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Janso Padickakudi1, Matthew Walters2, Alice McGarvey3

Author affiliations
1Royal College of Surgeons in Ireland; Academic Foundation Doctor 2010-2012, NHS Scotland, University of Glasgow
2Reader in Medicine and Honorary Consultant Physician, Division of Cardiovascular and Medical Sciences; Academic Foundation Programme Director, University of Glasgow
3Senior Lecturer in Anatomy; Vice Dean for Student Affairs, Royal College of Surgeons in Ireland

Royal College of Surgeons in Ireland Student Medical Journal 2010; 3: 17-19.


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The Royal College of Surgeons in Ireland (RCSI) Medical School has a significant international student population; therefore, it is natural for RCSI’s graduates to consider global career paths and opportunities. The United States and Canada are well-advertised options, with most students familiar with the difficulties of writing the United States Medical Licensing Examination (USMLE) and the Medical Council of Canada Evaluating Examination (MCCEE). But have you ever considered a career with the National Health Service (NHS) of the United Kingdom (UK)?

This article aims to inform students of the internship opportunities that are available in the UK. In particular, this article aims to point out the exceptional opportunities offered by the Academic Foundation Programmes (AFPs). It will be of particular interest to European Union/European Economic Area/Swiss students for whom the transition is quite simple. The EEA is comprised of the 27 EU Member States, Iceland, Lichteinstein and Norway. For simplicity, the term ‘EU’ in this article is used to represent the EU, the EEA and the Swiss. It can be noted here that in order to apply for AFPs, international medical graduates (IMGs) need to write the Professional and Linguistic Assessments Board (PLAB) examination and obtain a right to work. However, once the candidate is deemed eligible to apply, applications are considered regardless of nationality and PLAB score.

Background
In 2006, the Irish Department of Health endorsed the ‘Fottrell Report’ (‘Medical Education in Ireland: A new direction’) and its recommendation to decrease non-EU graduates at Irish medical schools from 60% of the student population (2003/2004 intake) to 25%. To achieve this, they proposed a variety of complex models that range from increasing EU student numbers to reducing non-EU spaces.
The eventual target was to produce 700-740 EU graduates per year (up from 305 EU graduates), who will hopefully stay in Ireland. In contrast, non-EU students “generally return to their country of origin upon graduation”.1 In this context, the UK may become an increasingly interesting option for RCSI graduates.

National Health Service
The NHS is the public healthcare service of the UK. It was established after World War II on the premise that good healthcare should be universally accessible. The NHS is government funded and the vast majority of services (from GP consultations to open heart surgery) are free to all residents of the UK at the point of service delivery.2

Foundation Programme
Upon graduation from medical school in the UK, doctors embark on a two-year internship entitled the ‘Foundation Programme’. The first year of the Programme aims to be a “bridge between medical school and speciality training”,3 and includes compulsory rotations in both medicine and surgery. At the end of this year, trainees are registered with the General Medical Council (GMC). The second year aims to introduce the doctor to disease management.
The Foundation Programme’s focus on outcomes is unique. A defined Foundation Programme curriculum outlines competencies that should be attained by trainees at the end of their training. The equivalent of such an extensive compendium for interns in Ireland does not yet exist.

Application process
Entry into the Foundation Programme is co-ordinated by the United Kingdom Foundation Programme Office (UKFPO) via a centralised process called the Medical Training Application Service (MTAS).
For EU students, the application is simple. The main process takes place between July and October in the year before the student intends to start their Foundation Programme (for example a student would apply in 2010 for a programme that starts in 2011). Each application on MTAS is scored out of 100 points, with 40 points allocated to academic ranking and 60 to answers to standardised questions.4
The UK is divided into 27 regions, each having its own ‘foundation school’, which administers all of the Foundation Year jobs in its area. All applicants rank the foundation schools in order of preference. In turn, the applicants are ranked based on their application scores. An electronic algorithm then matches students to foundation schools.

