Now I know what I don't know: how to reform the foundation years to fit 21st-century medicine

Editor – Dr Watts (Clin Med April 2013 pp163–5) portrays the success of the four nations Foundation Programme Curriculum (FPC) – providing a curriculum for the first 2 years of postgraduate practice where none previously existed, thus addressing the muddle facing senior house officers (SHOs) of the ‘lost tribe’.

She illustrates graphically the problems facing young doctors resulting from the EWTD with the resultant loss of the ‘firm’ system of support from seniors that they knew and with whom they shared mutual trust. If Dr Watts is ‘expected to cope single handedly with 80-100 patients out of hours’ this is totally contrary to the principles of FPC and a matter for urgent attention by the local Education Provider/Deanery Quality Management process.

Dr Watts’ concerns echo those in the Foundation for Excellence¹ report relating to delivery and over-assessment rather than the Curriculum itself.

The 2012 Foundation Programme Curriculum² (FPC) revision has addressed some of those concerns, in particular:

1. FPC consists outcome-based, high-level descriptors that indicate the expected performance at FY1/ FY2 level. There is no need to try to acquire evidence for every competence.

2. Assessment is based largely on observations of the FY doctor's performance in the workplace.

3. Supervised learning events (SLE) have replaced workplace-based assessments.³ SLEs exist purely to deliver feedback to help the trainee develop and provide material for reflection. SLEs do not form part of the assessment process.

There has been, and always will be, some dissatisfaction with allocation of rotations, but many deaneries (including Dr Watts’ own)⁴ offer opportunities to swap. Previously, many doctors had to seek a new job every 6–12 months. The primary requirement for placements and rotations is that trainees are able to demonstrate delivery of the educational objectives set out within the FPC.

The FPC is broad and generic. Following the Foundation Programme, trainees uncertain of their career direction can choose broad-based programmes⁵ and unthemed core training programmes in medicine⁶ and surgery.⁷

• © 2013 Royal College of Physicians