Intended for healthcare professionals

Student Careers

Laying good foundations

BMJ 2005; 331 doi: (Published 01 September 2005) Cite this as: BMJ 2005;331:0509328
  1. Johann Malawana, joint deputy chair for education1
  1. 1BMA Medical Students Committee

The foundation programme has been introduced this summer in the UK. But next year, there are plans for a national application scheme. Johann Malawana describes the proposals and the implications for students

Postgraduate medical education in the United Kingdom is undergoing the biggest changes since the Calman reforms of the mid-1990s. Most students in the UK will have heard about the new foundation training programmes, which resulted from the Modernising Medical Careers (MMC) agenda. MMC was a policy statement by the four UK health ministers in 2003 that sought to tackle the issue of the so-called lost tribe of senior house officers in the UK. This is the first training grade following entry into the full medical register in the UK. In the past, it has been either a stepping stone for trainees who know what they want to do and who are cruising along, or, for others, it has proved to be a quagmire, in which training doctors get stuck as they try to work out what they want to do. This has meant wasting years providing a huge service to the National Health Service, but not getting much further in their careers.

The MMC reforms are designed to streamline postgraduate training, drawing upon the experience and models of training elsewhere in the world. The main question underpinning these changes is, if it's possible to train a general surgeon in seven years, why does the UK take 10 years? This in turn has raised further questions about the level to which doctors will be trained and the impact of less time served on future careers. In essence, will doctors be less experienced?


The attempts at streamlining further along the career pathway, has huge implications for current trainees and undergraduate students. The senior house officer years were a time when …

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