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Factors Influencing Foundation Programme Choice among Medical Students

Authors:
Shelain Patel at Royal National Orthopaedic Hospital NHS Trust
Shelain Patel
Henry Colaco at Hampshire Hospitals NHS Foundation Trust
Henry Colaco
Fahad Hossain at Walsall Healthcare NHS Trust
Fahad Hossain
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The advent of Modernising Medical Careers has replaced the traditional pre-registration house officer (PRHO) year and first year of senior house officer (SHO) training with a combined foundation programme. The aim of this study was to find out the factors influencing choice of foundation programme among medical students. Prospective survey. Three medical schools based in England. A questionnaire was formulated containing the reasons for choosing a foundation programme with students asked to rank their choices. There were 46 replies. The most important factors identified were geographical location (score 154) and combination of specialties (score 178). The least important factors was the reputation of consultants (score 525) and opportunities for research (score 530). The factors influencing choice of foundation programme are not dissimilar to the choice of PRHO year despite the different emphasis in training which it offers.
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Factors influencing foundation
programme choice among
medical students
Shelain Patel •Henry B Colaco •Fahad S Hossain
Department of Orthopaedics, University College London Hospital, UK
Correspondence to: Shelain Patel. E-mail: shelain.patel@doctors.org.uk
Summary
Objectives The advent of Modernising Medical Careers has replaced
the traditional pre-registration house officer (PRHO) year and first year of
senior house officer (SHO) training with a combined foundation
programme. The aim of this study was to find out the factors influencing
choice of foundation programme among medical students.
Design Prospective survey.
Setting Three medical schools based in England.
Main outcome measures A questionnaire was formulated
containing the reasons for choosing a foundation programme with
students asked to rank their choices.
Results There were 46 replies. The most important factors identified
were geographical location (score 154) and combination of specialties
(score 178). The least important factors was the reputation of consultants
(score 525) and opportunities for research (score 530).
Conclusions The factors influencing choice of foundation programme
are not dissimilar to the choice of PRHO year despite the different
emphasis in training which it offers.
Introduction
In the UK, the advent of Modernising Medical
Careers (MMC) changed medical training for
doctors. It signalled the end of the traditional pre-
registration house officer (PRHO) year and first
year senior house officer (SHO) year into a
two-year combined foundation programme. This
programme was introduced in 2005 and com-
prised of six attachments over two years with
each attachment lasting four months. It was intro-
duced after the Chief Medical Officer’s report
‘Unfinished Business’
1
which reviewed the status
and structure of the SHO grade and highlighted
the need for a radical overhaul of this grade.
It was commented that half of SHO posts were
not part of a training programme and there was
a burden upon the SHOs through a constant
need to secure short-term positions. Furthermore,
there was no fixed endpoint to SHO training with
a lack of robust mechanisms for regular appraisal.
This and other issues led to poor workforce plan-
ning at a national level.
The aim was to develop essential generic skills
for all doctors, and extend and consolidate the
knowledge, skills, values and attitudes acquired
in medical school. Furthermore, while individual
house officer posts were often ring-fenced to be
filled by doctors graduating from a particular
medical school, this was stopped with MMC.
DECLARATIONS
Competing interests
None declared
Funding
None
Ethical approval
This study was
approved by
University College
London Medical
School; all data
analyses were
conducted using
de-identified data
Guarantor
SP
Contributorship
SP and HBC were
responsible for study
design and data
collection; SP and
FSH were
responsible for data
analysis and
write-up
Acknowledgements
The authors would
like to thank
University College
London Medical
School; Guy’s, King’s
and St Thomas’
Medical School; and
J R Soc Med Sh Rep 2010;1:4. DOI 10.1258/shorts.2009.100056
RESEARCH
1
Since competition for positions is now more
open and a much wider number of foundation
programmes can be applied for, we sought to
seek out which factors most influence foundation
programme choice. The findings from this study
are presented herein.
Methods
A questionnaire was designed by the authors with
reasons listed for choosing a particular foundation
programme. This was reviewed by a group of
foundation-year doctors to ensure all common
reasons for choosing a programme had been ident-
ified. All final-year medical students during the
academic year of 2007– 2008 at University
College London, Kings College London and
Oxford University were emailed the questionnaire
and asked to voluntarily and anonymously com-
plete and return it. To ensure a high response
rate, the questionnaire was sent out twice with
an interval of two months. The information
requested included demographic data (age at
time of starting foundation programme and
gender), intended specialty, and ranking of
reasons for choosing foundation programmes
(ranking =1 was the most important reason, 16
was the least important reason). For each factor,
the rankings were cumulated to give a score to
identify which were most important overall.
