Successful Applications For Foundation Training 2011

Careers Consultants University of Manchester &Dr. Maire Shelly – Associate Postgraduate DeanDr Ella Checkley – Foundation School Careers LeadSeptember 2010

Admin

Programme

• Introduction• Know the process• What to do before you start your application

form • Application form in detail• Checklist and Golden rules• Further sources of help available• Exercise• Q & A panel

Foundation Application Process

• Foundation Programme – 2 year training programme

• National process– National timeline– UK-wide single online application system –UK Foundation

Programme Office (UKFPO) www.foundationprogramme.nhs.uk– Fair and open competitive process– National scoring guidance & national person specification– Applications scored by panel from your first choice Foundation

School – Maximum score 100 points – 40 academic/60 application form

What happened last year?

• 100% of UK grads were placed in programmes• Over 90% got there first choice of Foundation

School• 97% of applicants from the NW got their first

choice of Foundation School• All Manchester students who put NW as 1st

choice Foundation School got it• Approx 60% of applicants from the NW got their

first choice of programme

What we do know:

• Broad areas questions will focus on– (Note: questions are likely to be very similar to

last year – no major changes until 2013)

• Types of things scorers are looking for

What we don’t know:– Marking criteria/mark scheme

TimelineStep 1 Register and enrol online with UKFPO 4 – 22 October 2010

Step 2 Complete online application form 11 - 22 October 2010

Step 3 Closing date for applications 22 October 2010 12 noon

Step 4 Foundation school allocation results 8 December 2010

Step 5 Preferences for training programmes submitted

25 January 2011

Step 6 Notification of match to programme

Breakdown of scores

15 February 2011

18 February 2011

Step 7 Pre employment checks begin April – July 2011

Step 8 Foundation Programme Placements begin August 2011

How does it all work?Application form divided into 8 sections– Personal

Name and address– Qualifications

educational– Clinical skills

self assessment of your own practical and clinical skills– Other (equality & diversity)

will be used by employers to build a demographic profile of their workforce– Key questions (this is the only part the panel will see)

6 questions which will be scored – References

Your references (x2) must be clinicians– Preferences

You must rank 24 foundation schools( check Applicants handbook for competition ratios from last year)

– SubmitConfirm application is completed and all information is correct and your own work

• You will be able to save your application at any time and come back to it at a later date during the application timeframe

Understand the background

• “Foundation programmes are designed to give basic competence in professional skills like communication, teamwork and the use of evidence and data. You will be expected to demonstrate increasingly sophisticated skills in these areas throughout the foundation programme.”

• “You will be responsible for your own learning.”

• “You should consider every activity a chance to learn something new.”

Rough Guide to the Foundation Programme, Ch 1.www.foundationprogramme.nhs.uk

Person Specification for 2011

Person Specification for 2011

Foundation Application 2010

6 Questions • Educational achievements• How professional teams

interact in first 24 hours of hospital admission

• Describe a memorable teaching experience

• Demonstration of appropriate professional behaviour

• Feedback altering subsequent practice

• Differing views of illness management (patient/doctor)

Preparation well in advance

• Start thinking about your application now • Think self-promotion…this is your chance to sell yourself• Read and understand the requirements of the National Person

Specification (UKFPO web site) and Good Medical Practice• Identify any gaps in your skills and abilities – action plan!• Be proactive – seek out opps to practice/improve existing skills

- Seek out opps to shadow/ expand skills and experiences

• Network – meet and talk to current Foundation doctors• Document and reflect on best practice/significant learning/critical

incidents – evidence from portfolio• Focus on achievements and results – develop a profile of your skills

particularly relevant to Foundation Training• Practice answering last year’s questions• Identify referees and seek permission to use them

Documents needed to Ace the Application

• The New Doctor (2009) www.gmc-uk.org/education/postgraduate/new_doctor.asp

• Good Medical Practice (2006) www.gmc-uk.org/guidance

• Medical students: professional behaviour and fitness to practise www.gmc-uk.org/students

• Person Specificationwww.foundationprogramme.nhs.uk

• Foundation Applicants Handbook 2011• www.foundationprogramme.nhs.uk/pages/home/key-

documents

Application forms – the basics

• Give yourself plenty of time• Read through the whole form before starting• Draft your answers in rough in word• Cut and paste but proof read• Complete all the sections – don’t cross ref• Grammar and spelling...check!• Tone - upbeat , positive and focused• Short, sharp sentences – no long prose passages• Complete and comprehensible sentences• Must be your own work• Submit in good time• keep a copy of your form!

