Causation comes into play here.
Before medical students selected in this way graduate, more than 80% of them change their minds about working as doctors in this country.
Is this because we are selecting the wrong students or because the students themselves come to realise that forging a career in the UIK is extraordinarily competitive.
At the end of FY2, more than 50% choose not to apply for specialist training.
T'was ever thus. Like many before her DD did not decide what she wanted to specialise in, until the end of F2. In order to move smoothly on to training at the end of F2 you need to be very clear from the get-go and start preparing your research and other CV enhancements. You also need to be strategic in your placement choice, so you have a relatively light load for the first couple of F2 placements. DD made the "error" of picking a Deanery still running the old contract and known to be chronically understaffed, and then picking demanding rotations. It means that she has bags of hands-on experience but no time to study and little opportunity to engage in research. The idea was to take an F3. Trouble is that the supply of short term contracts that would allow young doctors time to prepare has effectively dried up under the weight of open international competition. Whilst in the meantime, also affected by both international competition and the expansion in medical school places, application for training has become an arms race. No place for a bright, proficient and capable hands-on doctor. You need the high marks, the research and the competition prizes. Which requires absolute dedication sometimes to the point of selfishness, or good networks (daddy puts your name on his latest academic paper) or you pay. (£32,000 for two years at the BAPIO training school in India becomes a bargain if you get your UK training place.)
This might have been resolved, at least in theory, by recognising that we are not selecting the right people for a medical career and returning to the old system based on academic attainment.
From what I hear, resilience and stamina are also key. F1 was a whir of busy longs and nights. The system may have decided that DD should then go home and study but her survival mechanism is to go for a run or to play sport. She has survived the current and very responsible job, when four more experienced, higher-paid and more senior locums before her failed, because she is resilient. From what she has told me, the F1/F2s most likely to fail or drop out are those who suffer from anxiety. You may well be very academic and great at passing exams but if you are in tears three times before 9.00am you are not going to make it.
The big contrast is Australia who expect their trainees to have had good hands on experience. When googling DDs new employer I found a Reddit post where overseas doctors argued that the UK was a better destination than Australia because Australia expected their doctors to do "grunt work" before progressing onto a specialisation, in contrast to the UKs preference for high academic achievers.
we know that prior academic attainment predicts performance in postgraduate examinations most strongly
It probably does. DD went to one of those schools repeatedly mentioned on this thread and, when she has the time to prepare, can be expected to do herself justice. We also have the means to allow her to take time off or, as is increasingly common, take a Masters degree. Her peers during F1/F2 were mainly graduates of the local, well regarded medical school with quite an academic approach, who like her were applying with plenty of points so got the popular rotations, and importantly want to stay long term in a hard to recruit area. They were probably all within the top 10% of the national cohort but none got into training. What is wrong? There is certainly a mismatch between the medical school emphasis on communication and softer skills and the academic standards expected for the postgraduate exams. I think it is generally acknowledged that some other countries (Hungary being a random example) have much more academic and rigorous medical education. Bright UK doctors need time to catch up on the academic requirements. But equally overseas doctors who have graduated without apparently having seen a patient, also have a lot to catch on. (DDs mantra with her Gen Z F1s is that you can't diagnose from behind a computer screen. With very sick and unstable patients observation is key as their condition can change rapidly.) Should we be shaping our young doctor cohort to ensure they can sail through post graduate exams, or should we be reviewing a process that rewards those who can take a couple of years off to study and those that can buy their research/competition prizes. A London teaching hospital consultant neighbour says they are so exasperated with interviewing those with training numbers who are often un-appointable (as in not able to answer basic questions about their own research) whilst at the same time seeing talented locums and F3s who can't get that training number, that they have started a mentoring programme to help them get through the exams.
Alternatively, the number of medical school places could be increased in the hope that more of them might stick around afterwards.
Young doctors are not mud! The problem now is that due to the changes in immigration law those that want to stick around just can't. They can't compete with overseas doctors with a decade or more of experience, motivated by expedited family settlement rights, who are applying for and getting entry level jobs. I doubt there is any evidence that overseas doctors are better educated than UK ones. Some are good but others are worryingly weak. One was notorious for having to ask F2s for help. He apparently didn't know even basic things like treatment options for a patient who also had diabetes. DD had cause to raise concerns about another, to discover he had already been "moved on" from five other Trusts. There are also weak UK educated doctors. But that is not the point. In general the UK cohort is competent and able to hold down entry level staff level jobs. They should be given a least a level playing field when it comes to applying for jobs.
There are only 2-3000 GP and consultant retirals each year - which determines the number of speciality training posts - and 10,000 medical graduates each year, which will rise to 15,000 in the next few years.
I had actually thought 20,000 doctors were graduating each year, with 10,000 without work at the end of F2.
Regardless, is it sensible to fully open up our training to full overseas competition. There is a tradition of the NHS training overseas doctors but things have changed a lot since the 60s when those that came either stayed or used their education to make an important contribution in their own countries. UK training still has a cachet but there are so many well-paid consultant opportunities elsewhere that a much smaller proportion can be expected to stay.
We also have an uneven distribution. Training selection is undertaken nationally and the matching jobs are carefully counted out across the country. Ambitious high flyers, having got through selection, normally prefer training in big teaching hospitals with lots of research and international prestige. In one speciality requiring eight years training, DDs hospital had 16 training positions, ie 2 per year. Eight were vacant, leading to a two year wait for urgent referrals and consultants having to spend one night in four on call. High fliers will either wait for a job to come up in a more attractive deanery, switch during their training, or international graduates may decide that if they can't get the London teaching hospital they will go elsewhere and forfeit their place. In the meantime the department had good F2s they couldn't hire.
Realistically not everyone wants to be, or should be, a consultant. The NHS recognises this in their Specialty, Associate Specialist, and Specialist Doctor pathways, which would seem the obvious way of filling jobs in hard to recruit specialities or areas. DD seems to be covering an Associate Specialist role adequately, despite only foundation training and no prior experience of the speciality let alone the sub-speciality. Yet there is next to no chance, given the level of international competition, that she or her peers could land even an entry level job there. In 10, 20 or 30 years time we will realise we needed them and wonder where they went.
So like Cambridge we happily tell ourselves that achievement does not matter and that doctors from anywhere in the world are just as good as ones trained here. We know productivity is falling. Are standards slipping as well?
Consultants, including those who wrote her references, are telling DD that her Australian experience will be amazing. It is an area where the Australians are considered very strong with up to date equipment and organised hospitals. She likes the idea of working in a functioning health service, rather than one which is forever fire-fighting. Truth is though, that despite the huge investment, the NHS is not concerned about retaining her or her peers.