Different pathways into the modern medical profession

With the Foundation Programme set to be oversubscribed due to increased demand, Sarah Morrison looks at what the future holds

James Norman, 29, gained an undergraduate degree, a Masters, and then worked in the City before deciding to become a doctor. Yet as medical graduates face the possibility of unemployment for the first time in the NHS training scheme's history, it seems that there is no longer only one preferred pathway into the medical profession.

The British Medical Association (BMA) anticipates that the number of applications for this year's Foundation Programme, the two-year paid trainee placement that graduate medical students take to become registered doctors in the UK, will be oversubscribed owing to increased demand from applicants outside the country.

While a BMA spokesman said postgraduate training was in "flux", he added that they are working on a "contingency plan" with the Government to ensure every medical graduate gets a place on the programme. Dr Stuart Carney, the deputy national director for the UK Foundation Programme Office, said graduate medical students must now pay more attention to their application than ever. "Hopefully, every graduate will get a post this year, but the bottom line is that the current application for the Foundation Programme is going to be very competitive," he said.

The majority of students enter the workplace-based training from a five- or six-year undergraduate medical degree. However, in recent years, there has been an increased number of students entering from one of the UK's 16 accelerated graduate-entry courses.

Norman studied microbiology at the University of Edinburgh and immunology at Imperial College London (ICL), because it was not until his mid-twenties that he realised he wanted to enter medicine. Yet, with more than 10 per cent of all pre-clinical medical students in 2008/09 entering medicine through a four-year graduate-entry course, it seems that he was not alone in his indecision.

"I found my first degrees fascinating, but it was hard to see whether what I was doing was helping people," said Norman, who is now on a Foundation Programme after finishing his four-year medical degree at the University of Nottingham in July.

"I have always been good at cramming for exams... but going through Edinburgh and Imperial meant that I was more emotionally mature starting my medical degree."

In fact, around half of the 31 UK medical schools now run fast-track courses for graduate applicants, with the University of Warwick and Swansea University choosing to offer medical degrees only for graduate students. Top of the range include universities such as Oxford, Cambridge, ICL, Nottingham and the University of Edinburgh, but all have varying admission policies for graduates.

Universities such as Oxford and ICL dictate that the student's first degree must be in a relevant subject, such as biological sciences, while Cambridge accepts an upper second-class degree in any subject. Spaces on courses can also vary, with Oxford hosting just 20 positions while Nottingham has 93.

While graduate-entry students save a year or two off the standard course, all students finish with the same qualification after completion. To continue into paid training, students must apply for one of the generic placements – which form the bridge between medical school and specialist or general practice training – and were previously guaranteed to all.

Situated in more than 20 geographical regions around the UK, the foundation years occur in clinical environments and they are typically made up of six four-month placements in a range of specialities.

All graduates rate their regions in preference, and apply either for a standard placement or for an academic one, which can include four months of academic training.

Will Muirhead, 26, is in the first year of his Nottingham-based programme and describes his placement as "a way of formalising the skills and knowledge acquired during the first two years of medical practice – which is stressful and a bit scary at times, but ultimately really rewarding".

Some students, such as 23-year-old University of Edinburgh student Sarah Mann (not her real name), who is about to apply for her Foundation Programme, take "intercalated" undergraduate degrees, where they take a year out of their medical programme to qualify in another scientific degree, not only to broaden their knowledge but also to add valuable points to their applications.

"I hope that I get a job, and haven't really considered that I wouldn't," said Mann, who is in her sixth year at the University of Edinburgh, after studying for a reproductive biology BSc in her third year.

"My first choice for a placement is in Severn, but I don't really mind where I go. In a way, I know that it will be fine wherever. You might not do exactly what you want, but it might just send you down a different path altogether."