The Next Step

My next major task is going to be applying to FPAS. It occurs to me that there are plenty of folk who have no idea how a person might go about applying for a first post as a junior doctor, and I’ve become aware over the last week or two that the whole system sounds faintly ludicrous when you try to explain it out loud.

The things that I am about to say are not for the final year medical students, who are intimately familiar with it all; nor are they for the younger medical students or the people who might soon be applying to medical school, as some if not all of this will become obsolete within the next twelve months. This is for the families and friends of the final year medical students. It’s only fair. After all, they are the ones who will be moaned at about white-space questions, why we even have to rank Keele, and whose stupid idea it was to hold our first final exam on the same day as job allocations are released. (The last grumble is one probably exclusive to Glasgow.)

In the current system, most of the newly graduated junior doctors enter the two year Foundation Programme. In the first year, they have only provisional registration with the GMC and are what used to be called a house officer. In the second year, they are fully registered and are what used to be called an SHO. The two years are almost always joined together and are applied for at the same time, but are not necessarily in the same hospital or even in the same Trust. In Scotland, for example, it’s quite normal to do one year in a city hospital and one year in a DGH. In the course of the two years, a variety of medical and surgical specialties are rotated through. It is to this system that I will be applying to in October.

Between October 10th and October 21st, everyone who is going through this system fills in an application form that will eventually be scored out of 100 points. The first forty points are based on performance at medical school, or, in our case, performance in the first three years of medical school — yes, this is a sore point. The next ten are based on additional academic achievements, which includes having a second degree or having national publications or presentations or prizes. The additional academic achievements are subject to all kinds of stipulations, including that any publication must be in a PubMed indexed journal, which means that anyone who has any in the Student BMJ can’t list them, and that presentations must not have been at a medical student conference, which means that my epic journey to Bournemouth in the spring doesn’t count. The final fifty points are based on answers to white space questions, when five questions are asked and you have 200 words to answer each of them in such a way as to demonstrate how you meet the person specification. 10% of applicants will be chosen at random and asked to verify their answers, and we do not know yet how exactly we are supposed to do that.

For example, the 2010 applicants were asked:

Describe a clinical case you have observed where there has been a multi-disciplinary approach to discharge planning. Describe how the interactions between the multi-disciplinary team impacted on the quality of the patient’s care. What have you learned from this experience about effective multi-disciplinary team working and how will you put this into practice as a foundation doctor?

The set-up for job allocations is such that everyone starts out by applying for everything, but not really. First, the UK is split into twenty-one geographical areas that form Foundation Schools. You can tell that this system was dreamed up by someone in southern England by the way England divides into eighteen and Scotland doesn’t divide at all. In the initial application, every medical student ranks every foundation school from first choice to twenty-sixth choice. At this point, we know what we would have needed to score to get into each foundation school last year and we know what the competition ratios were like across the country but we will not have been told what our own score is, and so it involves a certain amount of guesswork and random chance. In early December, we learn the outcome of that first part of our application, including the score from our application form, and the next step, if successfully allocated to a foundation school, is to apply for the jobs within it. This part varies wildly within different parts of the country. In Scotland, applicants are asked to rank jobs from first choice to tenth choice — and can later be asked to rank all the others, but only if they aren’t allocated to their tenth choice. South Thames, on the other hand, have a sadistic streak and ask their applicants to rank about 350 jobs. Eventually, we are told where we will actually be working. And then there seems to be a third step and it seems to be this point at which applicants apply for their specific rotations, but this all happens at Trust level and so nobody ever tells you anything about it and it all remains a bit of a mystery until, presumably, some time next year.

So, taking into account all the variables and all the points where something could go massively wrong, I have ended up with a wishlist that looks a bit like this:

  1. I want to work in Scotland.
  2. I want to work within commuting distance of Glasgow.
  3. I do not want to be on any of the islands.
  4. I have a list of foundation schools that I am avoiding, based on geographical areas that I don’t like much and don’t want to live in.
  5. I have a list of hospitals that I liked in fourth year and would happily work in as an F1.
  6. I would prefer to do F1 in a DGH.
  7. I’d rather have more medical rotations and less surgical rotations than vice versa.
  8. I want my F2 job to have the opportunity for a haematology/oncology rotation.
  9. I’d like my F2 job to have the opportunity for an A&E rotation.

It doesn’t take into account all the variables, of course, nothing ever does, and being based almost entirely on Scotland and my experiences within Scotland, will need a considerable rethink if I end up being allocated to a foundation school other than Scotland. My second choice is Wessex. I don’t know anything about Wessex, really.

Besides, none of it is set in stone. I could change my mind. Indeed, this becomes more and more likely as the time approaches for me to actually make some decisions rather than to just talk about making them. I spent the better part of six months last year thinking that I wanted to do F1 in the Borders before realising that, however much I had liked the hospital, I’d probably not cope very well with being so far from a city for a whole year. I sat in the pub on Easter Sunday and revised my ideas with a speed that almost gave my parents whiplash. It could happen again.

But at least now you know. If I bemoan white space questions or why we even have to rank Keele or whose stupid idea it was to hold our first final exam on the same day as job allocations are released. Or when Christmas comes and goes and I’m still unable to properly answer the question of where I’ll be working in August. You will be able to nod intelligently and make sympathetic noises.

I did tell you that it all sounded faintly ludicrous when I said it out loud.


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