Advice for ranking foundation programme jobs

All things UKFPO

Before we tackle the focus of this blog with some tips and tools for ranking foundation programme jobs, it is apt to address the key changes to the UK Foundation Programme this year, including the allocation process move to Preference Informed Allocation (PIA), where applicants are assigned a random computer based generated ranking. This compares to previous years whereby ranking scores were comprised from academic performance (EPM) and the situational judgement test (SJT).  

A key aim of PIA should theoretically result in more applicants being allocated in their top 5 choices. However, despite UKFPO involving stakeholder engagement before implementation, this new system has come under criticism with removal of security for applicants and reports of deanery allocations in unwanted bottom choices. Furthermore, from 2025, it should be noted that the PIA system will also apply to the Specialised Foundation Programme and may have considerable impact on the future of clinical academia. 

We will be writing an up-to-date application guide for 2025 entry as further information is released so do look out for this! 

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So how does preferencing work after deanery allocations?

The preferencing process either occurs as a one-stage or two-stage process:

• One-stage process = rank all of the foundation jobs in that deanery 

• Two-stage process = firstly rank groups within the deanery (usually divided by trusts or further breakdown of regions); secondly after being assigned a group (with the same computer generated ranking) then rank all of the foundation jobs within that group 

Many of the larger deaneries have moved to the two-stage process which significantly cuts down the workload for applicants and technically should allow for more specific location preferencing. Then by mid-April, all applicants will find out the exact job they have been matched to; and the registration and employment checking process begins!

So where to start with ranking your jobs?

Firstly, it is well worth downloading the list of jobs in a spreadsheet so you can scroll through them easily rather than navigating individual details for each job manually on Oriel. You can do this by selecting “Click here to download preferences in an Excel compatible file (.csv)” under the programmes preferencing area on Oriel. Alternatively, lists of jobs can usually be found on the individual deanery websites but Oriel will have the most up to date job information. 

Note that most jobs will be listed 3 times due to different rotation orders (e.g. 1a- Cardiology, General Surgery, Paediatrics; 1b -  General Surgery, Paediatrics, Cardiology; 1c - Paediatrics, Cardiology, General Surgery) so make sure you start by organising in terms of the overall rotations in each job, THEN look more closely at your preferred order in what rotation you would like to start on - we will tackle a bit more on rotation order later on!

Next, you need to think about your priorities! Everyone has different priorities and there are multiple factors you may want to consider when ranking jobs. Click each dropdown to read more:

Location

• If planning on living at home, you may want to start by putting the jobs in the hospitals closer to you at the top for commuting purposes

• You may be staying in the same region you went to university and already have preferred hospitals from your experiences on placement 

• You might be going to a completely new area and want to be in hospitals closer to the city centre; or alternatively prefer a quieter region! 

• It is worth checking to see if rotations are in the same hospitals or how often you have to change hospitals for rotations for continuity of experience as well! For the most part F1 and F2 tend to be at different hospitals, but furthermore can change hospitals within years depending on type of specialty as well.

Type of hospital: teaching vs DGH?

• Teaching hospitals tend to be larger in inner-city and include more niche tertiary services as well which will open up a wider variety of rotations.

• District general hospitals (DGH) tend to be smaller, sometimes rural, which can be more supportive starting out, easier to get to know other F1s and could open up more opportunities for self-development

• To get a balance of both, you could also look at jobs which give you experience in both types of hospitals rather than just one!

Specialties of interest

• You may already know what you would like to specialise in the future so can start by prioritising jobs which include that rotation, or you may have a few career options that you are considering which you would like to explore further and compare. For example if you are interested in surgery, you might be more inclined to prioritise jobs which have 2 or 3 surgery rotations and less medicine rotations; and vice versa! This will be great for building your portfolio for the next stage in your career.

• Similarly, there may be some specialties that you have completely ruled out and are less keen to have rotations in which you can prioritise lower down your list.

Balance of specialties

• If you do not know what you would like to do in the future (which is completely okay by the way!) or simply want a breadth of experience, it is great to have variety! It is usually expected that you will complete at least 1 medical and 1 surgical job, but you may also want to include some others for range of acute/chronic specialties or hospital/community experience such as: A&E/Acute Medicine/GP; Paeds/OBGYN, Psych, Geriatrics, Anaesthetics/ITU

• Furthermore, you might want to think about the range of skills you want to develop and different opportunities that rotations can offer such as A&E/Anaesthetics- more exposure to procedural skills; Paeds/OBGYN - newborn assessments/ C-section theatre time

Rota intensity for work-life balance

• In relation to balance, it is important to think about the likelihood of intensity, whilst you might not know the exact timetable, many acute specialties lend themselves to more out of hours/higher frequency of weekends. You cannot avoid being on-call - they are usually integrated into most medicine and surgery rotations, but if you have a number of these rotations in row, you might want to consider lighter rotations for balance too. Some specialties are supernumerary in F1 so won’t entail any on-calls or nights such as paediatrics, psych, ENT/ max-fax to name a few

• It is important to note that this also has an impact on your pay i.e. the more additional contracted hours/weekends/on-calls you have, the more you will get paid for that rotation. However it is usual to have a mixture of lighter and heavier rotations.

