Posts Tagged ‘Foundation years’

No guarantee of jobs for UK medical graduates

By Francesca Robinson - 14th November 2011 11:25 am

It may not be possible to guarantee all future UK medical school graduates a place on the foundation programme, two new reports are warning.

A surge in applications from Sudan and Pakistan last year resulted in the 2011 foundation programme being oversubscribed, creating for the first time a surplus of demand for places.

There were 7,257 eligible applications for 7,073 places and as a result 184 applicants were placed on a reserve list. These applicants were all eventually offered a place after some students withdrew either for failing finals or for other personal reasons.

The 2012 programme has again been oversubscribed this year and although the UK Foundation Programme Office (UKFPO) is confident that all eligible applicants will eventually all be allocated jobs, there is increasing concern about the future.

Pressure on foundation programme jobs is coming from an unpredictable number of applications from both EU medical students and non-EU students eligible to work in the UK. In addition following an expansion of medical school places increasing numbers of doctors will be graduating in future years.

A recent GMC report on the state of medical education in the UK warns that the prospect of the foundation programme being oversubscribed in future years is an area of potential concern. It says: “Students who enter medical school have legitimate expectation that if they pass their examinations and graduate they should have the opportunity to qualify as a doctor.”

It calls on the Department of Health to expand the number of foundation programme places in order to fulfil this “moral obligation”.

A second report by the Medical Schools Council into steps being taken to improve the selection process for the foundation programme, also warns that it is “likely” in future that the number of posts will continue to exceed the number of applicants.

Unless the application process is made more robust ensuring the “best” candidates are selected it warns there could be legal challenges from unsuccessful applicants.

Proposed measures to toughen up the application process include the introduction of situational judgement tests replacing the current ‘white space’ questions, a prescribing skills exam and an educational performance measure to more accurately reflect performance at medical school.

Dr Ben Molyneaux, deputy chair of the BMA’s Junior Doctors Committee, said they were extremely concerned about the pressure on foundation programme places and  were actively working with the Medical Programme Board and the UKFPO to find long term solutions.

“One of our concerns has been that over the last five years the government has consistently reduced the number of foundation posts available. There used to be a headroom of 5-6% more posts than trainees but in the last few years that has been reduced to 2%.  Unfortunately in austerity times it is unlikely the Department of Health will want to increase the number of posts.”

He said he was optimistic that the changes to the foundation programme application process would ensure more UK graduates would win FY1 jobs in competition with foreign applicants because they would have a better understanding of how the NHS works. He said there had also been discussions about incorporating the FY1 and FY2 years into the undergraduate curriculum although the jury was still out on this idea.

Marion Matheson, co-chair of the BMA’s Medical Students Committee, said it would be a personal disaster if a medical graduate was not able to get an NHS job. “The BMA has made it clear on numerous occasions that the government and the UKFPO have a responsibility to ensure that all UK graduates receive a foundation post when they leave medical school so that they are able to achieve full GMC registration,” she said.

A UKFPO spokesman said: “We are in ongoing discussions with the four UK Health Departments regarding contingency plans for future over subscription.”

A DH spokesperson said: “To date all eligible applicants to the Foundation Programme have secured a place. We will, of course, be monitoring the situation for future years.”

Tags: ,
Posted in Hospital Dr News | 5 Comments »

Foundation Programme curriculum being revised

By Mike Broad - 15th August 2011 2:34 pm

The Foundation Programme is being updated to address criticisms that juniors are having to work beyond their competency.

A draft curriculum has been released following an evaluation of the Foundation Programme by Medical Education England last autumn which suggested that juniors were working beyond their competency and compromising patient safety.

The Foundation Programme curriculum sets out the framework for educational progression in the first two years of professional development after graduation from medical school.

Professor Collins led the MEE review and suggested that supervision deteriorated in specialties with a large number of foundation placements.

The Academy of Medical Royal Colleges says the new draft curriculum revises and updates competencies. It also outlines the purpose of foundation and ‘high level descriptors’, differentiating between F1 and F2 outcomes.

