UK foundation training
Congratulations! You’ve made it into medical school. You’ve dragged yourself to infinite early starts while your friends dozed till noon, stomached the smell of formaldehyde after a big night out, bought the stethoscope, and amused patients with your over-rehearsed introductions. Through all of this you’ve survived with no salary.
Now for the easy bit… getting a job.
Applying to the foundation programme can seem daunting, and the temptation is often to bury your head in the sand and pretend it’s not happening. But that’s where this page can help you. This step-by-step guide will lead you through the process so you know what to expect, and maybe even gain a few pearls of wisdom.
by Dr Imogen Welding
You must keep to deadlines – there is no leniency on this. You’ll need to start actively working on your application in September of your final year, or slightly earlier if you’re applying for an Academic Foundation Programme (AFP). However, it’s best to acquaint yourself with the timeline of events early on, which is found in the Foundation Programme Handbook.
overview of the key steps
Here’s a rundown of the main events happening between September and April of your final year.
We’ll go into detail for the important parts a bit later on.
The entire process takes place on the Oriel website. This is the recruitment portal for most postgraduate medical jobs, so you’ll need to become familiar with it.
Educational Performance Measure (EPM)
The EPM is a score that each candidate will be awarded out of a possible maximum of 50 points. This comprises half of your total score that will be used in your national ranking for deanery and job allocation, the remaining 50 points being accounted for by your SJT score.
The EPM comprises two elements: -
Your medical school performance is worth 43 points, and is determined by your medical school, who will ascribe you a decile score by dividing the year group into 10 equal groups based on your performance in various assessments. If you’re in the 1st decile of your year, you score the maximum 43 points. In the 2nd decile you get 42 points, and in the 10th decile, you receive 34 points etc. Your decile score will be available to view on Oriel once you register.
The remaining 7 points up for grabs are for educational achievements. This can be obtained by additional degrees (max. 5 points), and publications (max. 2 points). You provide evidence for these during the application process (see below).
For the full details on the exact requirements for each achievement, go to the UK Foundation Programme (UKFP) website, but in general, you can claim 5 points for a doctoral degree, 4 points for a first class honours degree, 3 points for a 2:1 honours degree and so on.
Again, for full details on the specifications made for publications, visit the UKFP website. The main point for this is that it must have a PubMed ID (PMID).
The Foundation Programme Application
Applications for both the Foundation Programme (FP) and Specialised Foundation Programme (SFP) (previously named the Academic Foundation Programme (AFP)) are submitted in a window of approximately 14 days in September. It’s a good idea to start thinking about what needs to be done before the beginning of September so you don’t feel rushed later. Remember there is no flexibility with these deadlines, so try to submit everything before the last day. Sometimes the website crashes in the final few hours due to the volume of activity going on, so don’t get caught out!
All applicants have to submit an FP application, and have the opportunity to submit up to two separate AFP applications as well. For the former, you have to complete the national application form, which is divided into 11 sections:
Provide your personal contact details and information about any disabilities and health issues that may require reasonable adjustments.
This section requires your current GMC registration status and information about your right to work in the UK.
Here you provide details of any unspent and spent convictions, investigations and/or warnings into fitness to practice.
You have to supply the details of an academic referee. This is someone from your medical school who holds some teaching responsibilities (e.g. a Professor or Lecturer) who has known you for at least 6 months and is able to comment on your performance. The referee will receive correspondence about completing your reference via the email address that you enter on Oriel, so make sure you enter one that they use actively. You should also check with them that they are happy to be your referee in advance to avoid any snags later on in the process as there’s a chance that they don’t feel they know you well enough to comment and may suggest choosing someone else. References aren’t sought until around March, so it’s worth reminding them around that time to look out for an email from Oriel. Don’t get too hung up on what your referee has written about you – the reference is only used as a pre-employment check and has no influence on the application process.
Here you are asked to provide details of your medical degree and medical school. Additional degrees are attended to in the ‘evidence’ section.
Foundation applicants don’t have to complete this. The page should appear blank.
This is where applicants can list and submit evidence of any extra academic achievements, namely additional degrees and publications with which you can nab those 7 juicy extra points for your EPM. Make sure you complete all the required fields and upload evidence to support your achievement. Double and triple check that any information you have uploaded meets the criteria laid out in the UKFP handbook. If the verification panel decides that your evidence doesn’t meet their requirements, you will not get the points you were expecting, and there is no opportunity to appeal this later. You don’t have to upload evidence for publications, but you must have a PubMed ID, and must complete all sections in the form correctly.
This section is for the Priority Foundation Programme (PFP) or the SFP only, and will appear blank for FP applicants.
This is where you get to rank all UK deaneries in order of preference. Drag and drop each option to create a list in the order of your choice. Pay attention whilst doing this as the system can be a bit buggy and has been known to list things in the exact opposite of the order you want. There is no submit button here. The last order that was saved when the application is submitted is the order that will be used.
When it comes to choosing your order, the first few tend to come naturally, but it can be difficult to choose between the twenty deaneries that you’d previously never considered. One tool that can be helpful when sorting through this is the Foundation Schools Chooser. This is a really useful website that has an interactive map of all of the deaneries, separate maps showing the location of every hospital in each deanery, statistics for each deanery such as competition ratios and score distribution charts from previous years, and links to each foundation school’s website. Double check information with the official website as it can sometimes be out of date.
