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

David Kessel and Ed Neville
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DOI: https://doi.org/10.7861/clinmedicine.13-4-416a
Clin Med August 2013
David Kessel
1Academy of Medical Royal Colleges
2Leeds University Medical School, Leeds, UK
Roles: Foundation Programme Committee, honorary clinical associate professor
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Ed Neville
1Academy of Medical Royal Colleges
Roles: Foundation assessment lead
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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

Footnotes

  • Please submit letters for the editor's consideration within three weeks of receipt of Clinical Medicine. Letters should ideally be limited to 350 words, and sent by email to: clinicalmedicine{at}rcplondon.ac.uk

  • © 2013 Royal College of Physicians

References

  1. ↵
    1. Collins J.
    Foundation for Excellence : An Evaluation of the Foundation Programme. London: Medical Education England, 2010. www.mee.nhs.uk/pdf/401339_MEE_FoundationExcellence_acc.pdf [Accessed 7 June 2013].
  2. ↵
    1. The UK Foundation Programme Curriculum
    , 2012. www.foundationprogramme.nhs.uk/download.asp?file=FP_Curriculum_2012_WEB_FINAL.PDF [Accessed 7 June 2013].
  3. ↵
    1. Kessel D,
    2. Jenkins J,
    3. Neville E
    . Workplace based assessments are no more. BMJ Careers, 26 September 2012. careers.bmj.com/careers/advice/view-article.html?id=20009002 [Accessed 7 June 2013].
  4. ↵
    1. Oxford Foundation Policy for swapping foundation year 2 rotations
    , 2012. www.oxforddeanery.nhs.uk/pdf/OFS%20SWAPS%20POLICY%20v2%203.pdf [Accessed 7 June 2013].
  5. ↵
    1. Academy of Medical Royal Colleges
    . Core Programmes, 2012. www.aomrc.org.uk/education-a-training/curriculum-and-framework/core-programmes.html [Accessed 7 June 2013].
  6. ↵
    1. Royal College of Physicians CT1 Recruitment
    . About CMT, 2013. www.ct1recruitment.org.uk/about-ct1/about-cmt.html [Accessed 7 June 2013].
  7. ↵
    1. Glancz L
    . Core surgical training: what's the difference between programmes? BMJ Careers, 23 Jan 2013. careers.bmj.com/careers/advice/view-article.html?id=20010562 [Accessed 7 June 2013].
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Now I know what I don't know: how to reform the foundation years to fit 21st-century medicine
David Kessel, Ed Neville
Clinical Medicine Aug 2013, 13 (4) 416-417; DOI: 10.7861/clinmedicine.13-4-416a

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Now I know what I don't know: how to reform the foundation years to fit 21st-century medicine
David Kessel, Ed Neville
Clinical Medicine Aug 2013, 13 (4) 416-417; DOI: 10.7861/clinmedicine.13-4-416a
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