The Collins review called on trainees to “step up” in their level of responsibility as they move from F1 to F2 but under appropriate supervision. This edition of the curriculum identifies the importance of supervised, practice-based learning.

The curriculum says: “Learning is best achieved when there is frequent observation of practice in the workplace with immediate feedback on performance from a senior clinician. Every clinical experience is a learning opportunity whether it occurs during ward rounds, in clinics, in primary care settings, on call, during procedures, etc.”

Other Collins review recommendations included greater focus on the total patient, long-term conditions, the increasing role of community care and the need for team-working.

Meanwhile, the way in which medical students are selected for the Foundation Programme is changing. Situational judgement tests are set to replace the current ‘white space’ questions after being piloted this autumn.

Candidates answer white space questions in their own time, which makes it harder to ensure that the work is their own.

Read the revised curriculum.

Offer your views to manjula.das@aomrc.org.uk

Tags: ,
Posted in Hospital Dr News | No Comments »

Students on the reserve list offered FY jobs

By Francesca Robinson - 1st April 2011 3:30 pm

More than half the medical students who missed out on a 2011 foundation year post because the programme was heavily oversubscribed have now been allocated jobs.

Last year the UK Foundation Programme Office (UKFPO) received an unprecedented surge of 1,600 extra applications.

The first 7,073 top scoring students were allocated places in December and 180 eligible applicants who did not get jobs were placed on a reserve list to be allocated in batches on set dates as vacancies arose.

The UKFPO has now announced that the first 104 applicants on the reserve list have been allocated to foundation schools. These students will begin their foundation programmes in August 2011.

There are now 69 applicants remaining on the reserve list who will be allocated places over the coming months.

Professor Derek Gallen, national director of the UKFPO, said: “I am pleased that so many applicants have been placed during this first allocation, but understand that it is still a difficult time for those who have not yet been allocated to a foundation school. The good news is that we are predicting that the whole of the reserve list will be allocated by early July.”

The second batch allocation is scheduled for 26 May. The UKFPO are predicting that 30 to 50 more applicants will be allocated in the next allocation, with the remainder allocated on 15 June and 4 July.

It is unlikely that the final batch allocation date of 22 July will be required.

Tags:
Posted in Hospital Dr News | No Comments »

Medical students run risk of unemployment

By Francesca Robinson - 30th November 2010 11:31 am

Two per cent of final year medical students will not receive a place on a 2011 Foundation Programme when places are allocated in December.

The UK Foundation Programme Office (UKFPO) has confirmed that the programme starting in August next year is oversubscribed following an unprecedented surge of 1,600 extra applications.

Applications will now be ranked in score order and the 7,073 top scoring students will be placed on a primary list to be allocated places on 8 December.

The surplus 184 applicants will be placed on a reserve list and are likely to be allocated a place by next summer and probably by March.

Based on previous years figures around 400 applicants are expected to withdraw between allocation of places in December and the start of the Foundation Programme in August. Last year about 200 applicants failed their final exams and others withdrew for personal reasons such as to go travelling or start a family.

Professor Derek Gallen, UKFPO national director, said: “I am confident that all eligible applicants will be placed by next summer. Although we are pleased that nearly 98% of students will be allocated during December, we appreciate that this is a time of uncertainty for those who will not know what foundation school they are going to for another few months.”

Applicants on the reserve list will have a dedicated contact person in their medical school to provide them with support and advice.

The BMA said it would be closely monitoring the UKFPO’s contingency plan. “It is unacceptable for any UK medical graduate to be in a position where they might not be able to start a job as a junior doctor after medical school,” said Karin Purshouse, chair of the BMA’s medical students committee.

“The UKFPO have given the BMA assurances that their contingency plan will mean that no medical graduate is left without a post by August. However, the UKFPO must take all necessary steps to ensure that their contingency plan works effectively,” she said.

