So you want to be an Academic Foundation Programme Doctor?

WHAT IS THE ACADEMIC FOUNDATION PROGRAMME?

The Academic Foundation Programme (AFP) provides many opportunities in clinical placements for foundation trainees to develop research, teaching and leadership skills.¹ These AFP posts are integrated within Foundation Year training schemes and may be part of Foundation Year 1 (FY1) or Year 2 (FY2) rotations. The generic academic skills are developed in addition to competencies within the core Foundation Programme Curriculum.

The AFP posts are an integral part of several initiatives to enhance and strengthen career structures for academic medicine to enable AFP doctors to develop research, teaching, leadership and management skills in addition to the competences outlined in the Foundation Programme Curriculum. An influential document (usually known as the “Walport report”) was published in 2005 by the UK Clinical Research Collaboration.¹ This highlighted the need for better integration of clinical and academic medicine training and recommend a new and clear structure in order to achieve this.² More recently, the “Shape of Training” report has emphasised that doctors in academic training pathways need training structures that are flexible enough to allow them to move in and out of clinical training while still attaining the competencies and standards of that training.³

In the UK there are now over 500 AFP posts available within a wide range of individual programmes. These are early stage career posts that allow foundation year trainees to experience first-hand the joys and challenges of clinical academic medicine. Each of the postgraduate deaneries in England, Wales, Scotland and Northern Ireland will have separate applications for AFP posts reflecting the diversity of AFP posts available.

WHAT IS THE STRUCTURE OF ACADEMIC MEDICINE?

A training path in academic medicine is designed to be flexible with opportunities for trainees to enter at different career stages. It is not necessary to have completed an AFP in order to train as an academic clinician.

An AFP post permits the integration of research projects throughout or during dedicated blocks of “academic time” within the foundation programme. This enables trainees to develop skills at an early stage to improve their success in an academic career. The structure of individual AFP posts varies between postgraduate deaneries in England, Scotland, Wales and Northern Ireland, so it is important to be familiar with the scheme within the local deanery.

In most AFP placements, the trainee will have completed an FY1 rotation and the academic component is undertaken in FY2. This may involve one of the four-month rotations effectively being supernumerary with fewer clinical responsibilities so that the trainee has protected time to complete a research project. In other AFP schemes the trainee may integrate a research theme throughout all of the FY2 rotations.

The type of research project undertaken varies widely reflecting the interests of the AFP trainee, their respective academic supervisor and specialty background. AFP doctors also obtain valuable transferable skills including enhanced understanding of research ethics, presenting at conferences, scientific writing, publishing, and experience of teaching and assessing medical students. Some AFP doctors may also obtain additional clinical or teaching qualifications and occasionally there is funding provided for these^1,3,4.

After completion of Foundation Programme FY1 and FY2 training (including the AFP post) it is usual for the doctors to enter core training posts or “run through” speciality training. There are further opportunities to pursue a clinical academic pathway including applying for an Academic Clinical Fellowship (ACF)^5,6. The ACF posts typically have 25% of training time protected for research and scholarly activity. ACF postholders are encouraged to pursue further postgraduate research and compete for funding to allow them to go Out-of-Programme for up to 3 years and complete a doctoral thesis (PhD or MD). These various training and research posts act as stepping stones to a longer term clinical academic career (Figure 1)⁷.

Fig 1.

Integrated pathway of medical and academic training. (from http://www.ecat.ed.ac.uk/clinical-academic-careers/uk-training-structures/)

HOW DO YOU APPLY TO BECOME AN AFP DOCTOR?

Applications by medical students to be an AFP trainee are included in the NHS’ new Oriel online application system (www.foundationprogramme.nhs.uk) and the AFP application is additional to that of the standard Foundation Programme schemes – which must always be completed by all applicants. Applicants may select up to two Academic Units of Application (AUoA) from the 14 available within the UK.

