Ranking Foundation Jobs

If you’re worried about not getting your top choice, you shouldn’t worry. It doesn’t affect your future career and wherever you will go, given everyone is in the same boat as you, you will enjoy & make friends!

It does not make it any easier to rank jobs for F1 when applying through FPAS & Oriel. You’re usually presented with a massive excel spreadsheet with no knowledge of how the hospitals are, what jobs to do and what impact this will have on your life.

In this article, we will provide you with some excellent information generated from the advice of many F1s before you! Please feel free to ask as many questions as you have! If you want to ask specific questions about individual hospitals or jobs, you should ask on the Facebook Groups for this year or on Discord.

The easiest way to rank the jobs in a fair & scientific way is to score your priorities.

Your priorities could be commute time, location, hospital and job. However, it helps to apply a score to each of these to provide some sort of mathematical way to rank the jobs. Start by thinking about what you must have & what you would definitely do not want in each of these categories.

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Commute & Location

How is commute time important?

A long commute time (>45 minutes) can be extremely tiring when you’re working on calls but also may be unsafe to travel when you’re working long hours between shifts. Importantly though, hospitals should all provide you with a room to stay overnight should you feel unsafe traveling home. A longer commute time may be preferred by some people than the expenses of having to move house or live away from friends & family. A further thing to consider is whether you will be using public transport or driving. Public transport offers the advantage of being safe even when you are exhausted but can be unreliable & impossible when shifts finish late.

What things are important about the location?

Factors to consider are how expensive accommodation & living is in the area, your commute time & whether you can continue the things you like to do. You may find it important that there is a gym or swimming pool nearby for example.

To get an idea of living & renting costs for the UK we really like numbeo.com.


Which hospital(s) should I work at?

It is really difficult to know what the different hospitals are like. You can use the GMC national survey where trainees score different aspects to guide you. Messly has a pretty cool training navigator which displays this information in an easier-to-read format. For F1s, important things are often the amount of supervision, workload, how supportive the environment is, rota design & the facilities. The problem is this changes across jobs in a hospital & because the senior staff who support you change too as they rotate.

Other factors to consider are whether you should stay at the same hospital for both years & whether it is a district general hospital or a teaching hospital. The benefits of staying in the same hospital are the ability to get more involved in leadership, quality improvement projects or audits, setting up teaching programmes or working with seniors on presentations & publications. Additionally, without having to re-learn a new system, you can spend less time learning how the hospital works and more learning how to be a good doctor. However, the disadvantages are that you have a more limited understanding of how clinical practice varies in different places and can work in very similar job roles (e.g. acute medical rota). The other issue can be that you’re stuck in the same place even if you dislike it.

Finally, consider whether the hospital uses electronic systems (if you struggle with paper documentation), the mess facilities, hospital canteen & the general atmosphere of the hospital.

Overall, there is no one size that fits all so think about what matters to you & ask F1s from the previous year via last year’s Facebook groups for the most up-to-date information.

Should I work at a DGH or teaching hospital?

When considering whether to work in a DGH or tertiary teaching hospital, it can depend on the jobs you’re doing. Very specialist units can be very top-heavy with the consultants or registrars making all the decisions. This can mean you get a wealth of experience in seeing how complex cases can be managed but may get very little experience in managing the average patient you’re likely to have to manage independently in the future. However, those that have an associated A&E can mean you can get the same experiences of managing patients yourself. In DGH settings you often have more abilities to do procedures or get involved, but it can also be very busy, stressful & challenging in some hospitals.

There are no set rules on whether it is better or worse to work in a DGH/teaching hospital first, second or at all. The training system as a whole over the two years will provide you with plenty of useful & helpful experiences for the future. If you’re unsure which to do first, consider which of the factors above appeal to you more at FY1/2.


Which jobs should I pick?

Firstly, recognise that whatever jobs you do – you will end up with a common set of competencies that allows you to apply to anything. No jobs are “must-haves” as you can apply to any career you’d like to in the future regardless of what you’ve done during your foundation years. This is even more true these days for the following reasons:

  • Most deaneries allow for a swap shop where you can ask for rotations or years to be swapped (don’t rely on this & check our own HEE deanery page for details on the local process!)
  • You can do tasters during FY1/2 in any specialty you like
  • FY3 years allows you to explore specialties you’ve missed out on
  • You can always change your career down the line (as many do). Therefore you can do a specialty training year or clinical fellow post in any specialty and then leave if it doesn’t meet your expectations

It is important to get a nice balance of different specialties including medical and surgical jobs so that you are comfortable managing a range of patients.

