Author: Altay Shaw
Artist: Atufa Shabnum
Editor: Amber Stratton
In February of this year, NHS England announced that the Specialised Foundation Programme (SFP) would be changing from a portfolio and academic focused application process to a Preference Information Allocation (PIA) system. This programme was originally designed as a route for newly qualified doctors to have a focus on academia, paving the way for the next generation of researchers and professors.
The UK Foundation Programme (UKFPO) have stated that their changes allow for more opportunities and provide a fairer approach to recruitment. In their official statements, the UKFPO argue that implementing these changes will allow for “better consistency” where there had not been as much support at the local level for applicants at some universities. However, an argument of providing greater access means nothing when only 5% of all foundation place programmes are research opportunities, even then for a period of only 4-6 months depending on rotations. Additionally, the UKFPO made no announcements of providing more bursaries for those who would require them, reducing the financial barrier for applicants when they already have over £40,000 worth of debt before accounting for living costs or inflation rises on their loan repayments.
Out of these changes, we will begin to see effects reaching far and wide across the profession. As the system now favours a random allocation process, we will have generations of doctors who were neither wanting or suited to academia, being forced into placements which do not benefit their future careers. I should note that I am not in favour of the return of the original scoring system which breeds damaging levels of competitiveness to medical students across the country. Such levels of stress and burnout, met with varying levels of support from medical schools, is unsustainable. However, without appropriate incentives for those who are more academically inclined, we stand to lose amazing researchers, even those who have gone to the extent of completing a PhD as part of their medical programme. Why should their additional 4 years of studying go to waste if they are placed in a programme where their PhD is with about as much dignity as a roll of toilet paper?
The changes will not solely affect those who are going to be doctors within the coming months. Rather, it will affect everyone who is yet to apply to medicine. One of the biggest factors in my decision to join University College London over King’s College was the fact that the former offered a chance for intercalation. These degrees allow for medical students to complete research in an area of their choosing, providing a much needed break between the pre-clinical and clinical years of their course. This allowed for a dedicated period of time for students to focus on gaining key research skills and gain an additional qualification for those who want to pursue competitive routes i.e., cardiology or surgery.
Intercalated degrees, typically of iBSc, would allow students to gain additional points under the old ranking system for foundation placements. Whilst some would have argued it was unfair to give students this kind of preferential treatment, I would argue it went a bit of the way to make medicine more attractive to those who were graduates, giving more people opportunities later on in life if they had not been successful the first time around or wished to change careers. Removing the significance of their previous degrees will only send thousands of potential applicants to other courses or career paths where their previous academic work is not only valued but rewarded appropriately.
Most striking of all, are the factors we overlook on a near daily basis. Whilst female identifying students are now outnumbering their male identifying counterparts for the first time in medical school entrants, women are still significantly underrepresented in clinical academia. Higher proportions of disabled women and those with carer responsibilities report that the current situation is untenable, leading to the formation of the Women in academic medicine (WAM) group. Their goal is to ensure women can remain in clinical academia, despite challenges that are posed to them by societal or professional challenges. WAM’s current goals include tackling the gender pay gap in medicine and building upon work undertaken by the BMA Equality, Inclusion and Culture team for the NHS.
Whilst groups like the WAM continue to ensure students have access to resources and guidance, the UKFPO have remained steadfast in ensuring no support is available for those who are currently affected by the changes. Furthermore, any attempts to discuss alternatives to the scheme have been unsuccessful, leading to thousands of applicants being denied their first choices in the newest allocation process for the academic year 2023/24.
The BMA has since called for recruitment to be done on an aptitude basis, owing to the lack of available academic opportunities for medical students. Students’ merits should be rewarded appropriately, especially as most of their careers until this point have centred around applying for specific rotations or degrees that incorporate the specialities they wish to work on in the future.
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