Dr Shree Datta, co-chair of the BMA’s junior doctors committee, added: “It is important, given this year’s problems that we begin immediate work to examine how we can prevent any repeat next year. Given the financial investment to train a doctor, ministers and the UKFPO have a responsibility to make sure that there is no repeat of these issues in the future.”

Read more about the contingency plan and how the reserve list allocations will work.

Tags: , ,
Posted in Hospital Dr News | No Comments »

“Foundation years need better supervision”

By Mike Broad - 5th November 2010 3:04 pm

Foundation year doctors need better supervision with some being asked to practise beyond their level of competence, a review finds.

Medical Education England’s evaluation of the Foundation Programme warns that it’s compromising patient safety.

While it calls on trainees to “step up” in their level of responsibility as they move from F1 to F2, it says this must be undertaken under appropriate supervision.

It suggests that supervision deteriorates in specialties with a large number of foundation placements and recommends that some of these placements should be reviewed.

Professor John Collins, review chair and visiting professor at the University of Oxford, said: “In meetings with trainees across England, the evaluation panel heard the repeated theme of some trainees being asked to practise beyond their level of competence and without adequate supervision.

“This places patients at unnecessary risk and gives the trainee the message that suboptimal care is condoned, neither of which is part of the professional values and aspirations of a good doctor.”

The review says that a lack of understanding about the role and the level of competence of F1 and F2 doctors could be contributing to their deployment in inappropriate roles beyond their level of competence.

In addition, the review acknowledges that the assessment of foundation doctors is considered to be excessive, onerous and not valued.

It describes the number of assessments required as “formidable” with a total of 249,564 clinical assessments being performed between August 2008 and August 2009 in 24 foundation schools, and 193,338 multi-source feedback appraisals undertaken on about 14,500 trainees.

The review also describes the large number of medical graduates who continue to apply for oversubscribed specialties as “a major issue which must be addressed”. It wants best practice in the provision of careers information and advice to be defined, and key workforce data collated to help trainees to make “early and wise decisions” regarding their long-term careers.

It makes 33 recommendations and the principal findings are supported by similar evidence from the 2009 PMETB Survey of Foundation Doctors, reports from Lord Patel and Professor Sir John Temple and the recently released GMC National Training Surveys 2010.

The Foundation Programme was implemented in 2005 as part of a substantial restructuring of medical education. The current evaluation follows the Tooke Report, which proposed in 2008 that “the structure of postgraduate training should be modified to provide a broad based platform for subsequent higher specialist training, increased flexibility, the valuing of experience and the promotion of excellence”.

On the positive side, MEE’s review believes the length of the programme should remain two years and says it successfully provides a critical interface between medical school and medical practice.

Health secretary Andrew Lansley called for a quick response to the recommendations. He said: “I have asked Medical Education England to work with the profession, the service and medical royal colleges to take forward the recommendations as swiftly as possible.

“This will fit with MEE’s ongoing work to improve the quality of training, ensuring that trainees have appropriate supervision and are not undertaking tasks for which they are not yet competent.”

Dr Tom Dolphin, co-chair of the BMA’s junior doctors committee, said: “We need to address the system failures that allow newly qualified doctors to be put in a position where they are working beyond their level of training. It is incredibly stressful for doctors to be put in this position and it will inevitably threaten patient safety.

“Where this is happening, employers need to be accountable for the systems in place to support juniors in clinical decision-making, and this must include juniors being withdrawn from a department if those systems are inadequate. We also need to urgently investigate problems with the selection of doctors into the programme, the length of work placements and the excessive levels of assessment.”

Niall Dickson, chief executive of the GMC, commented: “We support Professor Collins’s conclusion that the Foundation Programme has many strengths and that, while some changes are needed to improve its effectiveness, they should be approached in a spirit of evolution, not revolution. The GMC will now address the recommendations about the regulation of the Foundation Programme, some of which already form part of our new education strategy, including defining the outcomes required to complete the Foundation Programme and evaluating the case for student registration.