Application forms – evidence based/blank box questions• Select recent, relevant examples

• Quantify and be specific – analyse the event

• Describe your behaviour, not us, we and the team, what did you contribute?

• How and why? – personal insight and reflection

• Focus on results – what difference did you make? What was the outcome?

• What did you achieve/learn/insights gained?

• Structure your answers…think CAR:

Context – Action – Result

Describe one example from your medical training when you received feedback on an aspect of your performance. Explain how that feedback altered your subsequent practice.How will you use this experience to develop a specific aspect of your foundation training?

During my clinical training, I was asked to take a history of a patient and to present it to a doctor. At this stage I was more confident in taking a history than presenting it. I began presenting in an unstructured fashion and found that I continued to mention the presenting complaint throughout. I did not present the information I gathered in the history into the relevant subheadings such as history of presenting complaint and past medical history.

I was told that the best method of presenting the history was to begin with the presenting complaint and to continue with the subheadings, as taken in a history, and to end with the systems review.

Subsequently I have always aimed to present histories beginning with demographic details and the presenting complaint and then continue with the subheadings as this allows the findings to be presented in a fluent and logical manner.

 

As a foundation doctor I will present information in a clear and coherent sequence as it allows colleagues to understand information better when it is well structured and fluent. Moreover, it will reduce the likelihood of missing key information which is likely when information is presented in a random fashion. (200)

Is this a good answer?

Positive & Negative Indicators

• Attitudes and approaches evident from a candidates answer that we would either be hoping to see or hoping not to see

• Positive indicators largely derived from professional standards documents

• Positive indicators = the attitudes and approaches of a good doctor

Teamwork Example: +ve/-ve Indicators

+ Appropriate example+ Detailed explanation+ Shared team goal+ Collaboration+ Motivates others+ Aware of own skills &

limitations and the skills of others

+ Compromises

- Neglects others’ views

- Own agenda- No collaboration- Dominates team- Failure to share

responsibilities according to skills

- Failure to recognise team contribution

Describe a case from your clinical experience that you have observed in the first 24 hours from hospital admission. How did members of different professional teams interact and how did this contribute to effective patient care? What did you learn from this that will influence your future practice as a new doctor?

During my obstetrics placement I had the opportunity to observe on the delivery suite. On the first morning I attended, I was allocated to a patient who had been in labor for several hours prior to my arrival and was being managed by a midwife alone. Difficulty arose when the midwife noticed that the fetus was distressed as cord compression had occurred. I was asked to call for help as an emergency caesarean section was necessary.  The midwife informed the registrar about the events proceeding to the complication whilst the registrar supported the fetus with her fingers as the patient was transferred to theatre. The consultant and the pediatricians were bleeped whilst the anaesthetist was told of the change of plan.  The patient was given a general anaesthetic and the registrar continued to support the fetus until it was delivered successfully within 30 minutes. The doctors and midwives then documented the information in the patients notes so everyone involved in the patient’s care was made aware of what had happened. As a foundation doctor, communication skills are of paramount importance as they facilitate successful team work and allow for effective care to be delivered to patients quickly and efficiently. (199)

Describe a case from your clinical experience that you have observed in the first 24 hours fromhospital admission. How did members of different professional teams interact and how did thiscontribute to effective patient care? What did you learn from this that will influence your futurepractice as a new doctor?

Whilst shadowing a medical SHO in A&E, a patient with breathlessness was referred to him by an A&E registrar. The registrar provided the SHO with a concise history, including details of the blood tests already sent to the lab. The SHO wanted to test cardiac enzymes and called the lab to add these to the blood tests already requested. Thanks to the polite and relevant discussion he presented to the lab scientist, the request was promptly accepted. Meanwhile, a nurse performed an ECG on the patient and on suspecting an anomaly, she immediately alerted the SHO. Recognising the changes being those of a myocardial infarction, the SHO swiftly arranged admission to CCU for thrombolysis while the nurse calmly reassured the patient.

The concise communication between the doctors, the clear justification and reasoning behind the request made to the lab scientist and his cooperation; and the nurse’s initiative and urgent relaying of her concerns all contributed towards providing effective patient care without unnecessary delay.

