Intended for healthcare professionals

Career Focus

Modernising Medical Careers and the devolved nations

BMJ 2004; 329 doi: (Published 03 July 2004) Cite this as: BMJ 2004;329:s9
  1. Samena Chaudhry, Anatomy demonstrator
  1. Cambridge University


Samena Chaudhry finds out what's happening in Wales, Northern Ireland, and Scotland

The foundation programmes associated with Modernising Medical Careers will be implemented in August 2005. Many pilot schemes are under way in English deaneries, but what is happening in Wales, Northern Ireland, and Scotland?


Wales seems confident of getting everything ready by August 2005. Project manager of Modernising Medical Careers in Wales Dr Helen Baker explains: “We have a significant number of six month posts which will be converted to four month posts. From then on, we will be offering a two year foundation programme. Candidates will know the FP1 [first year foundation programme] year and will apply for the FP2 [second year foundation programme] year part way through the FP1 year. This will allow trainees to choose their career path more objectively since they will have experienced eight months as a house officer.”

She continues: “We will be piloting 84 FP2 posts from August this year. We are targeting already working house officers for our prototype since this is who the FP2 posts are aimed at. However, the posts were advertised in BMJ Careers and therefore subject to open competition.” She adds, “Wales is very keen to pilot the FP2 year in order to prepare for the increasing number of graduates requiring FP1 and FP2 posts over the coming years.”

Dr David Price is director of the Modernising Medical Careers programme in Swansea NHS trust. “The good thing about Wales is that we have a very close relationship between the Welsh Deanery and the Welsh Assembly, which means we are in a fairly well secured position and have no current problems with funding. We have just received roughly 300 applications for nine FP2 posts in the trust, with rotations in ITU [intensive treatment unit]/nephrology/burns and plastics/A&E [accident and emergency] as well as general practice/HIV medicine/paediatrics.

“We advertised within the trust asking for consultant bidders for an FP2 post, making clear that having such a trainee would mean increased education needs and assessments. I think many consultants put in a bid as they found it an advantage to have an extra pair of hands, but we also had interest from specialties like chemical pathology and radiology.” One of the dilemmas Dr Price and his team faced was deciding whether rotations should be theme based or more random: “We felt that themed ones were probably better.”

But what do the current house officers and medical students think? Dr Price replies: “There is a broad range of responses. The research that has been done shows that one third of medical students just want to get on with their preferred specialty, one third of students are uncertain, but that a third of students look upon the FP2 year in a positive light.”

Up to now it's been the consultants who have taken decisions, but Dr Price has just set up a trust working group on Modernising Medical Careers where junior doctors are also involved.

Northern Ireland

Unlike Wales, Northern Ireland will not be piloting a FP2 this year. From next August every graduate will be working in a two year foundation programme. Dr Paddy Woods, the medical adviser in staffing and development in Northern Ireland, is reasonably confident that things will be organised by then but does not underestimate the work that needs to be done.

“We are keeping a close eye on the pilot schemes in England. I think the major act will be to get the trainers up to speed. We will soon be commissioning training in assessment and appraisal procedures for our consultants.”

Dr Woods explains the reason why Northern Ireland is not piloting the FP2 year this August. “It ultimately came down to practical constraints and being unable to establish pilots in time.”

He has a reassuring answer for all those concerned about Modernising Medical Careers in Northern Ireland: “This will be better than currently and in my day, where you were in national competition for postgraduate jobs. Now you will be guaranteed two years' worth of jobs.”

But in his view, medical students are justified in criticising Modernising Medical Careers: “It has had very little publicity and no detailed plan. The problem is that not much is set in stone. The main complaint from students in their fourth year is that they have no idea what is in their FP2 year.” But he reassures, “Wherever possible, career aspirations will be facilitated but at the same time giving doctors a breadth of experience.”

“In Northern Ireland, I do not wish the rotations to be limited to just one hospital. In principle, it is important to have a varied experience and therefore the feasibility of experiencing different environments within a rotation is being explored.”


Like Northern Ireland, the four deaneries in Scotland will deliver the two year foundation programmes from August next year. In the guide Modernising Medical Careers Foundation Programmes aimed at fourth year medical students (see further information), the Scottish executive explain that the two foundation years will consist of programmes of around 30 doctors (15 in each year) pursuing their own personal programme. These aim to provide experience mainly in acute care settings as well as mental health and general practice.

Professor Gillian Needham, postgraduate dean for the North Scotland, feels prepared: “In Scotland we are prepared for FP1 implementation, having launched the SFAS website ( and are in the process of completing fourth year medical student talks.”

“Unlike Wales there has been no process of new post creation so far. Some deaneries have reconfigured current PRHO [preregistration house officer] posts into programmes, and some have reconfigured both PRHO and SHO [senior house officer] posts. Scotland is the only country to have a national matching scheme for students wishing to apply for Scottish FPs [foundation programmes].”

Professor Needham is confident that foundation programmes are being constructed appropriately: “FP placements are determined by appropriate educational opportunity and support. Only placements that meet deanery, GMC [General Medical Council], and royal colleges quality assurance standards are considered. Job descriptions for foundation tutors in Scotland are being prepared, and interim appointments have been made in some deaneries.”

According to Professor Needham: “Until there is more information on programme design specialty by specialty, current SHOs will continue in existing models of training. It is the colleges and PMETB [Postgraduate Medical Education and Training Board] who will determine the specialty programmes and when they will be implemented.” This could be August 2007.

She states: “We are using the SPA [Scottish PRHO allocation] teams in the deaneries and have adapted the matching process to best suit the FP design. I'm not aware it is any more complicated than before. In Scotland we are determined that the foundation programmes will offer graduates the best preparation for onward specialty training.

“The curriculum for the second year is still being developed and is likely to be formed by four month or six month posts. Trainees will keep the same tutor in both foundation years. It is unlikely that foundation programmes in Scotland will be confined to one hospital and will involve consistent in-training assessment. The curriculum is currently being developed and will move from theory or knowledge based assessment to skills/competency based assessment.”

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