OHFP.indb xxvi OHFP.indb xxvi 30/05/2014 16:17 30/05/2014 16:17 SYMBOLS AND ABBREVIATIONS xxvii min ml MMC mmH2O mmHg MMR MMSE MND MPS MR MRCP MRI MRSA MS MSF MSSA MST MSU MTPJ mth MVR N+ V NAD NAI NBM NEB NG NHS NICE NICU NIDDM NJ NNU N \230 nocte NPA NSAID NSTEMI NTN NVD NYHA Minute(s) Milliliter(s) Modernizing Medical Careers Millimeters of water Millimeters of mer cury Measles, mumps, and rubella Mini-mental State Examination Motor neuron disease Medical Protection Society Mitral regurgitation/modifi ed release Magnetic resonance cholangiopanc reatography Magnetic resonance imaging Meticillin-resistant Staphylococcus aureus Multiple sclerosis/Mitral stenosis Multisource feedback Meticillin-sensitive Staphylococcus aureus M orphine sulfate Mid-stream urine Metatarsal phalangeal joint Month(s) Mitral valve replacem ent Nausea and vomiting Nothing abnormal detected Non-accidental injury Nil by mouth By neb uliser Nasogastric National Health Service National Institute for Health and Care Excellenc e Neonatal intensive care unit Non-insulin dependent diabetes mellitus (outdated term) Naso jejunal Neonatal unit Neutrophil At night Nasopharyngeal aspirate Non-steroidal anti-infl a mmatory drug Non-ST-elevation myocardial infarction National training number Normal vaginal delivery New York Heart Association _OHFP.indb xxvii _OHFP.indb xxvii 30/05/2014 16:17 30/05/2014 16:17 xxviii SYMBOLS AND ABBREVIATIONS OA Obs OCD OCP od OD OGD OHA OHEM OHAM OHCC OHCLI OHCM OHCS OHFP OHGP OHOG om on ORIF OSCE OT P PA PaCO2 PACS Osteoarthritis Observations Obsessive-compulsive disorder Oral contraceptive pill/Ova, cyst s and parasites Omni die (once daily) Overdose Oesophagogastroduodenoscopy Oxford Handbook of Anesthesia Oxford Handbook of Emergency Medicine Oxford Handbook of Acute Medicine Oxfor d Handbook of Critical Care Oxford Handbook of Clinical and Laboratory Investigation Oxford Handbook of Clinical Medicine Oxford Handbook of Clinical Specialties Oxford Handbook for the Foundation Program Oxford Handbook of General Practice Oxford Handbook of Obstetrics an d Gynecology Omni mane (in the morning) Omni nocte (at night) Open reduction and internal f i xation Objective structured clinical examination Occupational therapy Pulse Posteroanteri or Partial pressure of arterial carbon dioxide Partial anterior circulation stroke/Picture archiving and communication systems Peripheral arterial disease Polyarteritis nodosa Partia l pressure of arterial oxygen Peer Assessment Tool Primary biliary cirrhosis Patient-contro lled analgesia Partial pressure of carbon dioxide Polycystic ovary syndrome Polymerase chai n reaction Primary care trust Packed cell volume Patent ductus arteriosus/Personal digital assistant Pulmonary embolism Pulseless electrical activity PAD PAN PaO2 PAT PBC PCA pCO2 PCOS PCR PCT PCV PDA PE PEA OHFP.indb xxviii OHFP.indb xxviii 30/05/2014 16:17 30/05/2014 16:17 SYMBOLS AND ABBREVIATIONS xxix PEEP PEFR PERLA PET PICU PID PIP PIPJ PMETB PMH PMT PND PNS PO pO2 PoC POCS PONV POP PPH PP I PR PRHO Positive end expiratory pressure Peak expiratory fl ow rate Pupils equal and reactive to li ght and accommodation Positron emission tomography Pediatric intensive care unit Pelvic inf l ammatory disease Peak inspiratory pressure Proximal interphalangeal joint Postgraduate Me dical Education and Training Board Past medical history Pre-menstrual tension Paroxysmal no cturnal dyspnoea Peripheral nervous system Per os (by mouth) Partial pressure of oxygen Pro ducts of conception Posterior circulation stroke Post-operative nausea and vomiting Plaster of Paris/Progesterone only pill Postpartum hemorrhage Proton pump inhibitor Per rectum Pre -registration house offi cer (old training system but still widely used) Pro re nata (as re quired) Premature rupture of membranes (pregnancy) Polycythaemia rubra vera Prostate specif i c antigen Past surgical history Prothrombin time Parathyroid hormone Passed urine/Peptic ulcer Peptic ulcer disease Pyrexia of unknown origin Plasma viscosity/Per vagina Peripheral vascular disease Fourth die sumendus (four times daily) Rheumatoid arthritis Radioallergos orbant test Right bundle branch block Red blood cell PRN PROM PRV PSA PSH PT PTH PU PUD PUO PV PVD qds RA RAST RBBB RBC _OHFP.indb xxix _OHFP.indb xxix 30/05/2014 16:17 30/05/2014 16:17 xxx SYMBOLS AND ABBREVIATIONS RDW RF Rh RhF RIF ROM ROS RR RS RSI RTA RTI RUQ RVH Rx s SAH SALT SARS Sats SBE SBP SC SCBU SCC SE SH SHDU SHO Red cell distribution width Rheumatic fever Rhesus Rheumatoid factor Right iliac fossa Rang e of movement Review of systems Respiratory rate Respiratory system Rapid sequence inductio n Road traffi c accident Road traffi c incident Right upper quadrant Right ventricular hype rtrophy Prescription Second(s) Sub-arachnoid hemorrhage Speech and language therapy Severe acute respiratory syndrome O2 saturation Sub-acute bacterial endocarditis Systolic blood pr essure Subcutaneous Special