Busier jobs include those with acute components (acute medicine, medical jobs with on calls, surgical jobs) but these can often be wonderful learning opportunities. Quieter jobs are often those that are super specialised where you aren’t necessary for providing the service (i.e. supernumerary) such as ENT, anaesthetics or ITU as an FY1.

Finally, ensure that you rank all the jobs to avoid losing out on having no job at all. That being said, if you know in which decile within the deanery you fall, then you can assess whether you need to rank every job. If you’re in the bottom decile, still ensure you rank jobs in your order of preference as your top choice may be an unpopular choice among others.

Messly does have some analytical data on their website which showcases which jobs are harder than others and which specialty has the happiest foundation trainees which you could read.

How is X job or Y hospital?

The ways to go about answering this are reviewing the GMC training survey outcomes, using Messly’s training navigator or asking on the foundation school groups for the previous year on Facebook and also discussing things on other social media sites (see below).

Does the order of jobs matter?

The simple answer is no. The advantages & disadvantages vastly vary. Doing “easy” jobs at the start might provide you with the time to get settled in and socialise, doing “easy” jobs later might give you time to work on your portfolio or exams. You might already have long-term career plans and therefore may want to do a certain job early to confirm your interest. Ultimately though, it makes no difference.

What if I start on a job where I’m supernumerary such as Psychiatry?

Some doctors may fear starting on a job with no on calls because they fear it’ll poorly prepare them for their second job when their peers will be far more confident managing medically unwell patients. There are many such jobs, but rest assured that this has been the case for many years and it isn’t an issue! Senior doctors are aware that their F1s abilities will be different, not only because of the jobs they’ve done before but also the things their medical school focussed on & other factors. For these reasons, we will support you as much as you need and expect you not to all be identical. In fact, every time there is a rotation, it takes a few weeks for the new juniors to get used to how everything works.

What do specialty jobs involve?

ENT, palliative medicine, obstetrics & gynaecology, dermatology and others are quite specialist jobs. These jobs often offer a vastly different experience in FY1 compared to FY2. In the former, you are frequently supernumerary and therefore benefit from the wealth of opportunities in observation and help with completing administrative tasks. In the latter, you are often placed alongside training (GP or specialty) SHOs, expected with extra support to take and assess referrals. Doing specialties in FY2 can therefore be incredibly rewarding but also challenging.

Do I have to do A&E to be able to locum during FY3?

No. First of all, you can locum in any specialty, especially general medicine where there are usually so many posts available and generally it is less stressful. Whilst it is true that some places will only hire those that have A&E experience, this is easily achievable through locums in hospitals where they are quite desperate for any doctor. After this, you can locum in A&E in your chosen hospital if you really want to. Nevertheless, A&E is an excellent rotation where you are challenged to become a competent doctor and I would highly recommend it!

Should I do GP?

It is important for every doctor to appreciate how challenging it is to be a GP. Differentiating between the emergency and the benign symptoms is incredibly challenging without investigations. Furthermore, having a comprehensive knowledge of every specialty is admirable. However, many doctors will become GPs without any previous GP experience. You can always do a taster week or talk to the many GP trainees that you will be working alongside.

Should I do the specialty I am interested in doing long term?

Doing the specialty that you’re considering long-term can be really helpful to ensure that you truly do love it. Try to do the specialty either late in FY1 or early in FY2 (if you’re planning on not taking an FY3). Specialty applications begin in November of FY2 meaning any later and it’ll be after you’ve already applied!

However, if you’re absolutely sure that you want to do a certain specialty, it makes sense to broaden your experiences by doing other things. For example, as an endocrinologist, it was key for me to obtain experience in gastroenterology, cardiology, respiratory and other specialties so I felt more confident with managing the medical take. Similarly, at your interview, you can discuss how doing specialties outside of the one you’re applying to ensures you are well-rounded and the best candidate for the job!

It is important, however, to consider that Anaesthetics/ACCS favours applicants who have related clinical experience. Therefore you get more points for your specialty application if you have more rotations in the relevant jobs. Similarly, for core surgical training, those with some days spent in surgery having observed some cases in theatre are favoured. Ensure you review the “Self Assessment Criteria” for whatever specialty you plan to apply to.

What if I get jobs I really dislike?

This is a distinct possibility because you may not get your top choice and even if you do, the job may not be what you are expecting of it. We are all different and therefore even if you pick a job others have liked it may not be ideal for you and vice versa.

If you don’t like a job, recognise that it is only for 4 months at an absolute maximum so don’t panic or worry. You can attempt to organise a swap, but even if you can’t – you may find you actually do enjoy the job. If not, try to introduce an aspect you do enjoy by also building your portfolio. For example, an FY1 who absolutely hated their surgical job set up a bedside teaching programme for medical students and a lecture programme where the medical team taught surgical doctors about common medical issues affecting surgical patients. You can get involved in QI projects, leadership opportunities and many other things you find interesting.

