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'The Next Stage Review: A High Quality Workforce' stated that 'new work needs to be undertaken to develop more reliable and valid selection tools for recruitment' to Foundation Programme Training. This was based, to some extent, on shared concerns about the current system which ranks applicants using a combined score derived from answers to a set of white space questions and an academic quartile ranking provided by the applicant's medical school. The concerns relate to reliability, validity, comparability, NHS consultation time required, possible plagiarism and longevity.

The following key issues with the current process were identified:

• Candidates answer white space questions in their own time, which makes it harder to ensure that the work is their own
• Marking the white space questions is labour intensive
• The academic quartile scores are not sufficiently standardised
• There is little evidence to provide the validity of white space questions as a selection technique

Some of these weaknesses would become critical if there were more applicants than posts, leaving the selection process open to legal challenge.

Option Appraisal

In response to this, the Medical Schools Council was commissioned by the Department of Health to lead a Steering Group to carry out an option appraisal for the best approach for selection of applicants into the UK Foundation Programme and allocation to Foundation Schools. As part of the nine month Option Appraisal the Steering Group commissioned three academic literature reviews, which were reviewed by an International Panel of Experts. There was extensive consultation with key stakeholders and an online survey. Academic evidence, expert advice and stakeholder feedback informed an independent Cost Benefit Analysis.

Recommendations

After considering all the evidence the Steering Group made the following recommendations:

• Evolution not revolution
• Pilot two new selection methods
  • Educational Performance Measure (EPM) - replace quartiles with a standardised scheme for medical schools to grade clinical knowledge and skills based on a student's performance to date
  • Situational Judgement Test (SJT) - replace white space questions with an invigilated machine-markable test of professional attributes, similar to selection methods used for GP specialty training

Proposed Selection Process

Applicants will continue to complete the online form specifying Foundation School preferences, but will take an invigilated SJT which will be added to the online system along with their EMP scores. The highest scoring applicants will continue to be selected and allocated to Foundation Schools using a national algorithm and then Foundation Schools will continue to allocate posts to applicants.

Pilots

The results of pilots will determine whether it will be possible to go live in 2012/2013. It is important to highlight that no component will be implemented into the live recruitment round in 2013/2013 without an in-depth analysis of the results and agreement from the Steering Group that this is the most efficient and effective way of recruiting medical students to the Foundation Programme.

Please note: The 2010/2011 and 2011/2012 recruitment rounds will run as normal using the current system of white space questions and academic quartiles.

SJT items will be written at workshops from Spring/Summer 2010 onwards. These will be written by staff members from the UK's 31 undergraduate medical schools, foundation schools and Deaneries.

More information on the project from the recommended options and timelines to a sample SJT question can be found in our briefing document and powerpoint presentation below:

Briefing document for ISFP 22.2.10.pdf
Briefing document on ISFP 22.2.10.doc
Briefing slides for ISFP 22.2.10.pdf

Members of the steering group

Paul O’Neill (Chair) - Medical Schools Council
Tim Crocker-Buque - Medical Students Committee
Ian Curran - Educational Supervisor
Sir Neil Douglas - Academy of Medical Royal Colleges
Ashley Fraser - NHS Employers
Derek Gallen - UKFPO and COPMeD
Martin Hart - General Medical Council
Matthew Langdon - Department of Health
Stuart Macpherson - Scottish Foundation Board
Jim McKillop - Scottish Board for Academic Medicine
Terry McMurray - NIMDTA
Katie Petty-Saphon - Medical Schools Council
Lindsey Proctor - Department of Health 
Kim Walker - Foundation School Directors
Professor Tony Weetman - Medical Schools Council

2010 meeting dates

3 February
26 March
23 April
25 June
15 July