care baby unit Squamous cell carcinoma Side eff ects Social his tory Surgical high dependency unit Senior house offi cer (old training system but still wid ely used) Syndrome of inappropriate antidiuretic hormone secretion Systemic infl ammatory r esponse syndrome Sublingual Systemic lupus erythematosus Swelling of ankles Short of breath Short of breath at rest Short of breath on exertion Space occupying lesion Oxygen saturati on in peripheral blood SIADH SIRS SL SLE SOA SOB SOBAR SOBOE SOL SpO2 OHFP.indb xxx OHFP.indb xxx 30/05/2014 16:17 30/05/2014 16:17 SYMBOLS AND ABBREVIATIONS xxxi SpR SR SSRI STAT ST STD STEMI STI STOP StR SVC SVR SVT Sx Temp T3 T4 TAB TACS TB TBG TCA td s Teds Temp TENS TFT THR TIA TIBC TIMI TIPS TKR TLC TMJ TNM TOE TPHA TPN TPR Specialist registrar (old training system but still widely used) Slow release/Sinus rhythm Selective serotonin re-uptake inhibitor Statim (immediately) Specialty Training/Trainee Sex ually transmitted disease ST-elevation myocardial infarction Sexually transmitted infection Surgical termination of pregnancy Specialty Training Registrar Superior vena cava Systemic vascular resistance Supraventricular tachycardia Symptoms Temperature Tri-iodothyronine Th yroxine Team Assessment of Behavior Total anterior circulation stroke Tuberculosis Thyroxin e-binding globulin Tricyclic antidepressant Ter die sumendus (three times daily) Thromboemb olism deterrent stockings Temperature Transcutaneous electrical nerve stimulation Thyroid f unction test Total hip replacement Transient ischaemic attack Total iron binding capacity T hrombolysis in myocardial infarction Transjugular intrahepatic porto-systemic shunting Tota l knee replacement Total lung capacity/Tender loving care Temporomandibular joint Tumor, no des, metastases \200\223 cancer staging Transoesophageal echocardiogram Treponema pallidum haemagglutination assay Total parenteral nutrition Total peripheral resistance _OHFP.indb xxxi _OHFP.indb xxxi 30/05/2014 16:17 30/05/2014 16:17 xxxii SYMBOLS AND ABBREVIATIONS TSH TTA TTO TTP TURP TWOC Tx u/U U+E UA UC UMN UO URTI US(S) UTI UV V/Q VA VC VDRL VE VF VM A VP shunt VSD VT VZV WB WBC WCC WHO wk WPW wt X-match yr ZN Thyroid stimulating hormone To take away To take out Thrombotic thrombocytopenic purpura Tr ansurethral resection of prostate Trial without catheter Treatment Units (write out \200 \230units \200\231 when prescribing) Urea and electrolytes Unstable angina Ulcerative colit is Upper motor neuron Urine output Upper respiratory tract infection Ultrasound scan Urinar y tract infection Ultraviolet Ventilation/perfusion scan Visual acuity Vital capacity Vener eal disease research laboratory (test) Vaginal examination/Ventricular ectopic Ventricular fi brillation Vanillylmandelic acid Ventriculoperitoneal shunt Ventriculoseptal defect Vent ricular tachycardia Varicella-zoster virus Weight bear(ing) White blood cell White cell cou nt World Health Organization Week(s) Wolff \200\223Parkinson \200\223White syndrome Weight Crossmatch year(s) Ziehl \200\223Neelsen OHFP.indb xxxii OHFP.indb xxxii 30/05/2014 16:17 30/05/2014 16:17 This page intentionally left blank xxxiv Introduction Welcome to the 4th edition of the Oxford Handbook for the Foundation Program \200\223 the ultimate FP doctor \200\231s survival book. It is set out diff erently from other books; pl ease take 2 minutes to read how it works: Being a doctor (b p1) covers the non-clinical sid e of being a junior doctor: \200 The FP (b p2) how to get a place, what it s all about, t he ePortfolio \200 Starting as an F1 (b p11) essential kit, effi ciency, being organized \200 Communication (b p19) breaking bad news, translators, languages \200 Quality and e thics (b p25) confi dentiality, consent, capacity \200 When things go wrong (b p30) error s, incident forms, hating your job \200 Boring but important stuff (b p36) NHS structure, money, benefi ts \200 Your career (b p43) exams, CVs, getting ST posts, audits, research . Life on the wards (b p65) is the defi nitive guide to ward jobs; it includes advice on wa rd rounds, being on-call, night shifts, making referrals and writing in the notes. A sectio n on common forms includes TTOs and \200\230fi t \200\231 notes. There s a whole new secti on on death \200\223 covering attitudes, palliative care, certifying, death certifi cates and cremation forms. Ward dilemmas including nutrition, pain, death, and aggression are cov ered in detail, along with a section designed to help surgical juniors pick their way throu gh the hazards of the operating theater and manage their patients peri-operatively. History and examination (b p123) covers these old medical school favor- ites, from a \200\230real -world \200\231 perspective, to help you rapidly identify pathology and integrate your fi n dings into a diagnosis. Prescribing (b p167) and Pharmacopeia (b p181) cover how to pre- sc ribe, best practice, complex patients, interactions, and