Results
Forty-six students (22 men and 24 women) com-
pleted the questionnaires. Their mean age at com-
mencing their foundation programme would be
25.4 years (range 23.3–32.8 years). There were 11
replies from University College London, 25 from
King’s College London and 10 from Oxford Univer-
sity. The choice of intended specialty was completed
by 44 students, of which nine gave two choices.
Seven specialties were given: general medicine; pae-
diatrics and women’s health; general practice;
surgery; anaesthesia and intensive care; psychiatry;
and radiology. The number of times that these were
chosenwas17,10,10,6,5,4and1,respectively.
Table 1 demonstrates that geographical location
and combination of specialties were the most
important factors when choosing a Foundation Pro-
gramme. They were chosen as one of the top three
Table 1
Ranking of factors influencing choice of foundation programmes
Factor Cumulative
of ranking
scores
Overall
ranking
Number for
whom this is the
most important
factor
Number for
whom this
is a top 3
factor
Geographical location 154 1 19 32
Combination of specialties 178 2 13 31
Quality of on-ward teaching 322 3 2 7
Reputation of hospital/programme 338 4 2 7
Anticipated experience of procedures 347 5 1 8
Educational activities 357 6 1 7
Relationship between juniors and seniors 363 7 2 7
Banding 371 8 2 10
Work load 422 9 0 0
Spouse/family issues 436 10 3 13
Cost of living 462 11 0 3
Number of on-calls 462 12 0 2
Experience of the hospital as a medical
student
479 13 0 6
Modernity of hospital 510 14 0 1
Reputation of consultants 525 15 0 1
Opportunities for research 530 16 1 3
J R Soc Med Sh Rep 2010;1:4. DOI 10.1258/shorts.2009.100056
Journal of the Royal Society of Medicine Short Reports
2
Oxford University
Medical School for
their participation in
the study
Reviewer
Marcus Lee
factorsbytwo-thirdsofstudents.Thereputationof
consultants and opportunities for research were the
least important factors identified.
Discussion
The factors influencing the choice of foundation
programme is of great interest to deaneries and
trainers. Recruitment involves selecting the best
available candidates and it is important to be
able to tailor programmes to meet this goal as
well as provide training to the doctor and a
service to the patient. We determined that geo-
graphical location, combination of specialties,
quality of on-ward teaching, reputation of hospital
or programme and anticipated experience of pro-
cedures were the most important factors when
choosing foundation programmes.
Our study is limited by the small number of
responses. Furthermore, our survey did not
allow for graded responses which may have
allowed for greater differentiation between the
mid-ranking factors where scores are clustered.
Despite this, we have still clearly identified the
two most important factors when choosing foun-
dation programmes.
The findings presented are similar to those by
McKeown and Boohan
2
during the PRHO years.
They found that location, undergraduate teaching,
friendly atmosphere, perceived clinical experience
and postgraduate teaching were the most impor-
tant factors. This would suggest that the factors
influencing job choice for final-year medical
students has not dramatically changed despite
the introduction of a new training programme.
With respect to tailoring foundation pro-
grammes to attract students, it is clear that the
location of a hospital cannot be changed but
does explain why particular programmes are
applied to more than others. However, the combi-
nation of specialties offered is something that can
be adjusted and we found that this is the second
most important factor influencing foundation
programme choice. While a balance should be
reached between what a junior doctor needs to
be trained in and wants to be trained in, pro-
grammes may be more popular if they include
general medicine, paediatrics, women’s health,
and general practice which were the most
popular intended career choices.
Our survey also highlights that opportunities
for undertaking research is the least important
factor when choosing a Foundation Programme.
This is in spite of its importance within MMC
3–5
which may reflect a lack of understanding of
career progression.
Future research is required to identify the
impact of this study and to determine if there are
any changing trends with respect to programme
choice. Furthermore, it is hoped that dissemina-
tion of this study’s findings will provide the
basis for a much larger study encompassing the
views of more students from a greater cohort of
medical schools. In doing so, not only would the
results be more robust but also variations in
beliefs between students from different schools
could be evaluated.
