Recruitment to foundation programmes in 2005-2006
April 2006, Update
On Saturday 1 April 2006, the Medical Students Conference passed the following policy:
This conference believes that the MSC should be explicit in its views on the foundation programme and calls on the MSC to represent the following statements to the relevant agencies and organisations:
(i) There is sound educational value in being able to continue foundation training in the same foundation school as ones medical school as recommended by the GMC.
(ii) Students wishing to work in a foundation school different to their medical should be allowed to
(iii) All UK graduates of good standing should be guaranteed a foundation programme
(iv) The foundation programme should consist of a two year seamless training programme as outlined in the operational guide to foundation programmes
(v) Competitive entry into a foundation programme should occur during the final year of medical school
March 2006
This paper outlines the BMA Medical Students Committee (MSC) position on recruitment to foundation programmes following the MSC meeting on 11 March 2006, electronic discussion of committee members, representations from individual BMA members and interim results of a BMA survey completed by applicants to the foundation programme.
The intended audience includes (but is not limited to) CoPMED, the MMC teams, the departments of health, medical school deans, foundation schools and UK medical students. A final version of the report referred to below and produced by the BMA HERPU will be available on the BMA website in April.
Summary of recommendations
Phase 2
(i) Clear identification of additional and amended posts being made available in the second phase needs to be made to the MDAP website
(ii) Advance warning of the results of the second phase should be given to medical schools to enable them to assist and support their students who are engaged in this process
(iii) Medical schools should provide pastoral support to students entering the second phase
(iv) All UK graduates who are fit to practise medicine should be entitled to access for foundation training
(v) Pre-employment checks should be undertaken only by employing trusts and should not deviate from existing guidance provided by NHS Employers
Future
(i) Accountability for the provision of accurate information to applicants as well as for quality assuring the recruitment process should rest with a publicly named entity
(ii) Regular and accurate information must be available to all regardless of location of study or location of application.
(iii) The word limit on the application form has been viewed by students to be too short and it is recommended that it be increased to around 100 words.
(iv) A slightly greater weighting needs to be given to academic performance. We would welcome an objective academic component of the applicant’s academic performance in the core undergraduate curriculum supplied by the applicant’s medical school. Increments between scores should be small.
(v) Information about pay, hours of work and F2 opportunities should be provided for every post advertised.
(vi) Solving the problems encountered this year will let get us much closer to a definitive process, rather than starting from scratch with an equally un-validated new form accompanied by a while new set of problems.
Current situation
The Medical Students Committee is very concerned by problems experienced by applicants to foundation programme posts during 2005 and 2006.
We note that of the 6090 applications for posts commencing in August 2006, 5333 applicants have been allocated a post in the first phase of the matching process.
There were 3736 applicants to MDAP (the multi-deanery application process) but only 3306 posts available. Approximately 592 applicants have entered the second round of matching, with around 467 of these being final year students from UK medical schools.
50.12% of respondents to a BMA survey rated the overall outcome of phase one of the matching process as “very good” (22.7%, 95/419 respondents) or “good” (27.5%, 115/419 respondents), with 32% of respondents reporting that the outcome was “bad” (14.1%, 59/419 respondents) or “very bad” (17.9%, 75/419 respondents).
Information about the process
The many parties involved (MMC team/website, MDAP website, foundation school websites, postgraduate deaneries and medical schools) has resulted in complete confusion amongst students as where to seek accurate information/advice.
Preliminary results from a BMA survey indicate that 35.2% of respondents (154/438 respondents) had sufficient information to help in their application for training opportunities. However, concern has been expressed about the absence of detail on pay, hours of work and F2 opportunities when applying to foundation training.
Students appear to have confused the process for recruiting trainees into foundation programme with wider policy of on reshaping doctor’s careers through Modernising Medical Careers; this needs urgent correction by those responsible for implementing MMC.
Accountability for the provision of accurate information to applicants as well as for quality assuring the recruitment process should rest with a publicly named entity.
User confidence in the technology has been undermined by system delay, security breaches and system failure. To rebuild trust in users of the system, regular and accurate information must be available to all regardless of location of study or location of application. This must be addressed by the Departments of Health when developing the technical requirements for MTAS.