Foundation Programmes are ranked by applicants in order of their preference of UK postgraduate deanery location. Unlike the standard Foundation Programme schemes the AFP posts do not need to be ranked by local deaneries but the individual jobs within an AUoA need to be ranked at the application stage. AFP posts are more competitive than the normal Foundation Programme rotations and, in 2016, there were 2,252 AFP applications for 515 AFP posts across the UK⁴

Applications to Foundation Programmes are ranked on the basis of combined scores from the Situational Judgement Test (SJT) and Educational Performance Measure (EPM)⁸. The SJT and EPM each have a maximum of 50 points. The EPM is a measure of clinical and non-clinical skills, knowledge and performance (up to the point of application). The EPM has three elements; medical school performance to date in deciles, for which 34-43 points are available; additional degrees, which are worth up to 5 points; and publications, for which up to 2 points are available. In addition to the normal points scored during the Foundation Programme, the majority of AUoAs award points to “white space questions”, national and international presentations, and undergraduate academic prizes. Some AUoA have a decile cut-off and will not accept applications from students in the lower 50% of their medical school cohort. “White space” questions are typically open-ended and provide candidates with an opportunity to demonstrate attributes and experience that are relevant to a clinical academic career. The answers to these questions in addition to the overall Foundation Programme application score will determine which applicants are called to AFP interviews.

Usually two applicants per available AFP post will be interviewed. The interview process varies between AUoA but will typically involve a personal interview with or without additional interview stations. In the personal interview candidates will usually be asked about their reasons for applying, academic interests and experience, and long-term career plans. In some AUoAs, additional interview stations might involve discussion of a written clinical scenario or a research abstract that candidates will be given a few minutes before the interview. In this time, they will be expected to come up with management plans for the clinical scenarios or critically appraise an abstract.

The interview score will form the majority of the overall AFP application score and those candidates that meet the cut-off score will be offered an AFP position. Highest performing applicants will be more likely to receive their first preference of AFP posts from the ranking process and all candidates above the cut off will be offered positions until the list is exhausted.

WHAT ARE THE BEST AND WORST ASPECTS OF AN ACADEMIC FOUNDATION PROGRAMME POST?

Applying to, obtaining a place and completing an AFP post is challenging. However, securing an AFP position also comes with many benefits. So, before applying, it’s important to consider the pros and cons.

AFP posts are competitive with more than four applicants for each place. Nevertheless, applicants who secure an AFP post can gain valuable experience and skills whilst adding achievements to their CV. Applications for future clinical training posts will be enhanced by research outputs including presentations and publications, formal teaching qualifications, quality improvement projects and leadership experience. For individuals interested in academic medicine careers – or those that already have additional degrees or research experience – an AFP post may act as a bridge to further academic training positions such as an academic clinical fellowship. Successful AFP applicants are usually able to rank all six posts within the two years of their foundation programme training and this may mean they have rotations based in larger teaching hospitals.

Some individual AFP posts may have lower levels of direct clinical responsibility and less day-to-day involvement in the specialty (compared to a standard FY2 post). This may provide some challenges for AFP doctors with attaining the range of FY2 competencies compared to their FY2 peers in standard rotations. In addition, AFP trainees will typically have more teaching responsibilities than other doctors at their stage of training. The additional teaching experience may actually be a benefit particularly for those trainees with a major career interest in medical education. Overall, AFP trainees may need to work harder to achieve all their targets (academic and clinical) and will learn at this early career stage that it can be challenging maintain a good work-life balance as a clinical academic.

Finally, it is worth noting that some AFP posts may be associated with a lower salary during the placement (reflecting a reduction in on-call clinical work) but this might be offset by the additional time the trainee has to explore the many and varied clinical academic roles.

I WANT TO KNOW MORE – WHERE SHOULD I GO NEXT?

The AFP guide may be downloaded from the Foundation Programme website (www.foundationprogramme.nhs.uk). This is updated annually and provides an overview of the Academic Foundation Programme posts in each AUoA. Further details can be found on each AUoA or local deanery’s website – often with testimony from current or past AFP doctors.