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Evaluating the validity of the selection measures used for the UK’s foundation medical training programme: a national cohort study
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    The Inverse Care Law and the UK Foundation Programme

    Dear Editor,
    I read this paper on the UK Foundation Programme with interest (1).
    The authors state that graduates with high scores relating to educational performance, additional educational achievements and the situational judgement test were more likely to complete foundation training. Of course, the ranking process used by the UK Foundation Programme means that those in receipt of high scores are more likely to work in their desired location and specialties. Conversely, doctors with low scores are more likely to receive jobs in undesirable locations. It is unsurprising that such doctors are less likely to complete foundation training. As Caroline Elton (2) writes:
    ‘More highly ranked students are likely to choose those programmes where students felt better supported and better trained, whilst weaker students are left to take whatever is left over… [they are also] more likely to end up working in parts of the country where they know absolutely nobody, and have no accessible systems of support. This is an educational variant of what GP Dr Julian Tutor-Hart famously termed the “inverse care law”’.
    It would be difficult, and likely unpopular, to remove the meritocratic nature of the ranking system used for selection to foundation training. The Foundation Priority Programme (3) may attract higher-ranking students to locations that usually experience recruitment difficulties, which could improve working environment at these locations. However, without...

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    Conflict of Interest:
    None declared.