Laying good foundations

The foundation programme has been introduced this summer in the UK. But next year, there are plans for a national application scheme. Johann Malawana describes the proposals and the implications for students

Postgraduate medical education in the United Kingdom is undergoing the biggest changes since the Calman reforms of the mid-1990s. Most students in the UK will have heard about the new foundation training programmes, which resulted from the Modernising Medical Careers (MMC) agenda. MMC was a policy statement by the four UK health ministers in 2003 that sought to tackle the issue of the so-called lost tribe of senior house officers in the UK. This is the first training grade following entry into the full medical register in the UK. In the past, it has been either a stepping stone for trainees who know what they want to do and who are cruising along, or, for others, it has proved to be a quagmire, in which training doctors get stuck as they try to work out what they want to do. This has meant wasting years providing a huge service to the National Health Service, but not getting much further in their careers.

The MMC reforms are designed to streamline postgraduate training, drawing upon the experience and models of training elsewhere in the world. The main question underpinning these changes is, if it’s possible to train a general surgeon in seven years, why does the UK take 10 years? This in turn has raised further questions about the level to which doctors will be trained and the impact of less time served on future careers. In essence, will doctors be less experienced?

Implications

The attempts at streamlining further along the career pathway, has huge implications for current trainees and undergraduate students. The senior house officer years were a time when most trainees took their time if they were unsure and tried out a few jobs to see what specialties they enjoyed. Most junior doctors in the UK who did not go straight into a senior house officer training rotation would attempt to spend sometime doing a six month emergency department job. This provided an invaluable opportunity for gaining practical experience in acute care. With the new system, after two years of the Foundation Programme (the first year of which is a pre-registration year (F1) which, after successful completion will result in registration with the General Medical Council and the second year (F2) of which is the first postregistration year), which should include exposure to acute care medicine, trainees are likely to have to make a significant career decision, choosing which specialty training programme they would like to enter.

The result of this will be important career decisions being made earlier and earlier. The opportunities to do stop gap jobs will be severely limited and are likely to be outside of approved training posts. Most trainees, therefore, will need to decide much earlier in their careers what they would like to do.

Application process

For 2006 entry into the foundation programme there will be a new nationally harmonised entry process. New organisations called foundation schools will be similar in size and geographical spread to the current undergraduate medical schools. Foundation schools will be led by postgraduate deaneries, which, in partnership with undergraduate medical schools, will develop the training programmes within them. Entry into foundation schools will be via a national process, using a standard person specification and structured application form. There is likely to be a single national date (probably early October) to enable all trainees eligible for a two year foundation programme to submit an application at the same time. It is hoped that an online application process will be introduced in time, although it is unlikely that this will be available for the first run of the scheme in 2006.

The idea of this national scheme is that it will introduce a formal structured application process that is transparent and allows trainees to have flexibility in applying for foundation training. Applicants should be able to find out in January whether they have been successful in getting into their first choice foundation school. There is likely to be a clearing process following this that will fill the remaining available posts. Currently the UK has about 10% more foundation programme posts than the output from medical schools.

Admission to some foundation schools will be through a single stage application, in which you apply to gain a place within a foundation school while applying for access to a specific foundation programme. It is unlikely that all schools will adopt this single stage process for the 2006 entry, but, in the long term, it is likely that this will be what happens. For those foundation schools through which admission is not via application for a particular post but is entry initially to the school, allocation of F1 posts will be locally organised.

The application form

Many students in the UK reading this will be painfully aware that this all sounds similar to the Universities and Colleges Admissions Service, which we all go through when applying to university. The comparison though does not end there. The actual application process will be similar to that system. There is a likelihood that all formal interviews will be scrapped and the entire application process will move towards a structured CV along with a structured personal statement. These would include examples of good team working skills, leadership skills, show an understanding of good medical practice (the General Medical Council’s guidance on good medical practice and standards of competence, care, and conduct expected of all doctors in the UK), and show their achievements both within and outside medicine.

Application forms are unlikely, however, to allow the applicant unlimited time and space to show all their achievements—there will probably be a limit of 900 words. This means the application needs to be written in a succinct and thoughtful manner—what is it the applicant wants to convey to the selection panel. Applicants will then be asked to rank the unit of applications or foundation school in order of preference. A trained panel of assessors will then score their form against the agreed national person specification. After this, the applicant will find out if they have gained a place at their first choice foundation school. For those candidates who are unsuccessful in gaining admission to their first choice, their score and preferences will be matched until all available posts are filled.

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Don't build your house on sand-get a good foundation

Where to apply

Many factors should be taken into consideration when deciding where to apply. When starting at a UK medical school, students may not have realised that choice of medical school can have a long term impact on job location—most British medical schools train doctors to work in the towns and cities around the medical school. Therefore, the distribution of medical schools and the numbers of vacancies should be carefully considered, against your perceived strength as a candidate. Studies in recent years show that students tend to apply and stay around the medical school at which they studied for at least the first year after qualification. If they don’t wish to stay within the area of their medical school, they usually attempt to undertake their preregistration training near to their family home. Because about 40% of UK medical students come from the south east of England, there is likely to be stiff competition in certain areas of the country, making job allocations extremely hard to predict. Therefore a frank appraisal of your ability to compete for a specific foundation programme placement or foundation school needs to be realistic.

Standing out

When approaching the application form, time spent presenting your achievements in the most positive light will pay dividends. You should not rush and fill the form out without a lot of thought. Most students coming out of medical school will look similar on paper—they have similar qualifications or experience and little to distinguish between them. Being an atypical candidate, therefore, is an extremely good method of standing out. Start thinking early how you can stand out from the crowd. And don’t forget that extracurricular activities at medical school can look similar. Many students do not start thinking about job applications until their third year of medical school, when they are exposed to clinical life in the NHS. But it is vital that with competition for jobs and national selection systems being introduced, students start early doing things that help them with job applications.

Student selected components may become important in selection, potentially showing both interest and achievement in a specialist area and allowing trainees to differentiate themselves from others. A quarter to a third of undergraduate medical degrees are supposed to be student selected and this is an opportunity for a student to show their interest in a given area. Selection of a module in paediatrics, for example, may not be what makes you stand out, but taking the opportunity that is presented and making the most of it may help. Areas of achievement that all person specifications are likely to take into account include research and publications, audit, presentations, and prizes. The elective is another great opportunity to show your interests.

Postgraduate medical education and training in the UK is changing incredibly quickly. The new systems being introduced need to be taken into account by medical students at an early stage in their medical school life so that they allow themselves the greatest opportunities to gain access to the career pathway they wish to pursue. Students should be aware of the changes that are happening to postgraduate medicine and should take steps to prepare themselves early.

Johann Malawana, joint deputy chair for education, BMA Medical Students Committee
Email: johann@bartslondon.com


studentBMJ 2005;13:309-352 September ISSN 0966-6494

   

           

	Responses published this month

Articles	Responses
CAREERS Laying good foundations       Johann Malawana(Sep 2005)	abubakre Seifeldin Ibrahim (September 19th, 2005) Read this response

	CAREERS Laying good foundations       Johann Malawana(Sep 2005)
	abubakre Seifeldin Ibrahim (September 19th, 2005)       studant advisor for sBMJ bakreleicester@hotmail.com
	Thank u first for this brief enlightment of the foundation programme that is adopted by BMA this year. overseas medical students and myself (one of them in Sudan) would like to know about thier chances in getting into foundation programme in Britain after graduation with more details concerning application procedures. Another question ; By completion of the 7 years or so new system instead of the old 10 years to specialize in surgery for egsamble, would both candidates hold the same certificate..?