References
1 Donaldson L. Unfinished business: proposals for reform
of the senior house officer grade – a paper for consultation.
London: Department of Health; 2002. See http://www.dh.
gov.uk/en/publicationsandstatistics/publications/
publicationspolicyandguidance/dh_4007842 (last checked
26/01/2010)
2 McKeown PP, Boohan M. Factors influencing choice of
hospital for the pre-registration house officer (PRHO) year.
Med Teach 2004;26:664
3 Blackburn D, Pengiran Tengah DS. Why bother with
research when training to be a neurologist? Pract Neurol
2007;7:282–4
4 Sholighur HK. Preparing for the MMC interviews: a
practical guide for trainees. Psych Bull 2008;32:113–15
5 Tooke J. Aspiring To Excellence Findings And Final
Recommendations Of The Independent Inquiry Into Modernising
Medical Careers. London: MMC Inquiry; 2008. See http://
www.mmcinquiry.org.uk/final_8_jan_08_mmc_all.pdf
(last checked 26/01/2010)
#2010 Royal Society of Medicine Press
This is an open-access article distributed under the terms of the Creative Commons Attribution License
(http://creativecommons.org/licenses/by-nc/2.0/), which permits non-commercial use, distribution and reproduction in
any medium, provided the original work is properly cited.
J R Soc Med Sh Rep 2010;1:4. DOI 10.1258/shorts.2009.100056
Foundation programme choice among medical students
3
... Since the introduction of the foundation program, the factors influencing students' choice of foundation schools and their subsequent views of their choices on completion of foundation training are unclear, with only two such studies addressing this. 9,10 This information would be of value to foundation schools, as they could potentially tailor their individual programs to attract a greater number of applicants based on their preferences. There is evidence that due to the current UK junior doctor contract changes, up to 70% of medical graduates will consider leaving the UK health system. ...
... Our study has demonstrated that location is the most important factor influencing undergraduate medical students in their choice of foundation school. This is in keeping with previous similar studies by Patel et al 9 and McElvanna et al. 10 Social relationships in the form of partner and family were second and third, respectively. ...
... Our low response rate could have been addressed with a second wave of emails or providing paper-based questionnaires. Our study had a superior number of participants compared to the two previous studies 9,10 (361 vs 149 [response rate=61%] 10 and 46 [response rate unknown] 9 ) and sampled of a greater percentage of medical schools (9 vs 1 10 and 3 9 ). Nevertheless, further studies should include a greater participant number from a more comprehensive number of foundation/medical schools. ...
What factors influence UK medical students’ choice of foundation school?
Article
Full-text available
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Background We aimed to identify the factors influencing UK medical student applicants’ choice of foundation school. We also explored the factors that doctors currently approaching the end of their 2-year program believe should be considered. Methods A cross-sectional study was conducted during the 2013–2014 academic year. An online questionnaire was distributed to 2092 final-year medical students from nine UK medical schools and 84 foundation year-2 (FY2) doctors from eight foundation schools. Participants were asked to rank their top 3 from a list of 12 factors that could potentially influence choice of foundation school on a 5-point Likert scale. Collated categorical data from the two groups were compared using a chi-square test with Yates correction. Results Geographic location was overwhelmingly the most important factor for medical students and FY2 doctors with 97.2% and 98.8% in agreement, respectively. Social relationships played a pivotal role for medical student applicants. Clinical specialties within the rotations were of less importance to medical students, in comparison to location and social relationships. In contrast, FY2 doctors placed a significantly greater importance on the specialties undertaken in their 2-year training program, when compared to medical students (chi-square; p=0.0001). Conclusion UK medical schools should make their foundation program applicants aware of the importance of choosing rotations based on specialties that will be undertaken. Individual foundation schools could provide a more favorable linked application system and greater choice and flexibility of specialties within their 2-year program, potentially making their institution more attractive to future applicants.
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... In 2010, Patel and colleagues did a similar study of medical students from three different medical schools. 4 They also reported that geographical location was the most important factor affecting medical students' choice of training programme. 4 Before the introduction of foundation training, McKeown and Boohan researched the choice of hospital for pre-registration house officers (equivalent to FY1), and again location was the most important deciding factor. ...