specifi c groups of drugs; commonl y prescribed drugs are described in detail, with indications, contraindications, side eff e cts, and dosing advice. Clinical chapters (b p223) These chapters cover common clinical and ward cover problems. They are described by symptoms because you are called to see a breath less patient, not someone having a PE: \200 Emergencies The inside front cover has a list of emergencies according to symptom (cardiac arrest, chest pain, seizures) with page references. These pages give step- by-step instructions to help you resuscitate and stabilize an acutely ill patient whilst wa iting for senior help to arrive Symptoms The clinical pages are arranged by symptom; causes are shown for each symptom, along with what to ask and look for, relevant investigations and a table showing the distinguishing features of each disease. Relevant diseases are described in the pages following each symptom Diseases If you know the disease you can look it up in the index to fi nd the symptoms, signs, results, and correct management. Procedures (b p509) contains instructions on how to perform specifi c pro- cedures, along w ith the equipment needed and contraindications. Interpreting results (b p565) gives a guide to understanding investigations including common patterns, the important features to note and possible causes of abnormalities. Appendices (b p599) are several pages of useful infor mation including contact numbers, growth charts, unit conversion charts, driving regulation s, blank timetables, and telephone number lists. OHFP.indb xxxiv OHFP.indb xxxiv 30/05/2014 16:17 30/05/2014 16:17 This page intentionally left blank xxxvi 10 TIPS ON BEING A SAFE JUNIOR DOCTOR 10 tips on being a safe junior doctor These tips are taken from or the National Confi denti al Enquiry into Patient Outcome and Death (NCEPOD) report An Acute Problem?1 NCEPOD is an i ndependent body which aims to improve the quality and safety of patient care. The report su mmarizes a survey over one month of admis- sions to UK Intensive Care Units. 1) More attent ion should be paid to patients exhibiting physiological abnormalities. This is a marker of increased mortality risk (b p224) 2) The importance of respiratory rate monitoring should b e high- lighted. This parameter should be recorded at any point that other observations are being made (b p224) 3) Education and training should be provided for staff that use pulse oximeters to allow pr oper interpretation and understanding of the limitations of this monitor. It should be emph asized that pulse oxi- metry does not replace respiratory rate monitoring (b p224) 4) It is inappropriate for referral and acceptance to ICU to happen at junior doctor (<ST3) level 5) Training must be provided for junior doctors in the recognition of critical illness and the immediate management of fl uid and oxygen therapy in these patients (b p226) 6) Consultants must supervise junior doctors more closely and should actively support junio rs in the management of patients rather than only reacting to requests for help 7) Junior doctors must seek advice more readily. This may be from specialized teams such as outreach services or from the supervising consultant 8) Each hospital should have a track and trigger system that allows rapid detection of the signs of early clinical deterioration and an early and appropriate response (b p224) 9) All entries in the notes should be dated and timed and should end with a legible name, s tatus and contact number (bleep or tel- ephone) (b p74) 10) Each entry in the notes should clearly identify the name and grade of the most senior d octor involved in the patient episode (b p74). The full report and several other NCEPOD rep orts are available online1 and are well worth reading; there are many learning points for d octors of all grades and specialties. 1 An Acute Problem? NCEPOD (2005) at (cid:27)www.ncepod.org.uk/2005aap.htm See also Emergen cy Admissions: A journey in the right direction? (2007) at (cid:27)www.ncepod.org.uk/2007ea .htm and Deaths in Acute Hospitals: Caring to the End? (2009) at (cid:27)www.ncepod.org.uk/ 2009dah.htm OHFP.indb xxxvi OHFP.indb xxxvi 30/05/2014 16:17 30/05/2014 16:17 10 TIPS ON BEING A HAPPY DOCTOR xxxvii 10 tips on being a happy doctor 1) Book your annual leave Time off is essential. Spend it d oing something you really enjoy with people you really like. If you have fi xed leave, at l east you ll get what you re owed (hopefully), but swaps can be a pain and take a lot of per sistence. If you have to book time off , it will be your responsibility to swap on-calls. Y ou usually need to book your leave 6wk in advance and summer is always popular. Sit down ea rly with your team and discuss your leave plans 2) Be organized This is important but diffi cult when you fi rst start as a doctor. Come in early, keep a list of useful names and numbers (there are pages in the appendix to help yo u with