A random number generator to determine where one works and which jobs they have during foundation training continues to cause uproar amongst medical students, with the current cohort of F1s, myself included, having been guinea pigs to this system. Although the new system does consider preferences and has enabled more people to be given their first-choice deanery (1), it has still left many with unwanted jobs.
It is important to note that the previous system was not flawless, which focused 50% on deciles/ academic achievements and 50% on the situational judgement test (SJT), however many described the SJT as an unofficial randomiser with a wide error of measurement (2). Therefore, the challenges of an aspiring paediatrician not having a paediatric foundation post has been an ongoing issue, albeit exacerbated by the new system. Looking at the Severn Deanery, where I work, for 2025/26 there are 92 foundation jobs in paediatrics, meaning 77% of foundation trainees will not have a paediatrics job.
Those who are considering paediatrics but do not have a foundation job in it can apply for taster days in the speciality, with 5 study leave days available across F1 and more across F2. Career planning is a key part of the portfolio for foundation doctors. It may also present a good chance to find paediatric themed audits. Foundation trainees can also look to maximise paediatric exposure in their current specialities where possible, for example I am on urology, and there is scope to attend paediatric urology clinics or theatres.
Although not having a paediatric foundation job does not pose a disadvantage for ST1 applications (3), many understandably feel the need to ‘try before you buy’ and as I am realising during my foundation training, an experience of a speciality at medical school can be very different to working in it. So, although I loved being a student in paediatrics, it can be difficult to know if that would translate into enjoying working as a paediatrician, particularly having spoken to older consultants who highlight the previously high attrition rates during paediatric training.
I believe RCPCH could look at increasing paediatric themed F3 posts (especially due to the ‘F3 phenomenon’ from 17% in 2010 to 65% in 2019 (4), with most looking to enhance their CVs in this time) or adopting a similar approach to RCPsych’s previous ‘Psychiatry Foundation Fellowship’ with development days organised by the college throughout F1/F2 to enhance understanding of paediatrics and what a career in the speciality could entail. It could offer a good opportunity for networking with peers and paediatricians, as well as for mentorship. The RCPCH website has fantastic resources and awards/ essay competitions aimed at aspiring paediatricians. Further access to a free RCPCH hub aimed specifically at foundation trainees with modules, podcasts (like the fantastic pre-existing ‘The paeds round’) and articles to keep up to date with exciting developments in paediatrics and new research could be of benefit. I believe these steps could help raise the next generation of paediatricians.
References:
Comparison of Foundation Programme Allocation results. Available at: https://foundationprogramme.nhs.uk/wp-content/uploads/sites/2/2024/03/Comparison-of-FP-allocation-results-.pdf (Accessed: 12 January 2025).
Sam, A.H. et al. (2023) ‘The Situational Judgement Test: Not The right answer for uk foundation programme allocation’, Clinical Medicine, 23(6), pp. 647–648. doi:10.7861/clinmed.let.23.6.4.
ST1 paediatrics applicant guidance. Available at: https://www.rcpch.ac.uk/sites/default/files/2024-10/st1_paediatrics_applicant_guidance_2025-26.pdf (Accessed: 12 January 2025).
UK Foundation programme office, 2019 F2 career destinations survey, 2020
