Medical graduates to be allocated foundation places with computer-generated ranking

A new computer-generated ranking will be used to allocate UK medical graduates to foundation schools, as part of a move to make the process ‘fairer’.

Health Education England said that there have been ‘some concerns’ about the current process for graduates to enter foundation training, including the system being perceived as ‘unfair’ and ‘stressful’ for applicants, as well as a ‘lack of standardisation within and across schools’.

Last year, almost 800 applicants were put on the reserve list for foundation training, after not being allocated a placement for FY1 – an increase of 300 on the previous highest total.

This was the highest number of medical graduates on the reserve list in the six years they have been recording numbers, according to the UK Foundation Programme Office (UKFPO).

Currently applicants are ranked based on a combination of their Educational Performance Measure and Situational Judgement Test scores, with the highest-ranking applicants being allocated their preferred foundation school first.

The move will see the introduction of a new allocation model for medical graduates in which they will be given a ranking generated via the Oriel System, and will not need to sit the SJT.

The process will allocate as many applicants to their first preference as possible, and where there are no remaining vacancies in an applicant’s first choice foundation school, they will be allocated their next highest available preferred foundation school.

The changes have been backed by the Medical Schools Council, the BMA and all four UK governments and apply to all medical graduates as part of their allocation to a foundation school in the UK.

Plans to look at the way the foundation programme works were announced in January when a new model was proposed for allocating places.

A survey on the changes received over 14,500 responses, with most respondents (66%) favouring a move to the ‘preference informed allocation’ option, compared to 33% who wanted to continue with the current method.

Professor Liz Hughes, medical director for undergraduate education in the workforce, training and education directorate at NHS England, said: ‘This engagement process has allowed us to take on board the views of stakeholders to bring about a change in the way we allocate foundation programme places from 2024 onwards.

‘The results show that there has been a strong appetite for changing the current system and we hope that this will create a fairer and less stressful process for applicants.’

The changes will be applied across England, Scotland, Wales and Northern Ireland and will be implemented for the 2024 Foundation Programme round which opens for applications in August.

HEE said that once implemented the new system will be ‘under constant review to make sure it is working well for applicants’, and if needed changes ‘can be made’.

Dr Matt Lee, sustainability lead at the Doctors’ Association UK, told Pulse: ‘We welcome the change to the foundation programme application process as a progressive step in the right direction, however we wait to see how fairly the system will run in practice.

‘Starting work as a foundation year 1 is already a very stressful time for new doctors, particularly in the current NHS climate, and we are pleased that the preferences for geographical location will be prioritised over an exam that did not demonstrate an applicant’s ability fairly and caused significant undue stress to medical students.’

Responding to the consultation on the changes, Tom Hughes, policy and development officer at the Association for the Study of Medical Education, said: ‘We welcome the changes to reduce differential attainment and the burden of stress on medical students. However, we believe that there are several important considerations that need to be considered before adopting the proposed system.

‘There was found to be no link between the SJT and academic performance in medical school; suggesting that the highest performing students could be disadvantaged by the judgement test.

‘Given the divided evidence on the SJT and its unpopularity among the students, we can understand the decision to provide an alternative system, provided that the proposed system can resolve concerns around the geographical distribution of foundation doctors without major problems.’

HEE told Pulse that any improvements in addressing the issue of under-doctored areas ‘would be seen as a bonus’ of implementing the new process but that it was not a driving force behind the decision.

Meanwhile, GP trainees will sit the new Simulated Consultation Assessment (SCA) from November, which will replace the Recorded Consultation Assessment (RCA), introduced during the pandemic to enable trainees to complete their training programmes remotely.