For many final-year medical students, finding out where you will begin working as a doctor is one of the most impactful moments of medical school. Your foundation programme allocation shapes where you live, the hospitals in which you will work and the specialties that you will experience. This is why the upcoming review of how foundation programme places are allocated is so important for medical students and resident doctors. 

How is this decision currently made? 

Foundation programme recruitment is coordinated by the UK Foundation Programme Office (UKFPO) across England, Scotland, Wales and Northern Ireland. Since 2024, places have been allocated through a system known as Preference Informed Allocation (PIA). Applicants are first allocated to a foundation school, determining the geographical area in which they will work, and then to a programme, which determines their hospitals and clinical rotations. 

There are several groups to consider within this allocation process: the main group of applicants, those eligible for pre-allocation, applicants who choose to link their applications and applicants who are matched through other schemes. Here I’m focusing on the main allocation process. 

 How has allocation happened historically? 

The way in which newly qualified doctors are allocated to their first jobs has changed many times over the past two decades. 

When the foundation programme began in 2005, applications were limited to specific geographical areas linked to a student's medical school. 

In 2006-7 a national application scheme was introduced, using academic ranking alongside competency-based ‘white-space questions’ (WSQs) to allocate posts, taking applicants’ stated preferences into account. 

Yet another change came with the introduction of the Educational Performance Measure (EPM) and Situational Judgement Test (SJT). From 2013, these measures were combined to form a total score used to rank final-year students nationally, which, alongside preferences, determined allocation. The EPM reflected performance at medical school (a student's decile ranking in their medical school cohort, with additional points for degrees or academic publications), while the SJT was a 2-hour computer-based exam to assess judgement in scenarios relevant to future work. 

The applicants who ranked highest in EPM + SJT scoring were allocated to a foundation school on the initial allocation day. Those below a cut-off point were placed on a ‘reserve list’ and allocated to foundation schools as places became available around the UK, either through withdrawals or the creation of new posts. More recently, following BMA pressure to give applicants greater certainty, the reserve list was replaced by a placeholder system. This guarantees every applicant a foundation school place on the same day, although those given a placeholder must wait for a post to become available within that school. Placeholder posts are not a consequence of any application system and have been used in conjunction with both the EPM + SJT system and the current PIA system. 

In 2024, the allocation system changed again. Following a national engagement exercise, the EPM and SJT were removed from the allocation process and Preference Informed Allocation (PIA), using computer-generated ranking, began. This change was supported by two thirds of medical student respondents that participated in the stakeholder engagement exercise, and given qualified support from the BMA on the basis that it was a temporary solution ahead of a more detailed review. 

How does PIA operate? 

Applicants rank the 18 foundation schools across the UK in the order in which they wish to be allocated. At the point of allocation, every eligible applicant remaining in the foundation programme process is assigned a randomised computer-generated rank by Oriel (the official online application portal). This rank is not informed by performance at medical school. 

The PIA algorithm then uses a two-pass system designed to allocate as many applicants as possible to their first-preference foundation school. More detailed information on PIA can be read here. 

PIA has been used for three years and UKFPO has confirmed that this allocation method will continue to be used for the 2027 application cycle. 

The main way this differs from the EPM + SJT system is that the random computer-generated rank is used in place of an EPM + SJT score. PIA and EPM + SJT are both preference-based systems using different ways to create the ranking system that intervenes when a particular foundation school has fewer places than the number of applicants who wish to be allocated there. 

Possible alternative approaches for allocation 

In the current PIA system, preferences are considered alongside a computer-generated rank that is independent of medical-school performance. 

A merit-based system, such as in the previous EPM + SJT system, could instead use measures of performance or achievement to rank applicants, with that ranking considered alongside their preferences. 

Unlike the preference-based PIA and EPM + SJT systems, a local allocation system could instead prioritise applicants’ medical school location, leading to a stronger link between medical school and foundation training, and giving graduates greater opportunity to remain in the region in which they studied.  

While a local system may require some refinement for regions where medical school places heavily outweigh foundation school places, such as London, these approaches do not necessarily have to be mutually exclusive. A future system could combine elements of preference, performance and geographical continuity. 

Have your say on foundation programme allocation 

The BMA medical students committee survey now is open to all medical students, and resident doctors who have been through PIA. The survey closes 31 October. We want to understand your priorities for allocation, your experiences of the current system and your thoughts on future developments. The question is broader than whether PIA should stay or go, we wish to know: what should a foundation programme allocation system prioritise, and what factors should determine where a newly qualified doctor starts their career? 

Whether you are yet to apply or have been through PIA yourself, please take our survey and help shape our position on the future of foundation programme allocation.