Foundation programme 2009
Thomas Kelley and Emily Finnigan explain how recruitment will work for UK junior doctors starting next August
In August 2009 the foundation programme will enter its fourth year, and final year medical students throughout the United
Kingdom are preparing to apply when the online system opens on 27 October 2008.
The foundation programme’s national online recruitment system was introduced in 2006 to recruit medical students into the
2007 foundation programme. This system made applying to other foundation schools easier than in the past, when medical students
were expected to get jobs locally or ask the express permission of their dean to move. During 2007 recruitment, all eligible
applicants were placed in programmes; more than 93% were accepted by their first choice foundation school and around 25% of
applicants applied outside their local area. The downside was that there were technical glitches and the site was reported
to run slowly.
During the 2008 recruitment round, 100% of UK medical graduates and other eligible applicants were placed into foundation
programmes, with more than 92% of these getting their first choice school, and about 30% applying to foundation schools outside
their local area. No technical faults were reported and the site ran more quickly. The satisfaction rating given by foundation
applicants soared. This is also the year that the UK Foundation Programme Office (UKFPO) was created to oversee the foundation
programme and recruitment across the four UK countries.
We were heartened to hear presentations from Derek Gallen, the national director of UKFPO, and Carrie Moore, the director
of strategy, at a recent UKFPO medical student board meeting who said that feedback from last year’s medical student board—along
with feedback from the BMA, NHS Employers, and foundation schools—was used to revise the process for this year.
Changes to the application process
The application form is still worth a maximum of 100 points and is made up of two parts: academic ranking and application
questions. The academic ranking provided by your medical school is worth a maximum of 40 points this year instead of 45; and
your application answers are worth up to 60 points instead of 55.
The academic ranking is determined by medical schools. They divide the year group into four quartiles, based on academic achievement.
For this year’s process, the difference between the scores given for each quartile has been reduced. This year, the academic
ranking points are allocated as—first quartile: 40 points; second quartile: 38 points; third quartile: 36 points; fourth quartile:
34 points. This change was requested by medical students for a number of reasons. One was because of a concern that there
is no way to tell whether a third quartile student of a “top” university was better or worse than a top quartile student of
a “lesser” university. There is no calibration between medical schools in the UK, or in the European Economic Area or the
rest of the world.
Another improvement is that you will be able to see the score for each individual question on your online account. Last year,
you could only see your overall score.
The biggest change to the system this year is the ability to link your application to another person’s. Any two people can
link their applications (partners, siblings, friends) providing both parties agree. This link ensures that you will both be
placed in the same foundation school. You should be aware, however, of the pitfalls. If your partner scores considerably lower
than you and thus does not get into their first choice foundation school, you also will not get into your first choice (you
must rank all your schools in the same order for the link to work). You will drop down to your next preference of school that
still has vacancies remaining. You should also note that this link is only to a foundation school, not to a specific programme.
Some foundation schools will try to honour the link as much as possible (some ensuring that you are no more than an hour’s
commute from each other); but others will not. Check the individual foundation school websites for more information. Links
to all of their websites can be found at www.foundationprogramme.nhs.uk. Once applications have been linked and the application submitted, you cannot unlink so think carefully before linking your
application.
How to apply
You can register online, from 13 October, at www.foundationprogramme.nhs.uk and it is crucial that you enter the details on this form exactly how you supplied them to your medical school. If you do
not, the system will not allow you to login. Only eligible applicants can apply and all of their details are pre-loaded onto
the application system, which validates your details when you register. As soon as you are registered an activation code will
be emailed to you. By following the link in this email to activate your account you will be able to enrol on the 2009 foundation
programme application process.
You then have from 27 October to 7 November to complete the online application form. Applications must be submitted by 12
noon GMT on 7 November 2008.
There are a total of eight sections to the application form: personal details; educational qualifications; self assessment
of your own practical and clinical skills; equal opportunities monitoring information; references (you will need two references,
either practising general practitioners, consultants, or associate specialists); seven white space questions; foundation school
preferences; and submission.
Scoring
Scoring is carried out by the candidate’s first choice foundation school, with each question being scored by a panel of two
trained scorers, at least one of whom is a clinician. This means that 14 different people score your form. The panels will
only see your answer to the question they mark, along with an applicant number; they will not have access to any other part
of the form, nor will they know what score you received for any of the other questions. All scoring is done blind.
A random sample of up to 10% of applicants will be asked to verify the answers on their application forms. If you are one
of these applicants, your foundation school will notify you.
Allocation to foundation school
Allocation to a foundation school is based on preference first and then score. Therefore, if you rank an oversubscribed school
as your first choice but get a low application score then you may not be allocated to that school. However, you also may not
get your second, third, fourth, etc choices either as these may be filled by people choosing these foundation schools as their
first choice. Therefore, it is crucial you rank the foundation schools carefully.
From 13 October you will be able to check on the UKFPO website to see the number of applicants for vacancies in each foundation
school from 2007 and 2008. These competition ratios may help you in deciding how to rank foundation schools. Clearly, it is
impossible to predict where medical students are going to apply, but London foundation schools are always popular, so you
will want to consider that when you are ranking foundation schools.
On 6 January 2009 you will be able to login to your area on the UKFPO website and see your total score as well as the foundation
school to which you have been allocated.
Matching to specific programmes
From 7 January onwards you will need to rank the programmes in your allocated foundation school in order of preference. It
is important that you check your specific foundation school’s website as deadlines and matching processes will vary between
schools.
