Is the educational performance measure a fair way of assessing candidates applying to the United Kingdom Foundation Programme? [Letter]

Dear editor

We read with great interest and are in agreement with the article by Ismail and Patel¹ who have highlighted the potential issues and pitfalls in using a situational judgment test (SJT) when stratifying medical students for the first stage of their postgraduate medical training. We would like to bring to their attention an equally important assessment in the application process, the United Kingdom Foundation Programme (UKFP).

Applicants of the UKFP must complete the Foundation Programme Application Service (FPAS). The FPAS is composed of 2 parts where the SJT forms only 50% (50 points) of the obtainable score. The other 50% is obtained from applicants’ educational performance measure (EPM) which, like Ismail and Patel¹ suggested with the SJT, has inherent flaws and shortfalls. The EPM is calculated in three parts where the majority (43 of 50 points) is calculated on the applicants’ performance at medical school. This is not standardized and potentially subject to great variability as UK medical schools have yet to adopt a standardized undergraduate medical exam such as the USMLE utilized by their counterparts in the United States and beyond. A further maximum of 5 points can be gained depending on the level of additional degrees an applicant has with a PhD giving 5 points down to 1 point given for a 3rd class BSc. Finally, 1 point can be given each publication that has a PubMed ID up to a maximum of 2 points. Again, there is a massive variability and bias in this part of the EPM as it does not account the type of publication (e.g., original research, review article, case report or letter), the impact factor of the journal or the location of the applicant’s name on the author list. This type of indiscriminate scoring on an applicant’s publication record has led to the term “PubMed” fever among medical students with its associated ailments and detrimental academic consequences.^2,3 On the flip side, it is interesting to note the main determining factors for applicants when ranking their preferred UKFP is not the institutions academic prowess or specific specialities offered but instead its location and how it will impact on the applicant already established social relationships.⁴

The SJT is the only part of the UKFP application process that acts as a standardized barometer of a prospective Foundation Trainee’s clinical potential. Additional degrees vary in academic rigor and for some medical schools are a mandatory entry requirement or component for the course. The prospect of standardizing all undergraduate assessments may seem a tall feat, but this has already been achieved with the SJT and National Prescribing Assessment. In order to achieve parity between medical schools through EPM, we propose that all assessments used for EPM are standardized nationally in order to prevent inequity between medical schools.