Oxford Handbook for Medical School

The application is fairly simple but requires you to make decisions that will shape the start of your career. Hence, it is worth giving it some thought and setting time aside to ensure it is completed correctly. There is an element of lottery to the application system, as the number of students choosing to apply to different deaneries and different jobs will fluctuate each year. However, all programmes are designed to give you the skills needed to progress beyond foundation and the vast majority of people really enjoy their foundation jobs, regardless of whether it was their first choice or their 191st. In addition, most people find that the foundation years fly past, so do not be afraid to try somewhere new or something different. This era signifies a new chapter of your life.

Types of application

Standard applications

Anyone wanting to become a junior doctor in the UK must apply to the Foundation Programme via the Foundation Programme Application System (FPAS). This application requires the submission of evidence of your academic achievements by both you and your medical school. It also requires you to rank the geographical areas (known as deaneries, or Units of Application) in which jobs are available, and then the jobs within an area, in order of preference.

Academic applications

If you wish to undertake or explore a career in medical research or medical education you can also apply for Academic Foundation Programme (AFP) posts. This application must be in addition to the standard non-academic application.

Linked applications

If you want to ensure that you will be placed in the same deanery as another applicant, most usually a partner, then it is possible to link your applications together. However, be aware that once linked it is impossible to unlink the applications, and that you will both be ranked according to the lower overall score. Some Units of Application treat linked applications in different ways when it comes to job allocations, so find out what rules apply in your preferred deaneries.

Timeline of applications

The exact dates vary from year to year and can be found online.

• September: registration opens and indicative programmes can be viewed online.

• October: website enables submission of applications—do not miss this!

• February: final programmes become available to view online.

• March: primary list allocation—most people are told their deanery and situational judgement test (SJT) score.

• April: deadline for submission of job preferences and jobs for the primary list are allocated.

• May–July: reserve list applicants are allocated to jobs.

• August: start work as a Foundation Year 1 (FY1) doctor.

Submitting your online application

Find out the window for submitting your application as soon as possible and then submit early—you can guarantee the website will be overloaded on the last day. At the very latest, try to submit a full 3 days before the deadline. If you are going to be out of the country (e.g. on elective), make sure you have Internet access at the required time. If you do not submit your application on time you will not be able to start the Foundation Programme alongside your peers. There are no exceptions, for anyone or anything. It is worth checking that your files of supporting documentation are downloadable from different computers. If the UK Foundation Programme Office (UKFPO) cannot access your documents then they will not be considered; there will be no opportunity to resend. Similarly, check that any PubMed IDs for publications link directly to the full article. More than one click and UKFPO will not go hunting for them and they will not count. (See Table 56.1.)

Table 56.1 Components of the application

Component	Maximum points available
Situational judgement test	50
Educational performance measure	50
(Decile ranking)	(43)
(Publications)	(2)
(Additional degrees)	(5)

Educational performance measure (EPM)

The EPM has three components:

1. Your decile ranking

Your decile is decided by your medical school, which will rank you against your peers according to your grades up to the point of application. If you fall in the top decile (10%) you will be awarded 43 points, 2nd decile 42 points and so on, with those in the 10th decile receiving 34 points. As you can see, there is only a 9-point difference between the top and bottom scores, so try not to feel too stressed if you receive a lower ranking.

2. Any publications

Up to 2 points are available for publications. To count, the work must have been undertaken while you were at medical school, have a PubMed ID, and you must be a named author (not a collaborator). Keep alert during your degree for opportunities to become involved with research and publications. Ask your tutors if they have any projects you could become involved in, or consider writing up a case report if you come across an interesting patient. Not only will this strengthen your Foundation Programme application, it will provide you with experience in an important part of modern medicine.

3. Any additional degrees

Previous degrees and intercalated degrees are worth extra points. If you have more than one additional degree, choose the one worth the most points. A guide to the points system is given on http://www.foundationprogramme.nhs.uk/ but look up individual degrees.

