Foundation job allocation in the UK

Newly qualified doctors in the UK complete two years of general postgraduate training after medical school—the foundation programme.1 In March 2024, a major change was made to job allocation, with a switch from performance based selection to preference informed allocation. Preference informed allocation combines medical students’ preference for particular regions and jobs with a randomly assigned ranking.2

The change has introduced a further dimension of uncertainty to UK’s newest doctors when the NHS is already under pressure from increasing demand,3 insufficient funding,3 poor workforce retention,3 and industrial action.4 In a recent cross-sectional survey of over 10 000 UK medical students, roughly a third (3392) reported that they were already considering moving abroad.5

Preference informed allocation is the latest attempt to make the allocation of roughly 9700 foundation programme jobs fairer across the UK.6 Every foundation programme applicant (typically final year medical students) ranks the different training regions (called foundation schools) in order of preference.7 An algorithm then lists the students in random order. Starting at the top of the list and working …