Examples of challenges of previous pre-registration house officer and senior house officer grades with relevant changes included in the Foundation Programme to address these.
| Challenges of the PRHO/SHO system | Change built into Foundation Programme |
|---|---|
| Short, stand-alone SHO placements with no overall co-ordination of training | Coordinated set of three to six placements designed to provide a balanced learning experience |
| No common competencies across placements | Nationally agreed curriculum with minimum common competencies |
| Lack of standardised end-of-placement assessment | Standardised end-of-placement reviews conducted through e-portfolio |
| Local, varying and often duplicated application process; requirement to apply for each SHO job every 4–6 months | Single centralised, national, standardised application process allocating 2 years of placements; occasional deaneries require selection of F2 placements based on F1 portfolio score |
| Service delivery and training imbalance with little accountability of training quality | Aim to readjust this through mandatory, weekly teaching requirement with specific national feedback surveys on training quality |
| Numbers of jobs based on local junior doctor need rather than workforce demands | Numbers nationally agreed, based on predicted workforce requirements |
| Placements not allowing for specialty-specific competencies | Focus in Foundation Programme on broad-based, generalisable skills as per General Medical Council's duties of a doctor 5 |
| Lack of formal career advice | Requirement for formal careers advice and access to services |
| Disparity between PRHO year reviewed by medical schools but trusts acting as PRHO employer | F1 sign off by postgraduate dean, assessment based by Foundation Programme director in trust. |
| Limited placements variety with excessive focus on secondary care | Broader range of available placements with recent commitment to ensure more foundation doctors undertake a community placement |
| Variable and often lacking supervision | Requirement to have allocated clinical and educational supervisor; national surveys assess level of day-to-day supervision |
F1 = foundation year 1; F2 = foundation year 2; PRHO = pre-registration house officer; SHO = senior house officer