this, b p608), and pick up hints and tips from your predecessor 3) Smile You cannot cure most diseases, you cannot make procedures pleasant, you cannot hel p the fact that you, ward staff , and patients are in the hospital, but smiling and being f riendly can make all the diff erence 4) Never shout at anyone Shouting or being insulting is unprofessional. If you have a probl em it should be addressed in private. The job rapidly becomes unpleasant if you get a reput ation for being rude and reputations (good and bad) travel quickly 5) Ask for senior help Never feel you cannot ask for help, even for something you feel you \200\230should \200\231 know. It is always better to speak to someone senior rather than g uess, even if it is in the middle of the night 6) Check in the BNF If you are not familiar with a drug then always check in the BNF before you give it. Trust nobody: it will be your name next to the prescription 7) Look at the obs Acutely ill patients nearly always have abnormal observations. Always re member to look at the respiratory rate as this is the observation most commonly ignored by junior doctors. 8) Stay calm It is easy to panic the fi rst time you are called to an acute ly ill patient, but staying calm is important to help you think clearly about how to manage the situation. Take a deep breath, work through the \200\230ABC \200\231 whilst performin g initial investigations and resus- citation (the emergency pages will guide you through th is) and call someone senior 9) Be reliable If you say you are going to do something then do it. If you are unable to do so then let someone know \200\223 nursing staff in particular also have many things to re member and constantly reminding doctors of outstanding jobs is frustrating 10) Prepare for the future Medicine is competitive, you need to give yourself the best chance. Over the fi rst 2 years you should: \200 Present interesting ca ses \200 Organize specialty taster sessions \200 Consider sitting examinations \200 E njoy being a proper doctor. Think about your career \200 Create a CV and portfolio \200 Get good referees and mento rs \200 Participate in audit _OHFP.indb xxxvii _OHFP.indb xxxvii 30/05/2014 16:17 30/05/2014 16:17 This page intentionally left blank Chapter 1 Being a doctor 1 The Foundation Program The Foundation Program 2 Boring but important stuff Pay and contracts 36 Making more money 38 Money and debt 40 NHS entitlements 42 Applying to the Foundation Program 4 Your career Specialty training 43 Specialty training applications 44 Career structure 45 Sp ecialty training options 46 Specialty training competition 48 Choosing a job 50 Specialties in medicine 51 Your curriculum vitae 52 Post-Foundation The FP curriculum and assessment 8 Starting as an F1 Before you start 11 Your fi rst day 12 Occupational health 13 What to car ry 14 How to be an F1 15 Getting organized 17 Being effi cient 18 Communication Patient-centered care 19 Communication and Program CV 54 Interviews 56 Membership exams 57 Continuing your education 58 conduct 20 Breaking bad news 22 Cross-cultural Audit 59 Presentations and teaching 60 communication 23 Outside agencies 24 Quality and ethics Clinical governance/ Teaching medical students 63 Research and academia 64 quality 25 Medical ethics 26 Patient confi dentiality 27 Capacity 28 Consent 29 When things go wrong Medical errors 30 Complaints 31 Incident reporting 32 Colleagues and p roblems 33 Hating your job 34 Relaxation 35 Causes of stress 35 _OHFP.indb 1 _OHFP.indb 1 30/05/2014 16:17 30/05/2014 16:17 2 CHAPTER 1 Being a doctor The Foundation Program \200\230Training is patient safety for the next 30 years \200\2311 The concept The UK Foundation Program (FP) was established in 2005 as part of a series of r eforms to UK medical training, known collectively as Modernizing Medical Careers (MMC). The intention of the FP was to provide a uniform, 2-year structured training for all newly qua lifi ed doctors working in the UK, to build upon medical school education and form the basi s for subsequent training. Sadly, much of the introduction of MMC was a shambles. In rel- a tive terms the FP fared well, although the early days were not without problems with a lack of fl exibility and an ideologically driven focus on com- petence rather than excellence, and as late as 2010 Professor John Collins reported to Medical Education England that the p rogram still lacked a clearly articulated purpose. His report2 identifi ed a number of area s for improvement to the FP, that led to key changes in the selection procedures and the as sessment process, amongst others. As such, the program continues to evolve. At a national l evel, a new curriculum was introduced in 2012, scheduled for review in 2015. Just as import antly, at a local level the reconfi gurations and adjustments necessary to deliver eff ecti ve training are fi ltering through \200\223 an iterative process that all FP doctors