... 4 They also reported that geographical location was the most important factor affecting medical students' choice of training programme. 4 Before the introduction of foundation training, McKeown and Boohan researched the choice of hospital for pre-registration house officers (equivalent to FY1), and again location was the most important deciding factor. 5 This finding is recognised across the country, the Workforce Review Team has reported a deficit of not only junior doctors but also consultants across the north west of England, Yorkshire, the Midlands, east of England and south-east Coast. ...
Factors influencing recruitment and retention of foundation doctors in geographically unpopular locations
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The North West Foundation School is home to 1,100 foundation trainees employed at 12 hospital trusts. Despite oversubscription to the Foundation Programme every year since 2011, University Hospitals of Morecambe Bay Foundation Trust (UHMBFT) has struggled to fill foundation training posts relying on locum doctors to sustain service provision. We did a study to explore the reasons for this and identify possible solutions. Final year medical students at Lancaster University and foundation doctors based at UHMBFT and Central Manchester Foundation Trust were invited to complete a structured questionnaire and then attend a focus group to expand on their answers. Location was identified as the single biggest factor affecting where foundation applicants applied to, followed by perceived reputation of the hospital trust and job track. Participants identified free/heavily subsidised accommodation or the offer of additional qualifications in leadership or teaching as the main incentives that would have a positive effect on applications to geographically undesirable trusts. These incentives would need to be well publicised, particularly on foundation school websites, UK Foundation Programme websites and trust websites. Overall these efforts should lead to savings in recruitment costs, a reduction in vacant training posts and thus a decreased reliance on locum doctors, culminating in improved patient care.
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... In fact, the ideal program for the majority of the students was a well-structured, interesting program that will offer high-quality training, that will be conducted in a recognized hospital, and will commence shortly (availability of residency position). Similar responses have been documented in former surveys, as well [10,11]. ...
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... Similar results were reported from a survey of Canadian family practice residents , where more than 50% replied that the ability to learn and work in a friendly professional environment was an important factor in choosing a training program [21]. Previous studies of criteria students worldwide use to select a residency program showed that the program's reputation, prestige, and location are among the major factors students utilize when selecting a program21222324. These results were echoed by the responses of the Israeli students, where over 60% indicated that they wanted to attend a residency program in a specific location within Israel. ...
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Specialty selection by medical students determines the future composition of the physician workforce. Selection of career specialties begins in earnest during the clinical rotations with exposure to the clinical and intellectual environments of various specialties. Career specialty selection is followed by choosing a residency program. This is the period where insight into the decision process might help healthcare leaders ascertain whether, when, and how to intervene and attempt to influence students' decisions. The criteria students consider important in selecting a specialty and a residency program during the early phases of their clinical rotations were examined. Questionnaires distributed to fifth-year medical students at two Israeli medical schools. 229 of 275 (83%) questionnaires were returned. 80% of the students had considered specialties; 62% considered one specialty, 25% two, the remainder 3-5 specialties. Students took a long-range view; 55% considered working conditions after residency more important than those during residency, another 42% considered both equally important. More than two-thirds wanted an interesting and challenging bedside specialty affording control over lifestyle and providing a reasonable relationship between salary and lifestyle. Men were more interested in well-remunerated procedure-oriented specialties that allowed for private practice. Most students rated as important selecting a challenging and interesting residency program characterized by good relationships between staff members, with positive treatment by the institution, and that provided much teaching. More women wanted short residencies with few on-calls and limited hours. More men rated as important residencies affording much responsibility for making clinical decisions and providing research opportunities. More than 50% of the students considered it important that their residency be in a leading department, and in a large university medical center. Only 5% considered it important to do their residency in the country's peripheral areas, while 30% reported interest in a residency in the country's center. The fifth year of a six-year medical school is an opportune time to provide students with information and guidance on the various specialties and selecting a residency program as they begin to solidify their perceptions and ideas about the various specialties. This study serves as an impetus to medical educators and healthcare leaders to become interested in students' career selection.
