Single Point of Reference

Junior doctors applying to specialty training programmes are faced with the prospects of ranking job, holding offers and in many cases, waiting for another year to re-apply. However, in many cases they do not have all the information about the posts to which they are applying. This is a recent phenomenon, since the revamp and nationalised competition of the registrar (Specialty Training/ST) and house officer (Foundation Programme/FP) application process. In this process, a central body such as the Foundation Programme Office or a Lead Deanery recruiting for ST applications receives information on posts from all deaneries and makes it available for applicants on their website. However, there are many central bodies.

For the ST programmes, this can result in a multitude of websites to wade through to read about all specialties, and application process. This becomes even more complicated as training programmes change, pilot programmes emerge or options vary by nations within the UK. For example, the ST1 Trauma & Orthopaedics programme is only available in Scotland, there is a pilot programme for OMFS and Cardiothoracic ST1 being run in 2013. This information is however, on three different websites, and that shouldn’t be the case. Specialty Training by Health Education England (http://specialtytraining.hee.nhs.uk/) attempts to collate information about specialties, and so do individual deanery websites. In these deanery websites, there is a large variation in the quality and quantity of information regarding specialty training applications run by other deaneries. I have attempted to create a single list of deaneries (see table).

This is subpar for applicants. Trainees should have all the information for training applications across the entire United Kingdom at a single point.

Document checking at interviews

Why is it different across recruitment processes?

Identity and Address- Why isn’t passport or driving licence sufficient? Some require 3 photos, some 2, and others none. (?If concerned about eligibility to work.) Trainees inevitable undergo checks through CRB (now called DBS), which require far stringent checks than that at the interview.

Documents – Why is the GMC certificate required? Application websites need only to check on the GMC database to find out if they are registered or not. Why do some processes require ALS certificate, ATLS certificates, etc. without any consistency.

Reimbursement – Why is the reimbursement for travel made difficult? Some deaneries accept scans of the original receipts, others require the original tickets to be posted, which is not feasible when they are swallowed up by the ticket barriers. Some require a signature on a paper to then be scanned. The integrity of the email from which it is sent should be sufficient proof that it is indeed the person. After all, the whole application process relies on the integrity of the email address being used for communicating offers, logging in to websites.

Copies – Why do some processes require copies of the application form, when the form was filled in online and no changes can be made to it afterwards? But other recruitment processes don’t. Candidates should be able to scan in any documents that the deanery requires and the send it as an electronic copy, saving paper for an arbitrary number of copies. Originals may be checked in the portfolio at the interview.

References

References do not provide any substance for ranking and selecting trainees during the application process. They are also generic in that they do not enquire about the candidate’s suitability for the specialty. It is mostly a tick-box exercise to demonstrate the trainee was of good character and exhibited good medical practice according to the referee. Most applications ask for 3 such references to be handed in at the time of the interview. If the trainee is successful, they are forwarded on to the employers.

To take toll of the enormous waste, let’s look back to 2012. In 2012, 17,206 applications were made for 6916 posts. That equates to 51,618 references! As only two-thirds of 7200 FY2s proceed onto the next step, there is a huge waste of about 37,000 references. About 70% of references are then discarded! This is a waste of time by both the supervisors who are ‘chased’ for references, and the applicants.

A better system would collect references from appointed trainees. Educational/clinical supervisors can even be encouraged to speak to their successor for even 5 minutes as that provides more useful information than a generic tick-box. Any concerns can be then shared confidentially.

Information about posts

All deaneries should make transparent their training programmes and potential changes. This includes information about the study budget, rota details (not just banding) which includes who else is on the rota, junior support, senior support, opportunities in the rota to attend theatre, clinic, ward, etc. regional teaching, local teaching, study leave. This should then be correlated to the JCST trainee survey, GMC trainee survey. I wouldn’t go as far as to have a review website as that would not be validated data. Information should also be available about the success rate of trainees passing exams, progressing onto the ST3/ST1/consultant/fellowships, analysis of surgical logbook during their placement to find out their experience, involvement in teaching juniors, etc. Trainees should be surveyed about what kind of things they want to know about a training post and this information used for future processes.

Now, this information should be made mandatory from all deaneries in good time for advertising the training programme nationally. Such transparency will allow informed decisions by trainees to get the relevant information in choosing a post. Currently, information about a post is sparse, especially details about cutting opportunities and service commitments, and they may not have been updated on a deanery website regularly.

Comparison with USA

Compare this to the US process of applying for specialty training, known as National Residency Matching Program or NRMP. It makes it mandatory to provide not just the appointed trainees but the INTERVIEWEES with the complete information including a copy of the contract prior to the ranking. This is a far cry from the sparse information available about posts in the UK, even for newly appointed trainees. “NRMP policy requires programs to provide complete, timely, and accurate information to interviewees, including a copy of the contract the applicant will be expected to sign if matched to the program and the institution’s policies on visa status and eligibility for appointment.  The information must be communicated to interviewees prior to the Rank Order List Deadline.” 

In addition, the NRMP website provides a centralised service for applicants. This makes the reporting of the application process transparent.

Letters of Recommendation take the place of references, and they are uploaded by the person writing them to a centralised service rather than the candidate. Much more efficient. And they only require 3 of them for the whole process.