can c ontribute to. The structure The FP consists of 2 years, and in >90% of programs, each year involves rotation through 3 diff erent 4-month placements, which may be in hospital or comm unity-based medicine. About a fourth of programs involve a placement in a shortage special ty (where the number of current trainees is likely to fall short of future consultant need s), and despite a shift towards the management of chronic disease in the community, much of the FP emphasis remains on the acute care of adult patients in a hospital setting. At the start of the FP, you will be required to hold provisional registra- tion with the General Medical Council (GMC)(Table 1.1). Strictly, the fi rst FP year (F1) represents the fi nal year of basic medical education and remains the responsibility of the medical school from w hich you graduated \200\223 this responsibility may be delegated for those doctors com- pl eting F1 in a diff erent geographical region from their medical school. After successfully completing F1, you will be issued with a Certifi cate of Experience, which entitles you to apply for full GMC registration and start F2. Successful completion of F2 results in the aw arding of a founda- tion achievement of competence document (FACD) which opens the door to higher specialty training (see b p43). The Foundation Program Offi ce All aspects of the administration of the FP are overseen by the UK Foundation Program Offi ce (UKFPO) which provides several impor- tant documents at ( cid:27)www.foundationprogramme.nhs.uk These include the application handbooks, the FP refer ence guide (the rules ), the Curriculum (full list of educational objectives), careers adv ice and advice for applicants from overseas. 1 Professor Sir John Temple, \200\230Time for Training \200\231, 2010 Crown Copyright avai lable free at (cid:27)www.mee.nhs.uk/pdf/JCEWTD_Final%20report.pdf 2 Professor John Collins, \200\230Foundation for Excellence An Evaluation of the Foundatio n Program \200\231 available at (cid:27)www.mee.nhs.uk/pdf/401339_MEE_FoundationExcellence_ac c.pdf OHFP.indb 2 OHFP.indb 2 30/05/2014 16:17 30/05/2014 16:17 3 THE FOUNDATION program Table 1.1 The FP hierarchy Overall responsibility for all aspects of medical practice and training in the UK The GMC Manages applications to and delivery of the FP The UK FPO Responsible for ensuring that local delivery of the FP is in accordance with GMC standards. The LETB support fi nancial costs of training and provide the acute employing trust with s alary costs for basic contract hours (additional out of hours banding is paid by the ac ute trust b p36) Local Education Training Boards (LETB) (formerly: Deaneries) Deliver the FP locally. May overlap with the LETB. Headed by Foundation school director Foundation school Foundation training program director (FTPD) Responsible for the management and quality control of a specifi c training program. Your FT PD will oversee the panel that reviews your annual progress and is responsible for signing off on successful completion of each foundation year Acute trusts provide the employment contract, salary and HR for foundation doctors. For com munity placements (eg GP practice), the responsibility for education passes to this Local Education Provider but the contract of employment remains with the acute trust. There can be confl icts between the needs of the acute trusts (doctors on the wards delivering servic es to patients) and some of the educational requirements of the FP (b p57) Acute Trust/Local Education Provider Educational supervisor Doctor with responsibility for training of individual foundation doctor \200\223 ideally for a whole year but occasionally for just a single attachment. Will meet and review your progress on a regular basis, check that your assessments are up to date, and help you plan your career Senior doctor who supervises your day-to-day learning and training for each attachment. In some posts, the roles of educational supervisor and clinical supervisor may be merged Those undertaking an academic foundation program (that includes a designated period of research) will be assigned an individual responsible for overseeing academic work and providing feed back Individuals in each trust and Foundation school who help with FP registration and admi nistration Clinical supervisor Academic supervisor Local administrator The Foundation Doctor Responsible for own learning and becoming fully involved in the educa tional, supervised learning and assessment processes of their foundation training. A key pa rt of this is providing constructive feedback through local routes (clinical and educationa l supervisors) as well as local and national training surveys _OHFP.indb 3 _OHFP.indb 3 30/05/2014 16:17 30/05/2014 16:17 4 CHAPTER 1 Being a doctor Applying to the Foundation Program All applications to the FP are through the on-line FP Ap plication System (FPAS) at (cid:27)www.foundationprogramme.nhs.uk. There