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What do UK medical students value most in their careers? A discrete choice experiment
Article
  • Mar 2017
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Context: Many individual- and job-related factors are known to influence medical careers decision making. Previous research has extensively studied medical trainees' (residents') and students' views of the factors that are important. However, how trainees and students trade off these factors at times of important careers-related decision making is under-researched. Information about trade-offs is crucial to the development of effective policies to enhance the recruitment and retention of junior doctors. Objectives: Our aim was to investigate the strength of UK medical students' preferences for the characteristics of training posts in terms of monetary value. Methods: We distributed a paper questionnaire that included a discrete choice experiment (DCE) to final-year medical students in six diverse medical schools across the UK. The main outcome measure was the monetary value of training post characteristics, based on willingness to forgo and willingness to accept extra income for a change in each job characteristic calculated from regression coefficients. Results: A total of 810 medical students answered the questionnaire. The presence of good working conditions was by far the most influential characteristic of a training position. Medical students consider that, as newly graduated doctors, they will require compensation of an additional 43.68% above average earnings to move from a post with excellent working conditions to one with poor working conditions. Female students value excellent working conditions more highly than male students, whereas older medical students value them less highly than younger students. Conclusions: Students on the point of completing medical school and starting postgraduate training value good working conditions significantly more than they value desirable geographical location, unit reputation, familiarity with the unit or opportunities for partners or spouses. This intelligence can be used to address the crisis in workforce staffing that has developed in the UK and opens up fruitful areas for future research across contexts and in terms of examining stated preferences versus actual career-related behaviour.
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Preparing for the MMC interviews: A practical guide for trainees
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  • Mar 2008
When the Modernising Medical Careers (MMC) programme was proposed in 2003, it was designed to ensure that ‘the end product of the training process, whether a Hospital Doctor or a General Practitioner, should be a high-quality, well-trained and accredited doctor who can deliver the care and treatment to patients in the modern NHS’ (Department of Health, 2003). Currently we are at the stage where interviews and recruitment for August 2007 have been completed, and recruitment for 2008 has commenced. It is vital for candidates to have an insight into the interview mechanism. In this article, the structure, types of questions, competencies tested and the methods used for selection such as Objective Structured Clinical Examinations, clinical vignettes, audit and research, teaching and presentation skills are discussed, so that candidates are able to better prepare themselves.
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Why bother with research when training to be a neurologist?
Article
  • Nov 2007
  • Practical Neurol
![Graphic][1] Doctor or scientist? Many if not most neurologists, at least in the UK, do some research, publish a few papers and obtain a postgraduate degree such as a PhD. The academic neurologist, usually working in a University Hospital, can clearly make a vital contribution to the advancement of clinical and basic sciences. But should non-academic neurologists, working in non-teaching hospitals or outpatient settings, also do some research—at least during their neurology training? Does a period of research make you a better clinical neurologist, and, if so, how and when should this research be incorporated into training? Research during training is time-consuming, liable to failure, costly, and potentially a waste of time if academia is not the intention. Now that UK doctors are undergoing a major shake-up of their postgraduate training (Modernising Medical Careers (MMC)),1 it is important that we ask for evidence to support a period of research for trainees who are destined to become non-academic as well as academic neurologists. It is said that the benefits of research during neurology training include a greater understanding of scientific methodology and disease mechanisms which will improve the aspiring neurologist’s ability to critically evaluate the evidence informing clinical practice. And very often a period of research is a way into subspeciality training, for example in epilepsy or stroke. In our recent survey, over 90% of UK neurology trainees do a period … [1]: /embed/graphic-1.gif
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Department of Health See http://www.dh. gov.uk/en
  • Jan 2002
  • London
London: Department of Health; 2002. See http://www.dh. gov.uk/en/publicationsandstatistics/publications/ publicationspolicyandguidance/dh_4007842 (last checked 26/01/2010)
Unfinished business: proposals for reform of the senior house officer grade-a paper for consultation. London: Department of Health
  • Jan 2002
  • L Donaldson
Donaldson L. Unfinished business: proposals for reform of the senior house officer grade-a paper for consultation. London: Department of Health; 2002. See http://www.dh. gov.uk/en/publicationsandstatistics/publications/ publicationspolicyandguidance/dh_4007842 (last checked 26/01/2010)
Preparing for the MMC interviews: a practical guide for trainees
  • Jan 2008
  • 113-128
  • H K Sholighur
Sholighur HK. Preparing for the MMC interviews: a practical guide for trainees. Psych Bull 2008;32:113-15
Aspiring To Excellence Findings And Final Recommendations Of The Independent Inquiry Into Modernising Medical Careers. London: MMC Inquiry
  • Jan 2008
  • J Tooke
Tooke J. Aspiring To Excellence Findings And Final Recommendations Of The Independent Inquiry Into Modernising Medical Careers. London: MMC Inquiry; 2008. See http:// www.mmcinquiry.org.uk/final_8_jan_08_mmc_all.pdf (last checked 26/01/2010)