Frustratingly, you have to submit all this before you know your full score as you’ve not yet taken the SJT, but there’s not much merit in being tactical with your preferences. For instance, if your first choice is a really competitive deanery and you’re not sure your score will be quite good enough, you’re not putting yourself at any disadvantage by placing it first anyway. If you don’t get it, you’ll get the next one on your list that your score is good enough for, just as if you had predicted your score and put the less competitive choice at the top in the first place. This way you at least gave yourself the chance to get the one you really wanted. Essentially, just submit the order you want, and don’t think about what your score might be.
This section asks you to provide your age, gender, ethnicity, religious beliefs and whether you consider yourself to have a disability.
Here there are several declarations that require you to confirm you have read and understood them, before you can submit your application.
The Situational Judgement Test (SJT)
The SJT is a test designed to assess the professional attributes expected of a Foundation Doctor, and is worth a whopping 50 out of the possible 100 points that determine your national rank. Despite this, it is worth emphasising that there is no need to (and no point in) panicking!
It’s taken on one of two dates that is usually chosen by your medical school, and comprises 70 questions to be answered in 2 hours 20 minutes (i.e 2 minutes per question). The questions take the form of a clinical scenario and ask you, as an F1, to decide which would be the most appropriate action or important consideration in each situation.
Honestly, this is a really difficult test to prepare for. There are various SJT courses available which may be very useful for some people, but they’re expensive and, in my opinion, far from essential. The best advice I can give for the SJT is to do the practice paper available on the foundation programme website. This will acquaint you with the types of questions asked, familiarise you with the answer sheet, and allow you to practice time-keeping. The people who walk out of the exam hall distraught are generally those who ran out of time – lots of points can be lost this way. There are also numerous books out there with endless practice questions. Be sure to get one that has good reviews, as some are a better representation of the real thing than others.
Another important piece of advice (and easier said than done) is not to stress too much about it. It’s daunting because it contributes the same as your entire medical school career towards your rank, but putting excessive energy and anxiety into preparing for it doesn’t seem to change outcomes all that much. Yes, it’s constructive to know what to expect, but it’s a test intended to assess your natural rapid responses to clinical scenarios that you may come across as an F1 doctor, and is not designed to be revised for.
Deanery Allocations, Programme Ranking and Job Offers
Applications are processed for all candidates who submitted an FP application and did not accept an AFP offer. After SJT sittings, each applicant will have a score out of 100 (50 from the EPM, 50 from the SJT). Applicants are then ranked in score order, and the ranks used to allocate each candidate to a foundation school. In rank order, each applicant will be allocated to their highest preference where a place is available.
Once allocated to a foundation school, applicants rank the individual two year programmes available in that school. Foundation schools should release statistics, including the score distribution of its accepted applicants. This is useful to get an idea of where you stand within your cohort, and by extension how many programmes you should rank. If your score puts you in the top decile of the group, you can be pretty confident that you don’t need to rank every job. However, if your score places you lower down, you may want to rank all of the jobs to avoid the possibility of all your selected jobs going to those who ranked more highly.
When choosing your preferences you should focus on the rotations offered and their location. As each individual places a completely different value on these factors, the job allocation process can be quite unpredictable, and people often end up with jobs that they thought were out of reach.
Be aware that this happens between March and April, which can coincide with when some final year students are scattered around the globe enjoying their electives. It’s just worth considering this when planning your elective, as you’ll need a reliable internet connection (or a long-suffering friend at the end of the phone) to complete this, and it can be quite a lengthy task.
Applicants are informed of their programme match results by email. And voilà – you’ve got yourself a job!
Candidates can link their applications to that of another applicant to ensure you’re both allocated to the same deanery.
You initiate the link by sending the second applicant an invitation via Oriel, to which they have to respond. Once accepted, Oriel should tell you that your application is now linked. Both applicants then have to rank all deaneries in exactly the same order – discrepancies can cause the link to break.
Importantly, both applicants will be allocated to a foundation school based on the lowerof the two scores, i.e. if one person scores 90 and other scores 80, they will both be placed in the first ranked deanery that accepts scores of 80.
After this point, the process differs from deanery to deanery. In some, the link is honoured and the foundation school will aim to place the two applicants near each other, whilst in others it’s random from this point.
One important consideration is that if one person accepts an AFP offer, the link is broken.
closing thoughts & additional resources
So that’s a rundown of the entire application process from start to finish – phew! Hopefully that’s ironed out some of the more baffling bits and has given you some food for thought.
A few last words of wisdom – it takes some time and effort, but the vast majority of the work has already been done to get you to where you are now. Your years as a Foundation Doctor will be some of the most exhilarating, eye-opening and enjoyable of your life, wherever you end up. So relax, savour your final year, and get ready to be a doctor! Good luck!
UKFP website: http://www.foundationprogramme.nhs.uk
SJT practice paper: http://sjt.foundationprogramme.nhs.uk/
Foundation schools chooser (now known as 'Messly'): https://www.messly.com/blog/which-are-the-most-competitive-foundation-schools OR http://w.foundationschools.info/
Page last updated: September 2021
Dr Imogen Welding is a Foundation Year 2 Doctor, currently working in Liaison Psychiatry at North Middlesex University Hospital, London. She studied Medicine at the University of Oxford for six years, during which she chose special modules in Infection and Immunity, and participated in research in the field of Neuroimmunology.
She applied to the North Central London Deanery and spent her FY1 year at University College London Hospital, working in Gastroenterology, Trauma and Orthopaedics, and Acute Medicine.
Imogen’s future plans currently include taking an ‘F3’ year out of training to spend time working in Emergency Departments and travelling. After this, she intends to start Core Medical Training, and is currently interested in pursuing careers in Rheumatology or Haematology.