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Foundation (nursery) schools

BMJ 2006; 333 doi: (Published 10 August 2006) Cite this as: BMJ 2006;333:333
  1. Chris Bird (chrisbird{at}
  1. F1 doctor in general practice, Berinsfield Health Centre, Wallingford

    After a long day as a surgical houseman and a glass of red wine, I was all set to blank out comfortably, if surreptitiously, in a chair near the back at an event held by my son's nursery school (no need to be awake as Will was at home with the babysitter). But when the head teacher began outlining a “foundation programme,” I sat up, worried that I was acutely confused.

    It turns out Will and I have more in common than genes and a love of Julia Donaldson's verse.1 We're both on foundation programmes, one of us on the wards, the other in a sandpit.

    After a year-long paper trail of DOP (directly observed procedure), CbD (case-based discussion), CEX (clinical evaluation exercise), and MSF (multi-source feedback), I worried that 4 year old Will was being asked a bit early to think about his public accountability and personal development.2 Surely he was just being left alone in said sandpit “to see the World in a grain of sand,” just so long as he wasn't throwing the stuff in his friends' faces?

    Not so. On one occasion, the teacher told the children to line up by a climbing frame and made a careful note of their alpine skills—a nursery DOP. During an expedition to find interesting shapes and patterns in the streets around the nursery, the teacher asked the children: “Who remembers what self appraisal is?”

    I thought guiltily of my own personal development plan and self appraisal forms yet to be filled in. Will piped up, saying that he thought he had “eaten well,” guzzling cold pizza, during a picnic at the end of a trip. Then, as instructed, he twisted round to give himself a pat on the back. At least his paperwork only involves potato shapes and saucers of paint.

    The government introduced the foundation stage for 3-4 year old children in 2000 with six “early learning goals” (a sense of déjà vu here, with the 2002 foundation programme's “seven principles”). Although the Department of Education promises that “most children see it as just fun and play,” the foundation stage sees Will tested on everything from his knowledge of the world to his communication skills.3 All this will be assessed in a “foundation stage profile,” a bit like my own foundation portfolio.

    “Re-inventing the wheel,” grumbled a consultant recently at a presentation on Modernising Medical Careers at my hospital. Given the existence of a preschool foundation programme two years before the medical one, he might be right.

    Meanwhile, with concerns about the limited number of school places for certain catchment areas echoing fears over numbers of medical posts available after foundation year 2, I hope Will is grateful for his recent offer of an “F1” placement at the local primary school. But if, by some mishap Will and I mix up our foundation placements, I suggest you don't get ill in August.


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