F1 and F2 doctors
Since August 2005 all medical graduates in the UK must enter a foundation programme. This is a two-year planned programme of training where doctors learn about working in the teams that deliver care in the NHS as well as the clinical aspects of caring for sick patients. It is a transition period of practice between being a student and undertaking more specialised training for a future career in a specialist branch of medicine such as general practice or hospital medicine.
The programme comprises a series of placements in a variety of specialties and healthcare settings as well as the opportunity for some doctors to experience working with academic teams. Learning objectives for each stage will be specific and focused on demonstration of clinical competencies.
Foundation year 1 (F1)
The learning objectives for this are set by the General Medical Council. At the end of the first year of the Foundation Programme doctors are able to register with the General Medical Council (GMC) if their practice has achieved the required standard.The requirements for full registration are time-based, with the addition of achievement of specific competencies as stipulated by the foundation programme curriculum.
Foundation year 2 (F2)
F2 placements will typically be allocated during the first year to afford doctors in training and their supervisors some flexibility and choice in response to early training experiences. The F2 year will encompass team working, the use of evidence and data, time management, communication and IT skills, although the main focus of training will be the assessment and management of the acutely ill patient.
Since 2006 there has been a national recruitment process, rather than at individual deanery levels. This is a fundamental change from the previous matching of a medical school's graduates into posts in the local deanery region. The Wessex Deanery may import trainees from a range of UK medical schools and some Southampton graduates may be appointed to foundation programmes elsewhere in the country.
For more information please visit the Wessex Deanery site.
UHSFT programmes and rotations
Traditionally, F1 rotations have consisted of 6 months in surgery specialties and six months in medical specialties, with each block split into two 3 month sub–specialties.
Some reconfiguration has taken place to suit the changing service delivery needs across the Trust. We currently have 58 foundation year one programmes at Southampton. A typical FY1 rotation now would be:
Examples of F1 rotations
Surgery - 4 months
Respiratory medicine / AMU - 4 months
ITU - 4 months
Surgery - sub specialities to be allocated - 6 months
Lymington (medicine) - 6 months
The F2 programme currently has 54 rotations with a variety of posts including seven full rotations in primary care. Twelve rotations are currently allocated to Academic Trainees and consist of two clinical posts, plus one in a variety of academic specialities.
Again, many of these 54 rotations are likely to be reconfigured to meet the educational and operational needs of the 2010 to 2011 training year. Some two year Foundation programmes will be linked with the Isle of Wight or Jersey.
Examples of F2 rotations
Cardiology - 4 months
Academic neurosciences - 4 months
Oncology - 6 months
Critical care / surgery - 6 months
Accident and emergency - 6 months
All doctors in the foundation programme have an allocated educational supervisor. Within the Trust there is a foundation programme lead responsible for each year of training and a foundation programme director who oversees the whole programme. For each post, the doctor has a clinical supervisor who will ensure progress and support assessments during the post.
All trainees must meet regularly with their educational supervisors for appraisal.
Foundation trainee portfolios
Trainee portfolios form a critical part of the education and training process. These are monitored by scheduled portfolio reviews with the foundation programme leads.
Sign-up for full GMC registration at the end of year one will depend on a minimum level of portfolio grading. In foundation year two, full sign-up will also be dependent on a minimum standard of portfolio.
In addition, portfolio reviews are held to underpin the F1 to F2 selection process, where trainees are invited to select a preferred element of their F2 rotation.
UHSFT foundation programme teaching
The Education Centre delivers the core elements of the curriculum in a multi-professional setting; this core F1/F2 curriculum teaching is run once a month. Other teaching opportunities include acute care / surgical teaching (Tuesday lunchtimes, Education Centre) and foundation Year 1 (Thursday lunchtimes, Education Centre). Additional training opportunities for F1 doctors include clinical skills competencies training days, safer prescribing course and consent training. All F1 doctors at Southampton will complete the ALS training course.
F2 doctors undertake NPSA (National Patient Safety Agency) training and an intensive one-day foundations of Acute Care (FACT) course. They also participate in a presentation competition which is judged by a panel at the end of the first term. This has been very successful in encouraging trainees to improve their public speaking skills for specialist training interviews.
There is an additional half-day learning programme for F2 doctors on the academic rotations, to provide an introduction to the skills that they will need to pursue an academic career. This typically covers subjects such as statistics, how to obtain a grant, how to source information and how to develop a research question.
Since these sessions are only once a month the foundation programme leads would ask for the co-operation of clinical / educational supervisors throughout the coming year in allowing academic trainees the appropriate time away from clinical duties.
Some teaching sessions are available to download from the downloads box to the right hand side of this page.
Foundation programme resources
There are many resources to help those involved with the foundation programme. The four main documents are: the curriculum, the operational framework, the rough guide and the learning portfolio. The curriculum for the foundation years in postgraduate education and training outlines the necessary experience and competencies doctors must gain in the programmes. The learning portfolio and details of the assessment process accompany the curriculum for doctors at this stage of their training. All these, as well as information on the application procedure, are available via the MMC website.
We have introduced the appraisal and assessment process for foundation programme doctors. We have held in-house courses and also have the support of the SHA who have a programme of training on this subject, accessible to educational supervisors at UHSFT. We audit attendance at these courses to ensure compliance with the SHA requirements
Quality of foundation programme posts
Postgraduate deans, acting on behalf of the universities, work with the postgraduate medical education and training board (PMETB) to ensure the quality of training in foundation programmes. Feedback from doctors in training is a key element of quality assurance for this phase of training.
The last quality assurance visit took place at UHSFT in November 2009 with generally very positive feedback from the foundation programme director and her visiting team.