“The report confirms evidence from our own quality assurance activity that some foundation trainees are not being adequately supervised and supported, pressuring them to act beyond their competence with obvious risks for patients. We will continue to act where we become of aware of this, but it is important that NHS organisations deploy foundation doctors appropriately.”

Read the full report.

Tags: , , ,
Posted in Hospital Dr News | 7 Comments »

Foundation Year jobs will be in short supply

By Francesca Robinson - 10th September 2010 9:13 am

Some final year medical students may be denied a place on the 2011 Foundation Programme because more than 1,000 additional applications have been received from overseas.

This year the UK Foundation programme Office (UKFPO) has received an unprecedented 1,606 extra applications from non-UK medical schools plus a few UK graduates who have been out of medical school for more than a year. Last year there were only 577 applications over and above those from UK medical schools.

Officials are stressing that not all of these overseas applicants will be eligible to work in the UK under immigration rules. But they are preparing for the possibility that there will be more eligible applicants than vacancies.

The final number of applicants who are fully eligible to compete for a 2011 Foundation Programme place will not be known until November when all eligibility documentation must be submitted. The majority of this year’s extra applications have come from medical schools in Pakistan and the Sudan.

Around 7,600 UK medical students are due to take their finals next year and based on historical data around 300 are expected to fail. There will be approximately 7,600 FY1 jobs to be filled in August next year.

The potential crisis was the subject of a heated debate at the July meeting of the Medical Programme Board, the professional advisory group that oversees specialty training in England. The body has called for additional foundation posts to be created.

But the Department of Health has declined to promise any extra funding. A spokesperson said: “There is always a possibility that the Foundation Programme may be over or under-subscribed and the UKFPO has agreed contingency plans for both scenarios.”

Richard Marks, head of policy at the pressure group Remedy said they had seen this problem looming for some time: “There is no easy answer and funding additional posts might simply move the bottleneck forward a few years. We already have Core trainees unable to progress into Higher Training; the indications are that in the future Higher Training posts are more likely to be cut than expanded.”

With medical students embarking on their degrees in the expectation that they would become doctors, Marks warned “this will be a bitter pill for medical students to face”.

BMA medical students committee co-chair Nick Deakin said: “To have a situation where any UK graduates are denied a place on the foundation programme is completely unacceptable.

“It will lead to serious concern and anger among students who are currently trying to focus on their intensive final year of study, strangled with average debts of £37,000, especially as failure to obtain a place on the foundation programme will deny them full registration with the GMC and the ability to practise medicine.”

BMA junior doctors committee chair Shree Datta added: “Given the financial implications of training our medical students, it is simply unthinkable to leave them with nowhere to go upon graduation.”

Katie Petty-Saphon, executive director of the Medical Schools Council, said: “The situation is tighter than it has been in other years. But under the new immigration rules we are pretty sure the number of eligible overseas applications will come down dramatically.

“What this is likely to mean is that there will be increased uncertainty for final year students who will probably not know where they will be working until quite close to August 1. The UKFPO will have to wait for people to fail exams to know where the gaps will open up.”

She advised students that given the level of competition this year it was more important than ever to submit a high quality application.

A UKFPO statement said: “The four UK health departments, the UKFPO, BMA and Medical Schools Council are working together to plan ways of managing and supporting those applicants who do not secure a place during the main recruitment round in December. The UKFPO will publish full details of this management plan on November 30.”

Tags: , ,
Posted in Hospital Dr News | 2 Comments »

Surgery, not basket-weaving, needed in foundation years

By Jerry Nelson - 24th May 2010 12:09 pm

I dunno about this Hospitably Doctored website. For every literary gem featuring Dr Sarah talking about her arse, there are a dozen featuring idiotic sub-1970 lefty nonsense and statements of the blindingly obvious, like how Foundation Year Training programmes are a waste of time.

Well, durr!

We used to have things called housemen, who were vaguely useful. They’d be on the firm for six months, and would know all the patients. They’d make the tea and wash your car, and finish off the aneurysm if it was getting late and the pubs were open. They’d talk to the relatives and go to the inquests, and best of all, they’d be so desperate for a good reference that they would put up with the sort of abuse that made Flashman look like a social worker. Which was good for morale. They could go for days without sleep, food, water, or even oxygen.

