did not end up applying to the scheme. Like the Scottish system, some of the medical schools in the rest of Britain require students to sign a form stating that they are bound to take up any posts offered to them through their regional matching schemes. But others, unlike Scotland, allow students to simultaneously apply for posts through other matching schemes in other regions.

New insider's guide to PRHO posts Assessment visits to all units will be made for the first time during 2000-1, to ensure that all posts are up to standard. The reactions of preregistration house officers in post are already monitored via feedback forms, which are studied carefully by postgraduate departments. In a separate development, the BMA Junior Doctors Committee is developing an "Insider's Guide" to house jobs in Scotland. Such guides have become commonplace in many health authority regions in England,¹ but historically there has never been one for Scotland owing to lack of BMA resources there. Year on year they have been shown to improve house officer posts in units that are featured in the guide. It is anticipated that the first Scottish guide will be ready by September 2000 and there are discussions to explore the possibility of putting the guide on the internet.

1. Smith AG, Cummings C. Producing a regional guide to house jobs [Career focus]. BMJ 1997; 315 (classified section 9 Aug): 2-3 (www.bmj.com/cgi/content/full/315/7104/52-7104)