What is Foundation Training?
The Foundation Programme is a structured, supervised workplace-based training programme typically made up of six four-month placements in a range of specialties and settings over two years.
It aims to give doctors in training competence in basic clinical skills and management of acutely ill patients as well as developing skills such as teamworking and communication. This is in effect your first paid job as a doctor and enables you to put into practice what you’ve learned at medical school while gaining additional skills, knowledge and experience.
The training comprises Foundation Year 1 (F1) and Foundation Year 2 (F2) and it usually involves six different rotations in medical or surgical specialties and general practice.
In order to practise unsupervised as a doctor in the UK, you will need to complete one year of Foundation Training. Upon successful completion of Foundation Year 1 doctors can apply to fully register with the General Medical Council. Completion of the full two-year programme is required to progress to Specialty training in the NHS.
Academic Foundation Programme (AFP)
Foundation doctors following an AFP have dedicated time set aside for academic activities, the nature of which will depend on the AFP itself.
The programme follows the same curriculum and outcomes as the standard foundation programme. However, it also includes a period (equivalent to one of the six rotations) of academic research during the second year (F2).
The vast majority of academic placements (over 80%) are in research but there are also opportunities in medical education or management and leadership. Placements are often for a four-month block, which may be good for laboratory-based research, but can also be day release over a longer period of time.
About 7% of foundation training posts each year (around 450) are academic foundation posts and competition for places is intense. In 2018 1,802 medical students applied for 557 places - a ratio of 3.2:1 applicants.
So, if you are considering a career in research, fancy developing innovative cures for diseases, or want to share your knowledge with future trainees as an educator, an Academic Foundation Programme will give you first-hand experience of this environment.
It is still possible to have a career in academic medicine without having completed an AFP but the early insight gained from the programme may help you decide if this is the path you wish to pursue.
What skills do AFP trainees need?
You’ll need excellent clinical skills, a strong record of academic achievement and ideally some published research or teaching experience.
If you’ve been awarded any prizes or other awards at medical school, this will also improve your chances.
It is not essential to have completed an intercalated degree during your medical training but students who have completed the Bachelor in Medical Science at the University have the opportunity to demonstrate some experience and understanding of, and passion for, research.
However, it is possible to demonstrate your ability and enthusiasm in other ways. For example, if you have experience in a research environment either through a prior degree or work experience, or by undertaking a summer research project or voluntary clinical audit.
Clinically you will need to achieve all the Foundation Programme outcomes in reduced time (as effectively 1/6th of your placements will be on your academic programme) so you need to be confident you have a strong clinical base and be committed to actively managing your learning from day one.
Benefits of clinical audit Rough Guide to the Academic Foundation Programme The UK Foundation Programme - Academic Compendium Health Careers - Academic Foundation Programme
Applying for the Foundation Programme
If you wish to apply for the Foundation Programme (or Academic Foundation Programme) you will usually do this in the October of your final year at medical school. If your application is successful you will start the programme the following August. For full details of the annual application process check, out the Applicants' Handbook.
Choosing your Foundation School
For the standard foundation programme you must rank all schools (or Units of Application* as they are known) in order of preference. In recent years almost 95% of all applicants were allocated to one of their top five preferences and almost 80% to their first choice.
Some of the factors you may take into account when comparing schools are:
- the programmes available at each school. For example, if you definitely want to do a rotation in paediatric surgery you will need to search for all programmes containing these rotations
- familiarity with the local area
- proximity to friends and family and your support network
- reputation of the training, hospitals and GP practices in the area
- whether the school allocates all F1 and F2 rotations at the start of the programme (50% of schools do this)
If you need to be in a geographical area for specific caring or health reasons, you can apply to the medical school to be considered for pre-allocation to a specific foundation school on the grounds of special circumstances.
*A Unit of Application comprises of one or more foundation schools that are grouped together for the purposes of processing applications.
The application process
Once you have completed the application form and ranked each location your application score is ranked amongst all other applicants nationally.
The score is based on two elements:
- Situational Judgement Test (SJT) result - worth up to 50 points
- Educational Performance Measure (EPM) - worth up to 50 points.
1. Situational Judgement Test (SJT)
You will be required to sit the SJT as part of your application. The test takes place on two dates each year - December and January - and your medical school determines the date for your university. Nottingham students usually sit the test in early December.
The SJT is an invigilated test in exam conditions which is designed to assess the professional attributes expected of a foundation doctor according to the person specification for the Foundation Programme.
The test consists of 70 multiple choice questions to be answered within two hours and 20 minutes.
The attributes being assessed are:
- commitment to professionalism
- coping with pressure
- effective communication
- learning and professional development
- organisation and planning
- patient focus
- problem-solving and decision-making
- self-awareness and insight
- working effectively as part of a team
How can I prepare?
The SJT is not something for which you can revise. The attributes listed should have been developed during your time at medical school. However, it is wise to familiarise yourself with the style of questions before you sit the test.
There is an interactive practice paper available on the Foundation Programme website which is designed to help applicants prepare for the test by familiarising themselves with the test format and answering questions within the time limit.
Since the introduction of the SJT in 2013, the marketplace has been flooded with resources claiming to help students do well. Carefully consider the reputation and cost of such resources when deciding if appropriate.
Neither we or the UK Foundation Programme Office, has any connection with, nor endorse or recommend, any of the preparatory materials provided by any individual or organisation, whether provided commercially or free of charge.
In the Student BMJ September 2015 a group of foundation doctors reviewed the pros and cons of some of the most popular revision aids.
Find out more about SJT
2. What is the Educational Performance Measure (EPM)?
An EPM decile score (up to 43 points) is calculated for each student and is based on your academic performance during medical school.
For example, when ranked amongst your fellow students if your academic record places you in the first decile (i.e. you are in the top 10% of your cohort) you will receive the maximum 43 points. If you are in the tenth decile (i.e. you are in the bottom 10% of your cohort) you will receive 34 points.
You will be able to see your EPM decile score once you have registered on the online application process.
In addition to this score you can gain seven points for educational achievements in the form of additional degrees or publications.
Applying for the Academic Foundation Programme
Currently the application process for academic training is run independently by each Foundation School. You will complete an extra section on your online foundation application and shortlisted candidates are invited to interview. Applicants can apply to up to two Units of Application.
Each Foundation School will use slightly different interview processes and scoring systems but all will be looking for candidates to demonstrate a strong academic ability, an understanding of, and passion for the programme and the potential to develop the competencies outlined in the Academic Compendium.
You will be required to answer up to six additional questions to support your AFP application. You will have space to write a maximum of 225 words for each item. Some Units of Application don't ask any questions, some ask two or three questions and others ask the maximum six questions.
The Academic Foundation Rough Guide (March 2013) says:
It is vital that you can demonstrate your interest and passion in the area that the programme offers... and demonstrating academic excellence provides a distinct advantage.
Health Careers - Foundation Training
Scottish Medical Training
Northern Ireland Medical & Dental Training Agency