This taught me how good communication, mutual respect, recognising others roles and expertise ,flexibility and a willingness to take responsibility can enhance the workings of a team and aid coordination of efforts towards a single goal: excellent patient care.(200 words)

We need you to verify: Appropriate evidence would include: Question 1 Your Bachelor of Dental Surgery

(BDS) Certificate

Question 2 1. That you continued to work as a locum registrar, 2. That you have a teaching position at Dublin Dental School

1. Evidence of employment as a locum registrar at St James' hospital (payslip, headed letter from employer), 2. Evidence of appointment as a teacher at Dublin Dental School (letter of appointment)

Question 3 That your father in law was critically ill and you broke the news to your relatives

Copy of father in law's letter from hospital, Letter of Confirmation from GP regarding his illness, Personal letter from a relative confirming you broke the bad news to them which should be addressed and signed

Question 4 That your involvement with the diabetic patient whilst on elective was as you described

Evidence of your elective in a Paediatrics Hospital in Canada, Testimony from team member that you were involved in the care of this patient, Anonymised patient notes, Notes from reflective journal

Question 5 That you completed your elective in Southampton assisting in the resuscitation of a patient

Evidence that you undertook your elective in Southampton, Notes from reflective journal, Testimony from team member that you were a member of the response team with this patient

Question 6 That you interviewed a patient with depression whilst on your Psychiatry rotation

Evidence that you completed a Psychiatry rotation, Testimony from supervisor that you interviewed the patient with depression, Notes from reflective journal, Anonymised patient notes

Question 7 That you witnessed the two patients with headaches as you described

Evidence of the placement where you observed the care of the two patients, Testimony from the supervising consultant that you were observing, Notes from reflective journal

Please note that you would not have to provide all evidence listed, but just a selection.

Please note that foundation schools will have their own local process for verification.

Exam

ple ve

rifica

tion re

quest

What makes a good answer?• Answer each part of the question clearly and fully.• Choose an appropriate example that demonstrates what the

question is looking for.• Use facts & figures to set the scene – help scorer appreciate

significance to you • Describe specific actions• Explain how – demonstrate your approach (more than just listing

what you did)• Outline results• Assess the impact of your contribution• Demonstrate skills which are directly relevant to foundation training• Show an awareness of principles of Good Medical Practice• Show development, learning and understanding.• Show a positive attitude – willing to learn from experience/mistakes

Mind your language - Use action verbs wherever possible…

• Achieved• Advised• Audited• Co-ordinated• Managed• Organised• Tested• Taught

• Led• Conducted• Initiated• Developed• Prioritised• Liaised• Negotiated• Analysed

For example…

“ A group of colleagues and I took part in an audit project into outpatient waiting times. After looking at the data we found a number of weaknesses in the booking process and subsequently made changes that improved efficiency and significantly reduced waiting times”

OR “I volunteered to coordinate an audit of outpatient waiting

times. I was responsible for leading a team of three colleagues . After analysing the data, we identified significant weaknesses and implemented changes that resulted in an average reduction in waiting time of two weeks”

(Both 43 words)

Help available after form released• Successful Applications For Foundation Training – Slides available from NW Deanery &

Careers Service website from 22nd September 2010

www.nwpgmd.nhs.uk/careershttp://www.careers.manchester.ac.uk/students/downloads/publications/talkshandouts

• Online Careers forums

Friday 15th October from 5.00pm-7.00pm

Monday 18th October from 5.00pm – 7.00pm

To view and join in the forums, go to http://forums.careers.manchester.ac.uk log in using your university username and password.

• Planning Your Medical Career: A practical guide

www.foundationprogramme.nhs.uk/news/story/ukfpo-publishes-careers-leaflet

• NHS Medical Careers Support Website

www.medicalcareers.nhs.uk

• Manchester Medical Students’ Careers Blog

www.manchestermedicalcareers.wordpress.com

And Next . . .

An Exercise

How to think laterally about your answers

Question A

You are one of two foundation doctors on a ward round. The registrar identifies a minor error made by your colleague and makes inappropriate critical comments in front of the patient and the healthcare team. Your colleague is visibly distressed. What actions would you take and how would you prioritise these? What actions do you believe your colleague should take in relation to these comments? How might you address a minor error made by a more junior colleague in the future?

