A firm foundation for your medical career

August 2005 saw the introduction of foundation training into postgraduate medical education in the UK. Following graduation from medical school, all UK graduates will undertake a two-year foundation programme. Successful completion of the first year (F1) will result in full registration with the General Medical Council (GMC). The F1 year will be undertaken with provisional registration and is a preregistration year. The second year (F2) will build on the first and develop further defined competences and skills, which will have been agreed by the standard setting competent authority for postgraduate medical education, the Postgraduate Medical Education and Training Board (PMETB). 

The two-year foundation programme has been introduced as part of changes to postgraduate medical education known as Modernising Medical Careers (MMC). This document was published in February 2003 as part of the response to the chief medical officers paper known as Unfinished Business. This, in turn, was part of the review of the senior house officer (SHO) grade promised in the NHS Plan (2000). The plan specifically indicated that the SHO grade needed to be changed in light of the reliance on SHOs for delivering patient care. The lack of a managed training structure for many SHOs has resulted in some doctors spending long, unproductive periods in the grade.

What does foundation training mean to you?

Foundation training will be delivered through both a clinical and a formal training programme. Foundation training programmes will be led by foundation training programme directors and will be managed through deanery foundation schools. As a trainee within a training programme you will have a named educational supervisor who will be responsible for ensuring that you progress in your training. This will be done through a formal process of appraisal. The Foundation Learning Portfolio will enable you to reflect on your training and progress systematically. Regular meetings with your educational supervisor should ensure your access to relevant clinical experiences, adequate supervision and robust assessment. 

At the heart of foundation training is the Curriculum for the Foundation Years in Postgraduate Education Training. Its introduction sets out key features of the foundation training, stipulating that doctors in foundation training programmes will:

• Take responsibility for their own learning and take advantage of all the learning opportunities presented within the day-to-day work of each attachment.
• Engage in programmes where competence and performance will be objectively assessed throughout.
• Understand the need for continuous professional development and lifelong learning.
• Fulfil the criteria for full registration to the GMC upon successful completion of the first year of the foundation programme.
• Be ready to start a programme of further specialist training upon successful completion of the second year, which will indicate that the doctor is professionally accountable for patient safety.

Why foundation training?

Foundation training offers an important win-win for newly qualified doctors, for the NHS and most importantly, for patients. For you, as a new medical graduate, on offer is a coherent, managed programme of learning integrated with your first introduction into working in the NHS. You will specifically learn how to manage the care of the acutely-ill patients while developing good professional skills, and you will have the opportunity to put into practice teamworking and communication skills, aimed specifically at improving patient care and safety. The NHS will be guaranteed a cadre of well-trained and assessed doctors who early in their careers make an important contribution to patient management. Finally, patients will receive care from doctors who have learned and worked in quality-assured training programmes. The UK will be able to say with a significant degree of certainty that doctors who are two years post graduation from medical school have achieved a good standard of practice, which has been demonstrated to be safe and robust. The use of in-work assessment tools, which will be quality assured by the PMETB, is another key innovation of foundation training and is designed to reassure the public about the standards doctors have achieved, and to instil confidence in you about your own level of competence. These are very big wins indeed. 

The opportunity of undertaking an additional generic year of training (F2) after registration with the GMC, prior to entering into specialist training, offers further significant benefits. There will be a range of opportunities to develop an academic career, explore different specialties, and, for many foundation trainees, spend time in general practice. A commitment to improved career planning for doctors early in their careers means that you will have a better understanding of the breadth of career opportunities in the NHS; you will have access to good information about future workforce trends in clinical specialties; most importantly, you will have the opportunity to think about and discuss your own attributes and aspirations and align these to the likelihood of success in achieving these. You will be encouraged to think widely and flexibly about your career and to develop an approach to your career development that will help you adjust to on-going changes in the clinical management of patients and in the NHS.

Foundation training and the next steps

Plans are being put into place to develop a national approach to recruitment that is open, transparent and fair for those UK, European economic area (EEA) and other medical graduates who are eligible to apply for foundation training. Eligibility to apply primarily depends on your need as a graduate to undertake a provisional registration year of training prior to registration with the GMC. The recruitment process to two-year foundation programmes commencing in August 2006 will start in October 2005. Details of the process will be available in the national press and on the Modernising Medical Careers website. 

And when you successfully complete the two-year foundation programme, there will be an opportunity to apply competitively for specialist training programmes. Many of the curricula of these are currently being reviewed by the Royal Colleges and will be submitted for approval to the PMETB. Discussions about how selection into specialist programmes will take place are still on going, but there will be firm plans in place in time for you to consider applications to these before you complete your foundation training in 2007. 

Foundation training is a great opportunity for you, as a new medical graduate, to develop your skills, aptitude and knowledge, in a co-ordinated learning programme whilst working in the NHS. Supported by a foundation curriculum and a learning portfolio, foundation training programmes will enable you to become confident and secure in your skills as a medical practitioner. It's great for you, great for the NHS and great for patients.