Situational judgement test

The SJT is a 140 min long exam that aims to test your problem-solving skills in a series of work-related scenarios. Questions 1–47 ask you to rank five responses to a given situation, while for questions 48–70 you must select the three most appropriate of eight possible responses. You should answer from the perspective of an FY1 doctor, and choose based on what you should do (not necessarily what you would do, or what you might have seen others do!). The test is held twice in each application year (in early December and in early January). Your medical school will tell you which sitting you have been entered into and you can only take the test once.

Top tips

Time management

This exam is tight for time so calculate in advance how long you have to spend on each question and set yourself targets for various time points. Do not be falsely reassured by the practice tests! In previous years, students have felt the actual exam had more text to read and was harder to complete in the time available. There is no negative marking, so it is vital to answer every question.

Key knowledge

Some questions require an understanding of people and hierarchies that you may not have come across as a medical student. Try to find out about the role of educational supervisors and the correct order in which to seek help. For example, as an FY1 you should normally approach the registrar and then consultant in your own team first, rather than approaching a different team. Other topics to brush up on include rules regarding diabetes, seizures, the DVLA, and the rare occasions when it is appropriate to breach patient confidentiality.

Practice tests

There are two official practice tests available and you should take both of them. It is possible to complete them online, but as the actual SJT will be paper based it is best to print out the papers. This will allow you to familiarize yourself with the printed format and practise filling in the answer sheet, which can be confusing the first time around.

Books and courses

Although various books and courses exist, they are not advised. Aside from being expensive, they are not created by those that write the actual SJTs and thus are based on guesswork. In many, the questions provided have shorter text, which prevents you from practising the timing component. Most people agree there is an element of luck to this test, and it is perhaps not worth spending too much time (or money) preparing.

Sample SJT question

One of the nurses, Jill, has undermined your decisions several times, and has twice called you incompetent in front of patients and staff. More recently, a FY1 colleague told you that you should not allow her to speak to you like that. You have not had feedback from any other team members to indicate that there are any problems with your performance.

Rank in order the appropriateness of the following actions in response to this situation (1= most appropriate; 5= least appropriate).

A. Continue to ignore Jill’s comments.

B. Inform the nurse in charge about Jill’s comments.

C. Find Jill when she is on a break and ask what her concerns are with you.

D. Inform your consultant about Jill’s comments.

E. Ask other FY1s if they have had similar problems with Jill.

Reproduced from UKPFO website: www.sjt.foundationprogramme.nhs.uk/sample.

Ranking jobs within a deanery

Whatever your deanery, you are likely to have a considerable number of jobs to rank, so start the process early. Studying a map of the area enables you to mark the different hospitals on the map so you can see them in relation to one another and the transport systems. Printing out a list of the jobs and cutting them up can help with physically re-arranging and comparing the various options.

Useful resources

• Applicant’s handbook for FPAS ( www.fpas.nhs.uk).

• For further information on the SJT and to access the practice papers go to www.sjt.foundationprogramme.nhs.uk.

Sample SJT question answer: DEBCA

Rationale

This question requires you to see that Jill is behaving unprofessionally and to understand this could have a negative effect on the team. In many SJT questions your first action should be to speak to the person offending. The best first move is to inform your consultant (D) who is in a position to investigate and take action as required. The next best option would be to talk to the other juniors (E) so that they can also recognize it as unprofessional behaviour and report anything relevant to the consultant. Although telling the nurse in charge (B) is not a bad thing to do, it is ranked lower down as your consultant would be a better person to undertake this. While talking directly to the person causing the issue (C) is often a good starting place, it is likely to result in further tension and an unfavourable interaction. However the worst approach listed would be just to ignore Jill’s comments (A) as the situation would persist.