are several stages . Registration for FPAS You will need to be nominated to apply. For fi nal year students in UK medical schools, your medical school will do this on your behalf. Those applying from o utside the UK will need to contact the UKFPO Eligibility Offi ce in good time to allow chec ks to take place.1 You can register for an account before nomination, but you will be unabl e to access the application form until your nomination is confi rmed. Completing the applic ation form Within a designated window each year (usually in early October) nominated applic ants will be able to access the application form. This has a number of parts: \200 Person al Name, contact details, DOB etc. \200 Quali \201 cations Educational qualifi cations \200 Clinical Skills You will be asked to self-assess against a list of practical skills \200\223 this does not form part of the assessment process but will be used by Foundation s chools for coordinating training Equal Opportunities Monitoring information \200 Referees Details of 2 referees: 1 academi c and 1 clinical. Seniority is not important: References are not part of the assessment pro cess but are only used once an off er has been made as part of pre- employment checks, and the only requirement is to tick a series of boxes indicating no signifi cant concerns about your suitability \200 Educational achievements You will be asked to list any additional degrees for scoring against a very specifi c system and to upload a copy of your certifi ca te; 5 total percentage points are available for your degree, with 2 further points for publ ications (proof is required and will be assessed) UoA Preferences Foundation schools are grouped into Units of Application (UoA) that process applications jointly. You will be asked to rank all UoA in o rder of preference, with successful applicants allocated to UoA in score order (you will be allocated to your highest preference UoA that still has places when your turn comes). Tabl es showing vacancies and competition ratios for previous years are available on the UKFPO w ebsite but these do tend to vary between years (see box) Academic selection If applying to the academic FP (see b p5) \200 Declaration You are req uired to sign various declarations of probity. Scoring Your application will be scored base d upon 2 components: \200 Educational Performance Measure (50 points) This comprises a score between 34-43 based upon which decile your medical school decides your performance fa lls in, relative to your peers (this is locally determined) with 7 further points for educa tion achievements detailed on the application form as above \200 Situational Judgment Tes ts (50 points) See box. 1 These include: evidence of the right to work in the UK; of having undertaken medical training solely in English or having IELTS scores of \211 7.5 in all domains; of complying with GMC requirements for provisional registration which may include passing PLAB; a statement of s upport from your medical school dean; academic transcripts and proof of medical qualifi ca- tions. You should allow suffi cient time for this complex process of verifi cation. OHFP.indb 4 OHFP.indb 4 30/05/2014 16:17 30/05/2014 16:17 5 APPLYING TO THE FOUNDATION program Units of Application and 2013 competition data \200 Coventry and Warwick North Western 511 South Thames 798 91 (87%) (86%) (117%) East Anglia 286 (57%) \200 LNR 140 (63%) \200 Mersey 306 (80%) \200 North Central Tha mes 315 Northern 386 (83%) \200 Northern Ireland Staff ordshire 108 (31%) Trent 311 (63%) \200 Wales 361 (66%) \200 Wessex 296 (75%) \200 West Midlands 244 (98%) Oxford 223 (148%) \200 Peninsula 198 (94%) \200 Scotland 787 (81%) \200 Severn 273 (1 62%) (156%) North East Thames 331 (89%) Central 430 (88%) North West Thames 263 Yorkshire and (424%) Humber 584 (80%) The 21 UoA shown represent the 25 UK Foundation schools. The number of F1 vacancies for app ointments in 2013 are shown, with fi gures in brackets representing the number of applicant s ranking the UoA as their fi rst preference, expressed as a percentage of this number of j obs. Situational Judgment Tests (SJT) These computer marked tests of 70 questions sat under exam ination conditions over 2h 20min confront you with situations in which you might be placed as an F1 doctor, and ask how you would respond. There are 2 basic response formats: (i) ran k fi ve possible responses in order and (ii) choose three from eight possible responses. Ma rks are assigned according to how close to an ideal answer you come, with marks for near misses and no negative marking. Raw scores are subject to statis- tical normalization and s caling to generate a fi nal mark out of 50. Offi cially, you cannot revise for the test, since it is an assessment of your attitudes, but there is a strong weighting on medical eth ics which certainly can be revised, and you can also familiarize yourself with what is expe cted of