Last week, applicants to the UK Foundation Programme who have been allocated to Scotland found out which geographical area they will spend the first two years of their training as doctors. This has been a stressful process for final-year medical students studying in the UK and for other applicants, even more so this year because for the first time, medical students and other candidates are being allocated their first post as a doctor through a Preference-informed allocation (PIA) process based on a randomly generated personal rank for each applicant. This blog outlines the BMA Scottish Medical Students Committee (SMSC) position on some of the issues that students have faced with further allocation stages in the Scottish Foundation School. Today, I have also written to NES on a similar basis to emphasise the concerns we have.
After allocation to Scotland, candidates go through a two-stage process of first ranking (preferencing) groups of programmes and later individual programmes – this involves making decisions about over 800 possible job placements across the whole of Scotland. During the week-long first stage of preferencing, we heard from many medical students who were confused by multiple instances of conflicting or missing information in the guidance published on the UK Foundation Programme Office (UKFPO) and Scottish Medical Training (ScotMT) websites. Specifically, this included several groups listed within the interface on Oriel (the web service that applicants use to apply for the UK Foundation Programme) that were non-existent on the ScotMT website, which otherwise lists details for all groups and programmes available to applicants in Scotland. These groups were specified to have zero places available, without any explanation for what these groups are or why they are listed as options at all. Furthermore, the list of groups available for ranking included a general “placeholder” group as well, which was listed with a number of places available – however, similarly the purpose of this group was not clear.
It was positive to see that the Scottish Foundation School team did respond to candidates via email in a timely manner. However, most of the information clarifying the issues described above was not released until day 5 of the week-long window, leaving little time for applicants to consider it when making their choices and potentially leaving many applicants without being informed about these issues, particularly because the release of these updates was to the best of our knowledge not shared with applicants directly. And even though the updated information clarified the nature of these “placeholder” groups, the new guidance to leave the groups without any places available (groups with zero places) differed from the advice in the initial email which warned applicants that leaving any groups unranked could lead to them being allocated to one of the unranked groups.
In addition to a lack of details about the groups themselves, there was also some confusion about the process that would be used to run the allocation after applicants expressed their preferences. The clarifying information about this was only published by the UKFPO after the first preferencing round had already closed. Prior to that, the ScotMT website Foundation Programme FAQs simply directed applicants to the arguably less than clear generic guidance about PIA.
Altogether, these issues contributed to the widespread uncertainty and feelings of confusion among those who are going through the process of getting allocated to a foundation post. We heard from foundation applicants allocated to Scotland who felt strongly they were left to figure out how to manage their way through an unfamiliar procedure on their own, with the guidance available often not helpful to aid their understanding. This unnecessary added stress had a significant impact on students’ well-being and made this difficult and volatile time that much harder to deal with.
Considering the tight timeline for preferencing, we feel strongly that medical students and all other candidates applying to pursue foundation training in Scotland deserve to have full clear information available to aid their decision-making about preferences for groups and programmes before the start of the preferencing window. Especially in the absence of medical students being able to rely on information from their predecessors, due to the introduction of significant changes to the allocation process, full comprehensive guidance for applicants to the Scottish Foundation School should have been readily available without contradicting information and without late additional updates unless absolutely necessary. Moreover, where any omissions are identified or further updates posted, these should have been directly notified to all candidates via email in the same manner as their initial email informing them of their allocation to Scotland.
Medical students have been dealing with frequent changes to the way their post-graduate training works, which has been causing a great deal of stress and uncertainty. SMSC has been voicing the feeling among many students that we are not appropriately consulted on changes that in many cases drastically change the way that we get allocated our first jobs or the way we enter into a further training programme, from the change of the Foundation Programme to PIA to the most recent change of moving the application process for Specialised Foundation Programmes into the general PIA process, rather than having a separate process that selects applicants on their merit. It is our firm belief that such significant changes should not happen without allowing all medical students to have their say and should not be introduced at speed without appropriate testing and establishing a robust process for raising issues and concerns so that when things go wrong, this can be promptly identified and addressed.
The issues described illustrate the current landscape where medical students are often left without enough support and guidance to help them navigate the ever-changing nature of the practice of medicine after graduating from medical school. In writing to NES and publishing this blog, we hope to highlight some of the pressing issues with the allocation process to foundation posts in Scotland, and we affirm that SMSC stands ready to work with NHS Education for Scotland and other relevant stakeholders to improve the whole process of entering medical practice as a foundation doctor in NHS Scotland.
UPDATE (10/4/2024) – we have received the following constructive response from NES on this issue:
Vash Loffelmann, chair of the BMA’s Scottish Medical Students Committee.
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