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 medical, surgical and community 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.
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.
In recent years a number of variations on the standard Foundation Programme have been introduced. At the time of writing (2020), these programmes are;
Specialised Foundation Programme (SFP) previously known as the Academic Foundation Programme (AFP)
Specialised Foundation Programme doctors have dedicated time set aside for academic activities. The vast majority of academic placements (over 80%) are in research but there are also opportunities in medical education or management and leadership.
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 usually during the second year (F2). Most placements offer a four-month block (the last of the six rotations) for the specialist activity but some do offer more of a day release model over a longer period of study.
About 8% of foundation training posts each year (around 550) are specialised foundation posts.
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, a SPF will give you first-hand experience of this environment.
It is still possible to have a career in academic medicine without having completed an SFP but the early insight gained from the programme may help you decide if this is the path you wish to pursue.
What skills do SFP 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 UK Foundation Programme The UK Foundation Programme - Academic Compendium Health Careers - Academic Foundation Programme
Priority Foundation Programme
Foundation Priority Programmes (FPP) have been developed to support specific areas of the UK that have historically found it difficult to attract and retain trainees through the foundation and specialty recruitment processes. The main aim is to maximise the opportunity for applicants who wish to be located in less popular areas and therefore improve supply for specialty training and beyond.
These programmes also offer a range of incentives, which vary depending on the foundation school offering them e.g. financial support with accommodation, innovative working rotas, opportunities to gain academic experience, opportunity to undertake management and leadership training.
NHS foundation programme website - FAQs on FPP
Psychiatry Foundation Fellowships
This programme may suit you if you have an interest in a career in psychiatry as it aims to improve exposure to the speciality during foundation training. It offers doctors access to educational opportunities relevant to psychiatry, for example, funded attendance at relevant conferences, on-line learning and psychiatry journals and psychiatric supervision.
The programme intends to provide sufficient exposure to the specialty to enable participants to be in a strong position to confirm psychiatry as their career of choice and to successfully apply to specialty training in this area.
Fellows may also choose to be linked to college faculties to provide additional mentoring in a potential sub-specialty (for example, child and adolescent, perinatal etc).
For further information visit the NHS psychiatry foundation fellowship website
From time to time foundation schools offer a locally devised programme within foundation training. An example of this is the Longitudinal Integrated Foundation Training offered by Health Education England Yorkshire and Humber.
In this programme instead of trainees receiving one four-month block of general practice training they experience two sessions per week (one day) in general practice throughout their two years of foundation training. This runs alongside four days each week in the traditional four-month hospital block placements, experiencing the six other usual placements across the two-year training programme.
For further information visit the Yorkshire and Humber foundational training website
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 UK Foundation website.
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 - each year the General Medical Council survey foundation trainees and produce a report with their feedback. You can also access this information in an easy format via this tool
- 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 UK Foundation Programme 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 is computer-based and is available to sit at a variety of test centre locations on dates in December and January in the year you apply.
It is designed to assess the professional attributes expected of a foundation doctor according to the person specification for the foundation programme and presents you with a series of work related scenarios and asks you how you would respond.
The test currently consists of 75 sections of 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 roles in the NHS and other healthcare providers
If you are you interested in applying for a role with the NHS or another healthcare provider, use our online guide to:
- understand where to search for vacancies
- prepare for an effective application which includes the importance of self-reflecting, researching your employer and understanding how you can best articulate your experience and motivation
- understand the recruitment processes for different roles and employers
Go to the online guide
Applying for the Specialised Foundation Programme
Currently the application process for specialised 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 SFP application. You will have space to write a maximum of 225 words for each item.
Health Careers - Foundation Training
Scottish Medical Training
Northern Ireland Medical & Dental Training Agency