FPAS: The Postmortem

The first stage of the application system finally closed yesterday and between the ticking clock on the website, the incessant reminder emails from both the medical school and the UKFPO, and the horror stories floating around about the one applicant who submitted last year at 12:03pm and subsequently scored zero, everyone hopefully got their forms in on time.

I said that once my ethical sensibilities had been satisfied that I wasn’t risking wrongdoing by doing so, I’d put the questions up for the interested and the bemused.

Mostly, I wanted you all to see why the two hundred word word limit was such a big deal.

  • Two essential attributes of a foundation doctor are to deal effectively with challenge and to demonstrate initiative. Describe a clinical case in which you have been involved and use this example to demonstrate how you possess both of these qualities. How will you apply what you have learned from this experience to your work as a foundation doctor?
  • Foundation doctors need to have an appreciation of the patient’s perspective in planning their care. You are a foundation year one doctor. An eighteen year old patient has been admitted as an emergency with diabetic ketoacidosis (DKA). On taking his history at admission you discovered that he had not used his insulin at a music festival, as he wa embarrassed to do so in front of his friends. You have established that his diabetes is generally poorly controlled because he is concealing it from his peers, as he does not wish to be different. He is now stable and ready to go home. Since you have established a rapport, your consultant asks you to see the patient in order to explore his concerns. You go to see him on the busy ward. What would you do? What would be your prioroties when undertaking this task? What additional learning needs does this scenario highlight for you and how would you share your learning with colleagues?
  • Teaching and learning in medicine takes place in a variety of settings which present different opportunities and challenges. Describe how you maximised your learning about the same topic in both a classroom setting and a clinical setting. What were the key challenges to learning in the clinical setting? Describe the strategies you will use as a foundation doctor to gain the most from workplace-based learning opportunities in the course of your clinical practice.
  • An understanding of appropriate professional behaviour is an essential requirement for a foundation doctor. You are a foundation doctor based on a busy medical ward. You are reviewing a patient for discharge when your bleep goes off. You excuse yourself to answer your bleep and return to find the patient reading your list of tasks that you have left on the bed. This includes patient names and diagnoses. What would your initial response be? What factors contribute to the pressure of the situation and how would you prioritise further actions? How may this scenario inform your professional behaviour as a foundation doctor?
  • Effective care, whether in the community or hospital environment, often requires the involvement of a multidisciplinary team. Using two cases that you have observed, describe how the MDT contributed to the care given to patients with similar clinical conditions, one within the hospital environment and one in the community environment. What were the challenges to effective team working in the community environment? How could you, as a hospital based foundation doctor, contribute positively to the management of patients being discharged to the care of a community team?

There are a few noteworthy points from this year. I think we all saw that the questions are starting to lean more in the direction of the hypothetical scenarios, presumably preparing for next year when these sorts of questions will be removed from the application and replaced with the Situational Judgement Test which my cohort is piloting between now and January. The questions have in the past varied between including opportunities for students to talk about their lives outside of medicine and not, and this was one of the years in which we weren’t given that opportunity — mine would admittedly have been based on writing about some of the more logistically impossible seeming things I’ve been involved in doing in the name of the Scottish Episcopal Church, and I was prepared to spin those things to fit all sorts of questions, but you can see how none of it would have been relevant to anything that we were asked. And, yes, in Question 2, the question was 161 words, don’t think I didn’t notice that.

So, that’s that.

I may share some of what I did write once I have a score, but, for now, it’s done and dusted and I shall shut up about the whole business until December 8th, when I learn roughly whereabouts in the country I can expect to be spending the next two years and the next stage of applications begins.



  1. I’d have been able to spin all kinds of stories from St Mary’s into answers relating to time management and teamwork and the ability to think on one’s feet, and could probably have talked more about being challenged and taking initiative in the context of the SEC than I did in the actual question.

    In reality, I’d most likely have written about +Gregor’s consecration.

  2. Well, i am sure I could never have answered any of them in 200 words – but of course I could never have answered any of them anyhow – but I do now ask much longer questions in essays than I used to. I used to say things like ‘Reformed or Counter-Reformed: discuss’ If I wanted to ask the same question now I would ask: ‘Either discuss why is is appropriate both to describe the Catholic Reformation as just that, and to call it the Counter Reformation. OR discuss if you would rather have experienced the Reformation in Knox’s Scotland, or the Counter-Reformation in Inquisitorial Spain.’ Which is the self-same question unpicked. I have learned unpicking is not, generally a skill students have. So I guess the over-long questions were to guide you as to points which, if missed, would lose marks. My heartiest sympathies. My already deep respect for your chosen profession grows apace.

  3. I take it you cannot answer the notes-on-the-bed one by saying ‘It would be simplest to euthanase the patient’ ?

  4. Pingback: Advice for the FPASing | The Road Less Travelled

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