But now, we’ve got these stupid things called F-Why-Bothers. Firstly, they are appointed by someone else, so half of them are drippy girls who keep bursting into tears every time you shout at them. Secondly, they only work 22.5 hours a week, and have complicated shift patterns between which they hand over essential information about what a total bastard their boss is, but nothing about any actual patients. And that’s when they’ve finished their Trust Induction course which seems to go on for four months, and where they learn all about diversity and climate change and How To Fill In Forms, without learning anything useful like putting in venflons or creative death certificate writing.

But that’s just the surgical job - you should see some of the nonsense they get up to after that. The anaesthetists always seem to have loads of them - learning how to deal with crushing pointlessness and boredom, and watching Dan the Fat Gasman evacuating his nasopharyx for eight hours a day. The last one on our firm rotated through surgery, psychiatry, basket-weaving, contemporary dance, and endocrinology.

That’s right, endocrinology!

Tags: ,
Posted in Nelson's Column, Bolg, Blog, whatever... | 3 Comments »

“FY trainees wasting time in dead end jobs”

By Francesca Robinson - 17th May 2010 4:53 pm

Many medical graduates are wasting time doing irrelevant jobs in their foundation years, a review of the training programme has been told.

The evaluation of the Foundation Programme for Medical Education England has also been warned that foundation trainees are failing to gain enough acute medical experience.

Several organisations are calling for the second foundation year (FY2) to be scrapped to enable trainees to move more swiftly into core training posts more relevant to their chosen career pathways.

This was recommended by the Tooke Review in 2008 but ignored by the then health secretary Alan Johnson.

This latest review, led by Professor John Collins, a general surgeon and academic from Oxford University, has been commissioned as part of the NHS next Stage Review.

Remedy UK, the campaign group which campaigns for training reform, has told Collins that trainees allocated FY1 jobs in areas such as radiology, pathology and anaesthetics are being given minimal levels of responsibility. On call experience is often lacking and too many FY1s are not getting experience of managing acute medical problems or working regularly as first on call doctor. 

Remedy says the FY1 year should be refocused on the “core bread and butter” with two six month posts in core medicine and surgery with sufficient exposure to common on call emergencies.

It suggests FY1 could be re-branded as the “house doctor” year to emphasise the professionalism and responsibility that come with the first year job. Remedy also recommends that foundation training should be better regulated with robust trainee surveys and frequent hospital visits to ensure trainees are gaining enough acute medical experience.

Ben Dean, a former Remedy committee member and surgical trainee from the Oxford region, said: “We have got to do something about the reduction in hours and experiential learning. Ten years ago house officer jobs used to be better regulated so a training post would not be allowed if it didn’t have any training content in the job.

“When Modernising Medical Careers came along in 2006-07 numerous non training jobs were incorporated into the Foundation Programme and now there are very specialised jobs such as radiology, pathology, lab based or public health work where trainees get no acute experience of seeing patients for the first time.”

The Royal College of Physicians is also calling for trainees to move directly into core medical training after FY1. “A large proportion of our consultants and doctors in training report that for many of them the significant proportion of the experiences they have in the second foundation year are often irrelevant to their future practice when they have already decided on a set route. Our finding is that many trainee doctors don’t find any step up of responsibility as they move into second year,” said a spokesman.

He said they acknowledged that there would some serious hurdles to overcome to change the system so instead they would like to see would-be physicians who have already chosen a defined career path to be allowed to choose more appropriate career options in FY2.  

The Royal College of Surgeons says the Foundation Programme as it is currently operating is failing to meet either the needs of the trainees or the service in surgery. In its submission, it says the four month placements are too short to give trainees sufficient exposure to all the elements of surgical care from a patient’s initial appointment through to post operative follow up. The RCS recommends that a single pre-registration foundation year should be followed by three years of core training. It says this proposal has near unanimous support from surgical trainees.