Answers to Question A1. My priority would be to speak to the patient, explaining the error and reassuring them that it had been resolved. I would apologise and address any questions or concerns surrounding the comments. My next priority would be supporting my fellow foundation doctor. I would ensure that they understood the comments were inappropriate and offer to cover their duties if they did not feel able to continue. 

I believe that my colleague should raise the incident with the registrar or the consultant; in this particular situation, discussion with the consultant may be more appropriate. I would recommend involving their educational supervisor for further support and advice if necessary. 

Here, critical comments were made in front of the patient; this may result in the patient losing trust in the ability of the foundation doctor to care for them. If I was in this situation, provided patient safety was not compromised, I would wait until I was able to discuss the error with my colleague in private. I would do so in a way that could be portrayed as a teaching opportunity, so that they learn from their mistake constructively, rather than feeling threatened or humiliated in front of the health care team.

Answers to Question A2. I believe that patient safety should be every doctor’s priority. Therefore my immediate response to this situation would be to assist my colleague in correcting the error. My next priority is to support my distressed colleague. I would offer an empathetic listening ear, be a source of reassurance and invite my colleague to reflect on the incident.

At a suitable time and in private I would explain to the registrar that it was unprofessional to make inappropriate critical comments in front of the patient and healthcare team. If the registrar continued to act inappropriately I would mention my concerns to my clinical supervisor, my educational supervisor or my foundation programme director. I would expect my colleague to explain to the patient what was being talked about at the bedside, to discuss the matter in private with the registrar, to accept peer support and to learn from the experience.

In the future, if I identified a minor error, I would assist my junior colleague in rectifying it. Feedback is vitally important. However I would avoid making the same mistake as the registrar. I would give balanced feedback at an appropriate time. I would also offer to help teach my junior colleague.

Question B

Describe a memorable experience of being taught and how this has shaped your thinking about teaching. Identify a particular situation in which you might be teaching as a doctor in the future. Describe how you might apply what you have learned to maximise the effectiveness of your teaching.

Answers to Question B

The most inspirational teacher I have had was a consultant oncologist. On one occasion I observed him delivering bad news to a patient. He was extremely caring and considerate of the patient’s fears, hopes and expectations. His relationship with the patient inspired me and the oncologist has become a role model to me. The lessons from that single experience have been of immense value in helping me empathise and relate to patients. I have always understood that effective teaching should follow several integral principles: a teacher should be enthusiastic, simplify a task into steps, and give structured feedback. These are still vitally important to me, but my attachment with the oncologist has taught me that an excellent teacher must also be a role model to their students.Throughout my medical career I expect to have countless opportunities to help students learn how to interact with patients. As a doctor I intend to be a role model for others, to help students understand the fundamental nature of the patient-doctor relationship, and to use this relationship as the cornerstone of clinically relevant teaching. I believe that setting a good example will be the best way to maximise the effectiveness of my teaching.

Answers to Question B

On a recent respiratory attachment, the consultant’s enthusiasm for teaching was particularly memorable. Although based on a busy ward, the consultant was opportunistic in his approach to teaching, whether this was by the bedside or during some spare time in his office. He was completely motivated to improving my knowledge of his speciality, which resulted in my increasing willingness to learn. 

I came to realise how teaching is an ongoing responsibility in medicine and an opportunity to help others. Through the enthusiasm of this consultant, I have learned the importance of seeing teaching as a pleasure, rather than a chore; if done well it can help inspire others to take an interest in your field.

I anticipate teaching medical students by the bedside, whether this is demonstrating how to examine patients or observing their skills and giving them feedback. 

I aim to be opportunistic, teaching interesting cases when I see them and aspire to do so with such enthusiasm as I have experienced here. I will remain encouraging towards students and offer to teach whenever possible. I also need to recognise my limitations; teaching will not always be a priority and remaining enthusiastic during busy periods may be challenging.

Think Laterally

• What would you do if .......?

• What element(s) of the person specification is covered?

• What if it were another element?

• What else would you include then?

The applicant must demonstrate:

• understanding of the importance of the patient as the central focus of care

• ability to prioritise tasks and information

• understanding of the importance of working with others

• ability to communicate effectively

• initiative and the ability to deal with pressure and/or challenge

• understanding of equality and diversity

• appropriate professional behaviour,

• an understanding of the major principles of Good Medical Practice