You will be notified of your match on 3 March 2009. A breakdown of the scores for each application answer will be available
from 6 March 2009.
More information
A special Foundation Applicant’s Handbook will be published on the UKFPO website on 13 October. This provides a wealth of
information regarding how to fill in the form and how the entire application process works. We would strongly encourage you
to read it and use it when completing the application.
Postgraduate medical education has received much negative press over recent years. Rest assured, however, that the foundation
programme has run smoothly since its introduction in 2005 and as highlighted above they have listened to stakeholders and
revised the process to ensure that it is a fair, reliable, and effective application process.
Competing interests: Both authors are advisers to the UK Foundation Programme Office.
Please go to www.foundationprogramme.nhs.uk for information, advice, and guidance on this year’s application process.
This article was first published in BMJ Careers (2008, http://careers.bmj.com/careers/advice/view-article.html?id=3091).
Thomas Kelley medical student adviser to the UK Foundation Programme Office Medical School, Manchester University, Manchester
thomas.kelley@student.manchester.ac.uk
Emily Finnigan medical student adviser to the UK Foundation Programme Office Birmingham
Student BMJ 2008;16:398 | 10
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CAREERS
Foundation programme 2009
(Thomas Kelley and Emily Finnigan, November 2008)
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Simon Lammy
(October 30th, 2008)
Final Year Medical Student, UCL Medical School s.lammy@ucl.ac.uk
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Dear Editor
The statistical nuances that the UKFPO, through Professor Derek Gallen and numerous supportive medical student representatives, broadcast concerning 93% (2007) and 92% (2008) of final year medical students being matched to their first choice foundation school always conveniently neglects two significant historic facts – that due to intense competition, significant proportions rank foundation schools according to competition ratios, not educational desire, and that significant proportions of London medical students have always been matched outside of their treasured London foundation schools, due to the shortage of posts compared to medical school output, a deteriorating situation that has never been paid serious attention that is being compounded by open competition.
Concerning comparing medical students amongst the medical schools, the obvious common sense solution has had significant resistance from both medical student and medical schools representatives.
Undergraduate national examinations, by ensuring more accurately than ever before that medical students upon exit, possess the precise number of theoretical and practical competencies as every other medical graduate, has been proven to work overseas. Accurate comparisons, the examinations main advantage, concerning academic knowledge, could thus be made.
The main counterargument, that national examinations may reduce diversity, leading to exam led teaching, makes no sense when no other accurate comparison concerning academic competency, for ranking to a foundation school, does not exist.
The authors mention that ‘because of a concern that there is no way to tell whether a third quartile student of a “top†university was better or worse than a top quartile student of a “lesser†university’ that the academic component concerning a medical students foundation programme application score has been reduced. This makes sense, declaring that the UKFPO recognizes that medical school graduates, although competent, possess varying standards superseding the minimum requirements dependent upon the medical school they attended. The deduction is that patients prefer doctors that exceed expectation, than simply attaining them.
An examination would be advantageous to guarantee that a first quartile medical student at a “bottom†medical school is comparable to a first quartile medical student at a “top†medical school. Thus the academic undergraduate component, a key predictor of a doctor’s success, particularly concerning the attainment of membership examinations, could be significantly increased during selection into the foundation programme.
The vast majority of medical students, once they become final years, agree that the academic component should have more bearing, provided accurate comparisons can be made. It seems the only medical students opposed to such national examinations, and subsequent increases concerning academic weighting, are some medical student representatives.
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CAREERS
Foundation programme 2009
(Thomas Kelley and Emily Finnigan, November 2008)
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Ned Naylor
(November 15th, 2008)
Sixth year medical student, University of Oxford edmund.naylor@medschool.ox.ac.uk
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Dear Editor
I am surprised that the UKFPO continue to state that a student's 'academic ranking' is worth 40 points in foundation school applications. With a minimum score of 34 and a maximum of 40, the score is in fact worth only six points.
The statement that academic ranking is worth 40 points is misleading, suggesting that academic achievement plays more of a part in the application process than is actually the case.
The UKFPO and our medical student leaders are entitled to the view that academic achievement should not be heavily represented in foundation programme applications. If this is the case, however, it should be unambiguously reflected in the scoring system: academic ranking should be scored on a scale of zero to six, not 34 to 40.
Yours faithfully,
Ned Naylor
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CAREERS
Foundation programme 2009
(Thomas Kelley and Emily Finnigan, November 2008)
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Dr Allan M Conway
(November 27th, 2008)
Foundation Year 2, Manchester Royal Infirmary allan.m.conway@doctors.org.uk
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Sir
I wholeheartedly agree with comments made by Ned Naylor. When MTAS and MMC initially designed the Foundation Application Process, there was NO reward given to the highest achieving candidates at medical school. This resulted in an outcry, hence changes were made in recent years.
The impression given by UKFPO is that academic weighting counts for 40% of ones score. To those with a basic levels of mathematics and statistics, it is clear to see that in fact academic weighting only counts for 6% of ones form. This is absolutely outrageous!
Those who work hard and achieve highly at medical are once again being ignored by the Foundation Programme. Students with high academic potential who have studied hard to achieve top quartile ranking should be rewarded justly. The Foundation Programme should also stop patronising current students with claims that academic ranking is worth far more than it actually is. This is simply more political spin which those going through this years process should protest about more vigorously!
Yours faithfully,
Dr Allan M Conway
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