Eligibility
EU students are eligible to apply through the UKFPO subject to confirmation of their eligibility status. This is a simple application form that is completed by the Medical School Dean or Vice Dean, in combination with a photocopy of the student’s passport.
Non-EU students are required to sit Step 1 and Step 2 of the Professional and Linguistic Assessments Board (PLAB) examination. Step 1 is a three-hour 200-EMQ/MCQ examination set at a level commensurate with Foundation Year 1. Step 2 is an objective structured clinical examination (OSCE). Passing the PLAB does not guarantee employment. In addition, a number of eligibility criteria need to be met before an application is considered. For 2010 programmes, applicants had to be an EU passport holder, a student of a UK medical school in their final year of study, or have the right to work as a doctor in training in the UK. Applicants who are unable to submit a valid right to work are only considered if there are insufficient eligible applicants who have the right to work in the UK.

Foundation Programme 2010 match
The UKFPO match for 2009/2010 graduates was completed in December 2009. The results of the match were that over 90% of EU applicants were allocated to their first choice of foundation school. In a second round of matching, all candidates who were eligible apart from the right to work (i.e., all international graduates who had completed their PLABs and had applied in time) were allocated to programmes that still had vacancies. The proportion of international applicants who obtained a job in the second round of matching has not been disclosed.

Academic Foundation Programmes
The AFP is a ‘Foundation Programme Plus’ and offers exceptional opportunities to successful candidates. It provides the regular foundation training, with additional structured opportunities for candidates to get involved with research, medical education or leadership/management. These programmes are becoming more competitive as awareness about them increases among UK medical students. Only 5% of UK graduates obtain an AFP.
In contrast to the centralised applications for the mainstream foundation programme, AFPs are recruited by each foundation school individually. In addition to the application process outlined above, supplementary questionnaires and interviews form the admissions process.
There is a wide variety of academic programmes on offer. For example, the Hull/York programme has a dedicated four-month block of clinical or laboratory research, including an exciting programme in HIV and genito-urinary medicine (HIV/GUM). By contrast, most Scottish and Welsh programmes offer academic training as a longitudinal theme throughout the two years, with didactic teaching in year one and research assignments and teaching responsibilities in year two. Leicester offers the largest cohort of academic foundation posts and stands out with an exceptional emergency medicine/clinical educator programme. If research, teaching or leadership/management are of interest, then the AFP is an opportunity to develop skills and competencies early in one’s career.
Applications for AFPs need to be submitted early (some as early as May 2010 for August 2011 entry), and students who pursue this route must commit to attending interviews from June to August 2010. Phone interviews are available at most schools for students on electives. The benefit of the AFP, apart from the opportunities it presents, is that the student can then start final med with job security.

Conclusion
The UK offers an interesting career option for graduates from the RCSI, particularly EU students. It offers a simple transition from medical school in Ireland to the highly structured, goal-oriented Foundation Programme in the UK. For non-EU students, it is of interest if they commit to the process of obtaining eligibility.
It is often difficult for students to navigate the plethora of opportunities available in the global medical community. The UK Foundation Programme is one route.

Bibliography

  1. Working Group on Undergraduate Medical Education and Training. Medical Education in Ireland: A new direction (the ‘Fottrell Report’). Cited 2006. Available from: http://www.dohc.ie /publications/ fottrell.html?lang=en.
  2. National Health Service. About the National Health Services. Cited 2009. Available from: http://www. nhs.uk/NHSEngland /aboutnhs/Pages/About.aspx.
  3. Moore C (ed.). The UK Foundation Programme Office. Rough Guide to the Foundation Programme. Cited 2007. Available from: http://www.foundationprogramme.nhs.uk.
  4. The UK Foundation Programme Office. Foundation Applicant’s Handbook 2010. Cited September 2009. Available from: http://www.foundation programme.nhs.uk.

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