Frequently Asked Questions


We are always keen to make sure that how we allocate places in the four nation Foundation Programme is as fair as possible.  There have been some concerns raised by medical schools and students about the current method of allocation, due to the stress and workload that the SJT causes final year medical students and the competitive elements introduced by the EPM There are also differential attainment concerns about SJT outcomes, and how the use of deciles discourages teamwork and encourages unproductive competition in students.  Furthermore, each institution uses a different methodology to calculate deciles. The UK Statutory Education Bodies (SEBs) which manage postgraduate medical education across the 4 nations have expressed concerns about unequal Foundation School fill rates which are partially due to the current allocation model.

We shall be asking for the views of our key stakeholders over and the next few weeks until Tuesday 28 February 2023. We will be speaking to a wide range of stakeholders including Foundation School Directors, Foundation School Managers, Postgraduate Deans, Foundation doctors, medical schools, and medical students. The responses will be carefully considered, and a final decision on the way forward in made in Spring 2023. 

Ways to get involved:

Stakeholder letter

We will be writing to our key stakeholders to ask for their views on the proposal.


Stakeholders will be invited to take part in our short survey which will run until Tuesday 28 February. Please find the survey here.

National webinar

We shall be hosting a webinar on 15 February 2023 to outline the reason for the engagement, what is being explored and to provide a chance to ask questions.

The aim is to explore whether the process should remain in its current format which sees applicants ranked according to their FP Score based on an Educational Performance Measure (EPM) and their Situational Judgement Test (SJT) score or move to a new system without those measures used which will see each applicant given a computer-generated ranking.  Removing the SJT and the EPM would mean that the only factors that influence the allocation would be the demand for the places in the Foundation School and local education provider (trust or health board) and applicant choice.

The two options are:

Score based allocation

To continue with the current method which sees applicants ranked according to their FP Score (EPM + SJT). Applicants are allocated to a foundation school according to their rank and then their preference e.g., 1st ranked applicant allocated first. Where there are no remaining vacancies in an applicant’s first choice foundation school, they will be allocated their next highest available preferred foundation school. The allocation to programme within Foundation Schools follows the same model using preference and ranking.

Preference Informed Allocation (EPM and SJT scores not included)

Applicants will not take the SJT and will not be ranked by medical schools. They will be given a ranking which is computer generated via the Oriel System. Applicants will preference all foundation schools. The allocation process will allocate as many applicants as possible to their first preference as possible. Where there are no remaining vacancies in an applicant’s first choice foundation school, they will be allocated their next highest available preferred foundation school. The allocation to programme within Foundation Schools will follow the same model using preference and computer-generated ranking.

We have compared the two options and modelling has shown that the preference informed system results in a higher number of applicants (79.47%) obtaining their first choice Foundation School when compared to the score-based allocation (73.90%).  The difference would be how applicants are ranked.  The current system uses a competitive ranking system based on applicants’ Education Performance Measure (EPM) and Situational Judgement Test (SJT) score. The Preference Informed Allocation will see applicants given a computer-generated ranking without those measures used. Because ranking is computer generated with no meritocratic assessment, the Preference Based Model should not be associated with any differential attainment according to protected characteristics. 

Both models will still allow applicants to select their preferred foundation school.

Score based allocation

– Process is influenced by applicants, ranking which is determined through their EPM and SJT scores.

– High percentage of applicants get their top preference Foundation School.

– Picks up a very small number of possible patient safety concerns through review of SJT very low scorers.


Preference Informed Allocation

– Less stressful.

– Removal of competitive elements from application process, which should improve collaboration and reduce unproductive competition between medical students.

– Removes inequity introduced by SJT.

– Simpler process to run.

– High percentage of applicants get their top preference Foundation School.

– Reduced assessment burden for applicants.

Score based allocation

– Differences in first choice competition ratios between Foundation schools.

– Current allocation implies some programmes are superior to others, despite evidence available showing that popularity of school has no correlation with quality of Foundation Programme training.

– Use of Educational Performance Measure (EPM; decile score) drives disruptive competitive behaviour in medical students.

– Differential attainment and consequent inequity of allocation identified within Situational Judgement Test (SJT).


Preference Informed Allocation

– No identification of candidates with possible patient safety concerns as previously low scoring applicants were picked up by the SJT and reviewed by UKFPO panels

– A change in applicant behaviour may change competition ratios at foundation schools

– Ranking will be computer generated meaning applicants will not be able to influence how they are ranked

We have had some concerns raised about the current process which include the system being perceived as unfair, stressful for applicants and lack of standardisation within and across schools. This engagement process will allow us to see if there is appetite to change the way things are done.

The responses to the engagement will be considered and a final decision on the way forward made in Spring 2023 with a view to changing the allocation process for those applying for a Foundation Programme place starting in August 2024. Any change to the foundation programme allocation process will be agreed by all four national health departments and Statutory Education Bodies at the UK Medical Education Reference Group.