you and try to understand model answers.1 When introduced into FP selection for 201 3 appointments, prob- lems with SJT marking led to hundreds of altered appointment off ers. Ongoing controversy surrounds SJTs as a means of selection into the FP, the thin evidence base behind them and the heavy weighting they receive. One prominent researcher closely inv olved in the pilots and advocating their use is also a director of a company that provides SJTs, as well as being a key fi gure behind the selection process that so spec- tacularly f ailed as part of the 2007 MMC reforms. Nonetheless, it is diffi cult to argue that previous systems based upon answering generic questions or students competing to get references fro m a few blessed Professors were any better. Our advice for now: Get studying! 1 Practice paper available on UKFPO website. Mock questions available as Situational Judgme nt Test (Oxford Assess and Progress) 2nd edition Metcalfe and Dev 2013 019968815X OUP The Academic Foundation Program For those interested approximately 450 programs off er a re search period alongside the same FP curriculum and outcomes. This may take the form of a de dicated aca- demic rotation, or time set aside throughout the year. You may select up to 2 Academic UoAs (these diff er slightly from standard UoAs) during the application process, and you will be asked to provide additional informa- tion on your academic suitability. Sh ortlisted candidates are interviewed and off ers made in advance of the main FP selection p rocess so that unsuccessful applicants can still compete for a regular FP position. _OHFP.indb 5 _OHFP.indb 5 30/05/2014 16:17 30/05/2014 16:17 6 CHAPTER 1 Being a doctor Results Your total score will be used to determine your place in the queue for matching to a FP, and you will be off ered a place in your highest preference UoA which still has FP va cancies when your turn comes. Results will be communicated by email and you will have a lim ited window to accept this. Depending on the UoA, you will either be able to review the ind ividual programs available and asked to rank these, or (in larger UoAs) you will be asked t o rank groups of programs clus- tered by, eg acute trusts. Methods of allocation will vary between UoAs, with some using crude FPAS scores, and others adding local scoring vari- able s. Further information should be available on each UoA website. Posts A typical F1 year usu ally consists of three placements of 4mth: one in a general medical specialty, one in a gen eral surgical specialty; options for the third specialty vary widely in just about all area s of medicine. F2 posts also typically consist of three 4mth jobs; for 80% of F2s one of th ese will be a GP placement. Allocation to F2 posts varies between UoAs, with some assigning all F1 and F2 posts at the outset, whilst others may invite you to select F2 posts during your F1 year. Once you are appointed to the FP, you are guaranteed an F2 post in the same F oundation school, but often in a diff erent acute trust. If you do not get an F2 post in a specialty you are particularly interested in, most will allow individual FP doctors to swap rotations, providing they have the support of their educational supervisors. Some Foundati on schools will organize swap shops to facili- tate this process. You can also arrange we ek-long \200\230tasters \200\231 in another spe- cialty to help plan your career; to arran ge these talk to your educational supervisor and a consultant in the relevant specialty. If you are unsuccessful In recent years, the supply of applicants has threatened to exceed pl aces on the FP. Those whose FPAS scores place them below the cutoff to be guaranteed a FP p ost will be placed on a reserve list and are often able to gain a training post when an une xpected event befalls another candidate. If you are not successful in securing a post fi rs t time round do not give up hope! If you feel you have been unfairly marked you may be able to appeal; discuss this with your medical school dean. Try to seek feedback from the appli cation process in order to identify weaknesses that you may be able to amend in case you ha ve to wait to reapply the next year. Should you still be without a post after you know you have qualifi ed from medical school, contact LETBs and hospi- tals directly; some of your p eers may not be able to take up their posts due to exam failure so you may be able to apply directly to these posts. Finally, consider taking a year out to either strengthen your application by doing research , further study, or other activities that add to your skills. Also consider applying overse as; it has been possible in previous years to do some or all of foundation training in Aust ralia or New Zealand with prior approval of posts from a UK LETB. Alternatively, it is poss ible to apply to any post within the EU or to consider equivalency exams for other countrie s. Finally, there is always