Academic Foundation Programme

Academic career pathways

The AFP will, for many doctors, be their first exposure to clinical research, and it may be that you wish to return to pure clinical medicine after this period. However, it is important to remember that the majority of academic doctors carry out research and teaching alongside their clinical work, and that it is not always necessary to choose one over the other. While specifics regarding training pathways alter with time and within different countries (NB England, Wales, and Scotland all have their own pathways. See the UK Foundation Programme website for a more detailed overview of the current schemes), for those considering remaining in academia long term, the following sections will provide a brief overview of the current pathway in England.

Specialist training (ST)

A natural path to take after an AFP is to apply for an Academic Clinical Fellowship within your specialty of interest. They are 3 years long (i.e. ST1–ST3), and while mostly clinical in nature, they will have ~25% of time allocated for academia. Like the AFP posts, the first year will focus on developing clinical experience, with the aim of the second and third year allowing you to determine an area to undertake a MD/PhD, and to apply for funding. While this may seem like a daunting task, you will certainly receive help and guidance from experienced clinical researchers who have successfully made this transition.

Training fellowship

Once successful in gaining funding, you will undertake a ‘training fellowship’, which will comprise the project that will hopefully lead to the award of a MD/PhD. While the inherent level of clinical medicine within this period will vary depending on your project, most doctors will continue to have protected clinic time to ensure skills are maintained/developed.

Academic clinical lectureship

Once you have completed your MD/PhD, you can apply for a clinical lectureship post (up to 4 years in length). This will allow you to complete your clinical training, alongside carrying out postdoctoral research. This stage will also likely require you to obtain your own funding via bodies such as the Wellcome Trust, the Medical Research Council, Cancer Research UK, etc.

Senior lectureship/consultant

Completion of your clinical training will then allow you to apply for consultant and senior lectureship positions. If you wish to continue in research, then grant applications and sourcing of funding will be an ever-present part of the job.

Career taster weeks

As a foundation doctor, it is important to think hard about your likely career so that you can tailor your efforts to what is required to get a job in that specialty. Time is shorter than you think: within 18 months, you will apply for core/specialty training and in doing so, you will likely have chosen the bearing of your training: medicine, surgery, general practice, or one of the specialties. The earlier you decide, the more efficient your efforts will be towards forming a competitive application by considering relevant Royal College examinations (MRCP, MRCS, etc.), conducting teaching, and undertaking research and audits. However, be reassured that many of the essential skills required at selection for jobs are generic. Specialty-specific achievements are more relevant to more competitive specialties (plastic surgery, neurosurgery, ophthalmology, etc.).

Career tasters

The UKFPO allocates 5 days per year for foundation trainees to ‘taste’ a selected specialty. Prior to the Modernising Medical Careers programme, trainees could spend as long as they desired as SHOs, sampling careers until they were certain of their decision. This is no longer possible under the modern system of postgraduate medical training. You will only have the opportunity to sample three or four specialties as a foundation doctor before you apply for core/specialist training, not necessarily in the specialties of your interest. Taster weeks can therefore be very helpful in examining a specialty with the sole purpose of considering whether it is the career you wish to pursue. It can also provide you with a way to demonstrate commitment to, and insight into, a specialty during the selection process. This is the most difficult step; once you know what you want, you can plan.

What to ask about on taster weeks

Ask a variety of people, including both trainees and consultants. Do not worry about approaching them to ask these sorts of questions; on the whole, people generally thoroughly enjoy talking about their stories, work, and experiences. Ask the questions that really matter about your considered specialty:

• The best and the worst aspects of the job.

• Work–life balance (and option for less than full-time training).

• Career satisfaction.

• Likely changes to the speciality over the next 30 years.

• Opportunities for clinical/basic science research.

• The need for a higher research degree.

• Opportunities for working abroad/developing countries.

• Ask registrars what it is like being a trainee in their deanery (the nature and intensity of the work, the nature of exams, morale, quality of training).

• Ask consultants how they see their work, and if there are any regrets.

• Why do trainees leave the specialty? What do trainees struggle with?

• What are the attributes of a successful trainee?

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