UK foundation programme: Why are some trainees so unhappy with the new allocation system?

What is preference informed allocation (PIA)?

In June 2023 the UK Foundation Programme Office (UKFPO) confirmed that PIA would be introduced for the 2024 foundation programme.1 It uses a ranking system that’s “computer generated with no meritocratic assessment.”2 Medical students are ordered randomly by the Oriel system, which uses an algorithm to assign applicants to their preferred deanery.

This means that those ranked higher by the computer are more likely to receive their first preference, while those ranked lower are less fortunate. Those left unallocated after this first pass are granted their highest available preference on the algorithm’s second pass, and so on.

Previously, students’ rankings were based on their performance in exams throughout medical school, as well as a one-off situational judgment test. Similarly to PIA, that ranking would determine the order in which students were assigned to their preferred area of the country or deanery.3

Why was PIA introduced?

The UKFPO said that PIA would create a fairer system and reduce stress for applicants. Modelling suggested that PIA would result in more applicants (79.47%) obtaining their first choice foundation school than with the score based allocation (73.90%).4 The UKFPO argued that removing academic performance, which it claims “drives disruptive competitive behaviour in medical students,” should “improve collaboration and reduce unproductive competition between medical students.”2

When PIA was proposed in February …