the option of a career outside of medicine. Advice on this and oth er options will be available from your university careers offi ce, or from websites such as Prospects ((cid:27)www.prospects.ac.uk). OHFP.indb 6 OHFP.indb 6 30/05/2014 16:17 30/05/2014 16:17 7 APPLYING TO THE FOUNDATION program Linked applications During the FPAS application process, it is possible for any two individ uals to link their applications. In this case, you must both supply each other s email addr esses in the relevant section of the applica- tion form, and rank all UoAs in identical ord er. The score of the lower scoring applicant will then be used to allocate both applicants to the same UoA. Although policies vary between UoAs, linking does not necessarily guarante e appointment to the same trust or town \200\223 check individual UoA websites for their p olicies. Note also that if one of you accepts a place on an Academic Foundation Program, th e link is broken. Special circumstance For those who meet specifi c criteria, it may be pos sible to be allocated to a specifi c Foundation school, regardless of your FPAS score. Thes e cases include if: \200 You are a parent or legal guardian of a child <18, who lives wit h you \200 You are a primary carer for someone who is disabled (defi ned by the Equality Act 2010) You have a medical condition or disability for which ongoing follow-up in the specifi ed location is an absolute requirement. If any of these apply to you, discuss with your medical school dean or tutor well in advanc e of the application process opening. Less than full-time training Those wishing to train less than full- time should apply throu gh the FPAS alongside other candidates; upon successful appointment, they should contact th eir new Foundation school to discuss training opportunities and plans. _OHFP.indb 7 _OHFP.indb 7 30/05/2014 16:17 30/05/2014 16:17 8 CHAPTER 1 Being a doctor The FP curriculum and assessment The Foundation Program Curriculum acts as a guide for what you will be expected to achieve over the 2 years of the FP, how you will get there, and ho w you will be assessed. Core to the curriculum is a syllabus that lists a large number of c ore competences that you will be expected to achieve, divided into subsections. Each subs ection is headed by outcome descriptors indicating the broad levels of performance that you must achieve in each year, and the subsections grouped into principal sections with core t hemes. Principal sections of the FP curriculum (2012 version) 1 Professionalism 2 Relationship and communication 7 Good clinical care 8 Recognition and management of the with patients acutely ill patient 3 Safety and clinical governance 4 Ethical and legal issues 5 Teaching and training 6 Maint aining good medical practice 9 Resuscitation and end of life care 10 Patients with long-term conditions 11 Investigation s 12 Procedures ePortfolio The ePortfolio tool forms an electronic personal record of your progress through the FP. At the core is a copy of the syllabus to which you can link evidence of achievemen t of competences using a variety of tools. Alongside this sits a record of all meetings tha t you have with your supervisors and your end of year reports. It may also be used in inter views for specialty training programs to demonstrate competence and high- light your achiev ements. You can also upload a wide range of supporting material (see box b p10). It is abso lutely vital that you engage with your ePortfolio early on and continue to keep it up to da te since this forms a measure by which you will be judged. The eff ort required is not mini mal, but nor should you underestimate the burden placed on your supervisors who will also b e required to access and inspect your ePortfolio. You can certainly help them by keeping yo ur ePortfolio current and complete. Assessment It would be impossible to document evidence of achieve- ment of every one of the competences in the curriculum. Instead, you need to provide evidence that you have achieve d the outcome descriptors for each subsection appropriate to F1, and subsequently F2. In or der to do this, a variety of tools are available (see Table 1.2). For some subsections, the descriptors for F1 and F2 are the same, in which case in your F2 year no further evidence may be required, or you may wish to document evidence of ongoing achievement. In previous y ears the burden of documentation was overwhelming, both for FP doctors and their seniors, w hilst the cur- riculum used forms designed to allow for formative feedback as a means of su mmative evaluation. This risked creating a checkbox mentality amongst many concerned. Sen se has (partially) prevailed in the 2012 curriculum, with the number of assessments signifi cantly reduced and a shift towards use of assessments for formative feedback. Meetings The re are a number of meetings you need to record in your ePortfolio. These are detailed in th e box b p10.