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16 thoughts on “Ranking Foundation Jobs”

  1. “Make sure you rank all the jobs depending on where your score is within your deanery.”

    Why? Surely it makes absolutely no difference? You get allocated according to rankings, so surely this makes absolutely no difference at all?

    It’s not like if you ranked average and put a mediocre choice first you’ll be more likely to get it compared to if the mediocre choice was your 100th preference

    1. Hey Samuel! By this what I meant is if you’re in the top 10% you don’t need to rank 100% of the jobs. I am not commenting on the order of preferences which of course is exactly as you say. I’ll rephrase for clarification. Thanks for flagging it up!

    1. Supernumerary means a job where you aren’t required. For example, if you were only there to observe and learn or complete documentation. In these jobs, you aren’t on an on call rota and you typically never manage patients on your own. These jobs may include anaesthetics, obs & gynae, paediatrics, psychiatry and others – but this varies by hospital. In contrast, medicine & surgery you are essential to the service providing on call cover for patients and escalating patients as required.

  2. Is there any difference in doing Obstetrics and Gynaecology as an FY1 than an FY2 or does it depend on the hospital?

    1. It does depend on the hospital. However, usually FY2s are added to the SHO rota where they additionally cover maternity triage, complete postnatal checks, more frequently assist in theatre, do night shifts, more commonly are added to the clinic rota. They will also often attend maternity crash calls and help manage these.

  3. If I do jobs like paeds, rheumatology and surgery in FY1 does that mean that:

    1. I won’t be prepared for what’s to come for things like medical ward covers in FY2?

    2. I will have a lot more things to get signed off in FY2?

    1. Excellent question! The short answer is that you’ll be absolutely fine. Rheumatology is usually an inpatient medical job which is very similar to any other general medical rotation. Even if it weren’t, FY1 prepares you to work in a hospital & do admin efficiently as well as pick up some skills for looking after patients. There is always a steep learning curve for FY2 for everyone – so don’t fret that you’ll be alone in this. Your colleagues will also have to learn how to manage medical ward covers in FY2s. As seniors, we know this can be challenging, so in the first few weeks, we should provide you with extra support. Finally, the foundation curriculum is designed to help support you obtain the same generic competencies regardless of rotations. You will have opportunities to get sign-offs during teaching sessions & they will prepare you for FY2 by teaching you the core parts of the curriculum.

  4. Currently ranking jobs for Severn deanery and all 6 jobs in the sets I like are based in the same hospital. Is this disadvantageous? Particularly in terms of picking up locum shifts at other hospitals in the deanery?
    I’m also finding that no single set has my perfect bunch of rotations (surprise surprise!)…do you have any tips on how to compromise?

    1. Great question! Advantages of staying in the same hospital are longer QI projects, leadership opportunities, contacts & knowing the system therefore you’re more efficient. Advantages of changing are differences in pathologies/exposure to specialties, different seniors to learn from and if by chance you don’t like the hospital you’re not stuck there for 2 years. Once you are fully registered after FY1, you can very easily work anywhere – don’t worry about being in the same hospital.

      I really wouldn’t worry about this. They are by design not a perfect bunch as they need to cover the entire FY curriculum and skills. I’d recommend priorising your favourite jobs in FY2 – this is where you have more independence so having an interest or enjoying the job makes this much better. In FY1, many of your tasks are administrative whatever the job you do – so if there are jobs you don’t like do them in FY1. But if you’re planning on applying straight through to training, note that you apply midway through your first rotation in FY2.

      Finally don’t forget to watch the webinar if you want more information 🙂

  5. Hi there, thank you for the webinar it was very helpful 🙂 I have scored pretty low in my current foundation deanery, probably towards the 10th decile. Do you happen to know whether jobs then to go based on best location first, with the last few jobs all tending to be in the same hospital / town, or do they tend to go more evenly distributed with there still being jobs in different locations left when the last decile gets to chose jobs? Appreciate this is a tough question and may well not have an answer for it!

    1. Hi! I’m really sorry to hear that. You should still rank them in the order that you want. The jobs go based on ranking order so you’ll get the first available in your list, but I do appreciate it is likely you’ll get something at the bottom of your list. That said, it is also completely possible that people might not want the job you want because it isn’t their favourite location. If you’re unsure how to rank the order – I’ve got some excellent tools in the webinar that you can use & you can ask on Facebook about the jobs.

  6. Hey! I have noticed that there are Psych Fellowship Foundation or foundation priority programs on the list on oriel for ranking, are we allowed to rank these if we had just gone for the normal foundation application? Thank you 🙂

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