The process
Student feel dissatisfied with the information they were given and the technological failings of the system. Preliminary results from a BMA survey indicate a high level of dissatisfaction with the process of applying to foundation programmes with 65.8% of respondents reported that the process was “bad” (32.4%, 142/439 respondents) or “very bad” (33.5%, 147/439 respondents).
The form
73.1% of respondents (320/438 respondents) to a BMA survey felt that the application form did not give them sufficient opportunity to represent themselves fairly for the purposes of their application to foundation programme training.
Individual representations from BMA members suggest a lack of confidence in the quality assurance of scoring application forms. Both deliberations in committee and comments received through the BMA’s preliminary report on foundation programmes have called for two main changes to the application form. Firstly, the word limit on the application form was felt to be too short and it is recommended that it be increased to around 100 words. Secondly, it appears that slightly greater weighting needs to be given to academic performance.
We would welcome an objective assessment of a student’s performance in the core curriculum supplied by the medical school and used on the application form, but academic weighting should not be overstated in the overall score. The steps between ratings should be small and applicants should be made aware of the information that medical schools provide in relation to their academic performance. Being mindful of the diversity of the medical curriculum, medical schools should determine this data in an open and transparent way.
There is confusion as to who is accountable for validating the statements made by students on the form. This has lead to the perception that the system is open to abuse. The quality assurance process should be published and those that score application forms should be properly trained. Any audit of scoring and verification of the content of individual application forms must apply to all candidates, regardless of the score achieved by an individual. Decisions about whether to inform applicants of their score should be standardised.
Low scores
We are particularly concerned that applicants with low scores have been given the impression in written correspondence from MDAP and CoPMED that they have somehow ‘failed’. We reject any suggestion that students with a low score may be required to sit additional tests to confirm their clinical skills, especially as the requirement for additional testing on low scores was not made evident at the time of application.
Furthermore, evidence of having gained the skills required to become a doctor is shown by passing final examinations and graduating from medical school. Pre-employment checks should be undertaken only by employing trusts and should not deviate from existing guidance provided by NHS Employers. Currently these checks must comply with discrimination and data protection legislation and include confirming identity, work permit status, GMC registration, references and criminal record status, as well as occupational health and risk assessments.
Given the significant cost of training students to become doctors, it is crucial that all UK graduates who are fit to practise medicine should be entitled to access for foundation training.
Phase two
Representations from students entering the second round of matching indicate they are in a state of distress about their future, especially in the lead up to final year exams. Medical schools are urged to use existing structures to provide dedicated pastoral support to these students to assist them through this difficult time.
Advance warning of the results of the second phase should be given to medical schools to enable them to assist in supporting their students who are engaged in this process. We understand that additional posts are being added to the MDAP website in the second phase and call for clear identification of these new posts on the MDAP website. Changes to existing posts should also be clearly identified.
London
Although London medical schools have traditionally been a net exporter of medical graduates, it appears that applications to London were more competitive than in previous years and that more London graduates may be placed outside their medical school environs than in the past.
Unusually, posts in London foundation schools required applicants list three possible orders for each post. This resulted in fewer choices per applicant. The algorithm dictates that the more choices displayed, the more likely a student is to achieve a successful match. It is likely that the anonymity of MDAP and the creation of a single entry point for London posts have exacerbated competition from outside applicants. We suggest that wherever there are linked rotations for one post, the rotations should be displayed as a group.
What’s important to students
Interim results from a BMA survey also show that the two most important factors in applying for an FP job were ‘the location being the same as their medical school’ (40.9%, 170/415 respondents) and ‘local ties e.g. friends and family’ (38.6%, 160/415 respondents). These factors should be taken into consideration when developing the marking system in future.
Finally, committee members and BMA members have also expressed concern that interviews did not form part of the application process, despite communication skills being an important part of the undergraduate medical curriculum and key to being a doctor. Should interviews form part of the application process, they be as objective as possible for example include standardised questions and be comprised of trained panel members rather than an individual.