Shree Datta, chair of the Junior Doctors Committee, said they were very supportive of the foundation programme and the measures that had been introduced by the UKFPO to develop the programme. 

“Like anything there is always room for development and nothing will ever be perfect for everyone but certainly we feel the Foundation Programme has achieved what it aimed to do in that it has made sure that most people have a broad based training,” she said.

Collins said the needs of patients and medical graduates would be central to his evaluation of the Foundation Programme: “I can give trainees my personal assurance that their views will be listened to and taken into account in considering the best way forward in managing the transition points as doctors move through their training.”

His report is expected to be submitted to the health secretary in the autumn.

Trainees can voice their opinions on MEE events being held on 19/20 May in London and Leeds.

Tags: , ,
Posted in Hospital Dr News | 2 Comments »

Medical graduates are poorly prepared

By Mike Broad - 10th November 2009 8:16 am

Newly qualified medical graduates are poorly prepared to work as trainee doctors, a survey reveals.

The findings, published in Postgraduate Medical Journal, are based on 228 senior doctors’ critical assessment of a wide range of core skills and competencies among trainee doctors at two teaching hospitals in the East Midlands.

Trainee doctors now complete a two-year generic Foundation Programme, which forms the bridge between medical school and specialist or general practice training.

The senior doctors were asked to score how well prepared their F1 trainees were to work as doctors, six months after they had graduated from medical school, using a five point scale.

The junior doctors were assessed against most of the expectations for newly qualified doctors set out by the GMC, in Tomorrow’s Doctors, as well as 18 general criteria.

The senior doctors (107 consultants and 121 specialist registrars) scored the juniors below three on 48 of the 70 items assessed against the GMC criteria and above the midway point for only six of the 20 clinical and practical skills.

Carrying out basic respiratory function tests, prescribing, and more advanced communication skills were some of the areas where juniors performed below par.

But they scored well on basic communication skills and how to ask for help, prompting the authors to wonder whether medical schools have not “gone too far in emphasising risk management and, perhaps inadvertently, helplessness”.

The responses, which reflected a high degree of agreement between the two groups, showed that the senior doctors felt the fledgling juniors were inadequately prepared to start work as a doctor.

They said: “The findings give cause for concern. Senior doctors perceived that the undergraduate medical degree had not adequately prepared F1s for practice, especially in clinical and practical skills.”

Among other things, they call for more opportunities for ward based experiential learning and for senior doctors to be more explicit about what is expected of F1 trainees.

The GMC’s publication Tomorrow’s Doctors is also to blame. The report says: “SpRs and consultants may have inappropriate or unrealistic expectations made more likely by the lack of specific criteria in Tomorrow’s Doctors.

“In addition, the perceived lack of preparedness of F1s is further challenged by the lack of explicit criteria in the work based assessments of the Foundation Programme that F1s must pass to gain full registration with the GMC. As a consequence of the lack of specific criteria, expectations about preparedness for practice at the undergraduate and postgraduate level are not aligned and the transition between medical graduate and first year junior doctor remains highly problematic.”

The authors point out their survey provides only a snapshot of graduates from one medical school and in one area of England, so may not be indicative of trends across the UK. But they also say that their findings back up other broadly similar research.

A GMC spokesperson said Tomorrow’s Doctors had been re-launched since this research’s questionnaires were conducted.

She said: “It is important not to jump to conclusions from this study. Tomorrow’s Doctors will require that students have more opportunity to apply their medical knowledge and skills in hospitals and surgeries before they graduate. ’Student assistantships’, which are work placements, will be rolled out to help prepare medical students for the Foundation programme.

“A lot of work was undertaken to map F1 outcomes to the undergraduate competencies, including clinical and procedural skills. The GMC also agreed a revised Foundation programme curriculum and specific outcomes for F1 doctors which will give medical schools a clear understanding of what they should be preparing medical students for in the workplace.”

Tags: , ,
Posted in Hospital Dr News | 1 Comment »