• You might also want to consider how this may affect your ability to get annual leave. You are entitled to 9 days per rotation, with additional days in lieu if you work bank holidays but you can only book annual leave on normal working days and might need to try lots of swaps of on-calls and weekend shifts to get a block of time off for holiday. This will be easier on lighter rotations as well.

Job satisfaction

• Like with all things new, it is useful to get reviews and opinions of those who have experienced them to get a better insight into what it’s really like! You may be lucky enough to know doctors in the deanery you are applying to who can tell you the downlow of their hospital experience. You could also make the most of social media such as LinkedIn, X (using the #medtwitter) or Reddit to find doctors that you can ask questions 

• Another useful way you can use tools such as Messly or Medibuddy who use the results of the GMC national training surveys to give insights into workload, learning, supervision and overall culture, plus competition ratings as well. These tools also contain job rankers which are incredibly useful that you can insert some of your priorities and automates ranking for you to start you out, if you prefer not to manually sort your jobs on excel yourself

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So does the rotation order of foundation jobs really matter?

There are different opinions on this. Technically no, because at the end of the day you will get to do all 3 of those rotations in one year no matter what, but there are some factors you might want to consider. Click each dropdown to find out more:

Portfolio head-starts

• If you already have settled on a specialty you might want to have it earlier on to confirm your interest and also get started on portfolio for that job e.g. start an audit cycle so you can close the loop later in the year or log theatre hours

Pros to starting on medicine/surgery

• You might want to specifically start on medicine or surgery to expose you to on-calls sooner and gain skills earlier on to build on as you progress through F1. It’s worth mentioning that you will only get to shadow your first rotation before starting, after that you will go straight into each rotation with brief inductions so the transitions may be harder for example if you started with psychiatry then going into a surgical block.

Time for adjustment

• Alternatively, you might prefer to start on “lighter” jobs to give you more time to adjust and not be overwhelmed straight away by on-calls or nights.

Enjoying Summer

• Similarly, starting on "lighter jobs", is beneficial to enjoy summer! After all, you are starting in August so might not want to be bogged down too quickly! 

• Also, your 3rd rotation (April to July) leads into summer and may be easier to match up rotas/find time to book holidays with friends/family/partners on lighter rotations where you have less on-calls/weekends.

Christmas/ New Year's

• You also might want to consider what specialty you will have in your 2nd rotation (December to March) as this covers Christmas and New Year’s, so the lighter rotations may not have weekends rota’d in or the heavier rotations will increase your chances of having on-calls/nights in this period if this is important to you.

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Tools to help you with ranking

Excel

• Using Excel or Google Sheets is probably one of the most popular ways to rank jobs as your list of jobs will already be downloaded as a spreadsheet and you can colour code certain rotations or hospitals to help you rank jobs easily.

• Here is a useful guide on conditional formatting so you can do this more automatically to highlight cells that contain certain text rather than going through manually and highlighting yourself. You may want to assign certain rotations a value from 0-3 and so the higher overall value of jobs the more likely it contains more of your job preferences.

Notion

• If you already use Notion, you can import your spreadsheet into a Notion database and create tags/use advanced filters/create ratings based on your preferences to help you rank jobs

Automated ranking tools

• As mentioned previously,  Messly or Medibuddy provide job ranking tools to help do the sorting for you!

• There are also Chrome extensions that you can use to instantly move job preferences into Oriel afterwards (note does contain one-time purchase though!) or alternatively manually drag and drop your list into Oriel afterwards!

Pen and paper

If you are old school, you could use pen and paper but this would be tedious to write out all the jobs; however you might find it useful to jot down your priorities on paper and jot the job codes that link to these perhaps!

Whatever method you use to rank, make sure to give yourself time to review a couple of times before you add them in on Oriel - sometimes a fresh night’s sleep can give you a different perspective! It is wise to rank ALL of the jobs in the deanery group you have been allocated to increase your chance of preferred choices.

We hope you find this advice useful and all the best for your future job allocations! We will be updating our application guides across aspiring medics, medical students and doctors content this year - do not hesitate to reach out for blog requests!

Written by,

Dr Ellen Nelson-Rowe,

Melanin Medics Blog Lead