Intended for healthcare professionals

Rapid response to:


BMA calls for urgent review of online exam for medical students

BMJ 2021; 372 doi: (Published 27 January 2021) Cite this as: BMJ 2021;372:n253

Linked Opinion

We need to move towards a student-centred application process for foundation training

Rapid Response:

Re: BMA calls for urgent review of online exam for medical students

Dear Editor

Prospective doctors have had an early introduction to the sad reality of the strained NHS postgraduate recruitment and training programme. This year brought complex and nuanced problems which will continue to influence and impact on future doctors in years to come. With the benefit of hindsight, starting the year with a deanery changing its interview criteria after the close of applications was a canary in the coalmine of how the system was going to fail our final years, and one only needs a brief foray into #MedStudentTwitter to see the damage that has been done to the psychological relationship between employer and future employee. The principle “nothing about us without us “ was disregarded to the detriment of students and the professional standing of national recruitment organisations.

Throughout discussions on the removal of educational achievement points (EAs) from the Foundation Programme Application Score (FPAS), we at the BMA consistently highlighted the need for any such change to be made with significant lead time due to the significant commitment students make a good number of years before graduation (in some cases, choosing a 6 year course before even entering medicine). At the time of the announcement, our understanding was that removal had been postponed pending review - hence the announcement not being made in February. We were not informed that the change was going to happen regardless, and the sudden announcement in Autumn 2020, when thousands of students in the affected graduating year had already begun their intercalation journey, was completely inappropriate. This became part of a pattern of wanton miscommunication and one has to question the rationale of reform like this at a time of acute stress. The initial decision to take on the aforementioned significant time and financial commitment had been made on the understanding of a benefit in an application process which can otherwise feel outside of many medical students’ control. While undertaking further qualifications and experiencing academia in the context of clinical practice is of course beneficial to personal development and patient care, the personal benefits of intercalating become less immediate.

The delay in the removal of EAs to the 2023 cohort has been presented as a condescending allowance granted to the national medical student body but the context for this suggests otherwise. Inconsistent rationale has been presented: for example, the letter to medical schools from the UKFPO Co-chairs (as referenced in the BMJ (1)) presents EAs as no longer being “a useful way of distinguishing candidates”, however on multiple occasions we have been told it is the impact on widening participation students that necessitates an urgent change. It is easier to convince people of change if you bring them with you rather than pulling the rug from under them; as an organisation we are actively working to improve access to medicine and know our members care deeply about this issue, however despite continuous requests from the BMA and other stakeholders, no data or evidence has been available to review outside of the anecdotal, which is why we have continued to advocate for at minimum a delay in removal.

SJT booking
The 2021 SJT cycle and delivery by Pearson Vue was seriously mishandled, with poor exam conditions, inordinate pressure on students and technical and procedural errors from open to close. Firstly, the technical error in allocating approved reasonable adjustments to students’ profiles ahead of the booking window forced disabled students to make unreasonable travel arrangements or settle for inconvenient booking slots, whether in location or time. This was amplified by the requirement for many students with adjustments to telephone to adjust their bookings, where students without could book online as soon as a preferable slot became available. This inequity was a completely unacceptable oversight for an international company in this sector. Students with disabilities and learning differences face enough challenges without the addition of structural barriers which could have been easily foreseen, and of which Pearson Vue were forewarned. Secondly, whilst several thousands students successfully sat the test in person or via remote proctoring, the experiences of innumerable students who faced inconsistencies in in-person and online delivery cannot be ignored. The decision to allow note-taking at test centres but not remotely presents clear variance in test conditions in and of itself, but the fact the latter was not communicated to students, who then had their tests terminated, was abhorrent. Refusal of comfort breaks remotely effectively meant that the Pearson Vue proctors were mandating inhumane conditions; no person should have to choose between soiling themselves and the termination of a life-changing test. Adding to this the reports of students having their tests terminated without warning or reason, and it is clear this cycle was not a success but rather an abject failure. The attempts to blame the pandemic were frankly insulting; remote proctoring was planned long before COVID-19 even came into being, and throughout the changeover to the new provider we have been firm in the need to ensure that students with access needs were sufficiently supported, and all received the same opportunity to succeed. COVID-19 only meant that travelling further to mask these errors was not appropriate or ethical.

This year has been a grossly incompetent failure and our members showed how much this had impacted them at our April conference, threatening a vote of no confidence in the UKFPO. Delivering national medical recruitment is a challenging feat, but the system and those leading on the decision-making must still centre those participating in it: despite being present within the room, the voices of students across our four nations have been repeatedly ignored and disregarded. The complexity demands enthusiastic collaboration with trainees, via their trade union, because seemingly small changes to systems can have a significant impact on our lives. When viewed in the context of wider issues in NHS postgraduate training, alongside the exceptionally high number of UK graduates on the reserve list this year who are yet to be allocated to foundation posts, we see a flawed system which demonstrates little regard for us. We are hopeful that the BMA medical students committee will be able use the issues raised by this challenging year to shape a system which will benefit all and showcase the wide range of abilities and experience necessary within the NHS. These challenges will impact students for years to come, and it is essential that leaders of training programmes recognise the stress, hurt feeling and detriment to medical students in this time of global uncertainty. With other health system challenges occurring, restraint, flexibility, and above all regular engagement and communication are vital.

Engagement with, and completion of, FY1 is of course necessary to achieve full GMC registration, and we hope that our future doctors will be able to overcome the loss of trust in their soon-to-be-employers resulting from this year. The BMA look forward to supporting them in their working lives as their trade union.

Yours sincerely,

Rebecca S Bates
Co-chair, BMA Medical Students Committee (2020/21)

Tinaye Mapako
Co-chair, BMA Medical Students Committee (2020/21)

Vassili Crispi
Deputy Chair (Education), BMA Medical Students Committee (2020/21)

(1) Nabavi N. BMA strongly opposes changes to foundation programme applications BMJ 2020; 371 :m4837 doi:10.1136/bmj.m4837

Competing interests: RS Bates and T Mapako are the 2020/21 Co-chairs of the BMA Medical Students Committee. V Crispi is the 2020/21 Deputy Chair (Education) of the BMA Medical Students Committee

09 May 2021
Rebecca S Bates
Tinaye Mapake (Co-chair, BMA Medical Students Committee); Vassili Crispi (Deputy Chair (Education), BMA Medical Students Committee))
BMA Medical Students Committee