Changes to SFP – AGAIN
Dear Friend,
I hope you are having a lovely week. Best of luck to those of you starting your new academic year this week. With medical school being 5 to 6 years long, it is possible to get overwhelmed in the medical student bubble, and sometimes even forget the end goal, which is graduating as a doctor. From personal advise, I’d say that the final few years (clinical years) usually go by very quickly and before you know it you will find yourself as a foundation doctor on the wards.
Many of you will be aware of the changes to the foundation doctor allocation process. If you want a refresher, check out my blog explaining how the Preference Informed Allocation system works here. This algorithm has formed the basis of applications for the last year – for both normal foundation posts and the specialised foundation programme (which used to have a separate application process). Whilst this has removed the stress of exams and doing the SJT, it also means that students had no control over their ranking (which is computer generated) and some students by no fault of their own have ended up getting their last choice and being very far away from friends and families.
After a backlash from students, there has now been another change in the application process FOR SPECIALISED FOUNDATION PROGRAMME students only! It is definitely worth knowing about.
1/3 of places reserved by medical schools
The new announcement is that 1/3 of SFP places will now be available to students from that associated medical school.
Medical school students in England who have demonstrated to their medical school that they have the interest, aptitude and commitment to pursue a career in academia, leadership or education will be able to apply through their medical school for an SFP post in the Foundation School linked to the medical school.
This means if you go to Imperial medical school, you will be able to directly apply to a limited number of SFP posts that would be at the associated trust, Imperial College NHS trust. These few posts will only be available to students of Imperial College so you will be competing against students of your own university, rather than students around the country.
The Foundation School have not yet released the criteria which will be used to select students, but we can imagine that it will be based on number of publications, presentations, prizes and possibly an interview (similar to the previous application process).
Keep in mind that the remaining two thirds of SFP posts will be managed by NHS England through the preference informed allocation process (PIA). For these posts, you still will rely on a computer generated rank.
Is it fair?
In my opinion, this move to reserve 1/3 of the SFP post is a bit confusing. Either all the posts should be in the preference informed allocation system, or it would make sense to go back to the previous system where there was a separate application process for these posts, which are designed to give students a glimpse into academia.
It also seems peculiar that you can only apply to your medical school associated trust. I went to Cambridge university, and though I loved it, by the end of 6 years, I really wanted a new challenge and to move to London. I feel this move disadvantages students who may want to move elsewhere for foundation training.
I feel happy that these decisions about whether to apply and how to rank my deaneries are behind me. Though I am not out of the woods yet, this year I will be applying for my oncology specialist training, and so will also be hoping to get an oncology job in an area I want. Just one of the challenges of being a doctor.
I hope you found that useful. There is still time to apply so don’t miss out on this opportunity.
Drug of the week
Dostarlimab (Jemperli)
Dostarlimab is a type of immunotherapy known as a ‘checkpoint inhibitor’, which works by attaching to a specific protein (PD-L1) on the surface of the cancer cells, helping the body’s immune system to detect and attack them
Dostarlimab was approved for the treatment of endometrial cancer in both the United States and the European Union in April 2021
It can also be used for some solid tumours and colorectal carcinoma.
Immune-mediated adverse reactions can occur including pneumonitis, colitis, hepatitis, endocrine disease (endocrinopathies), and nephritis
A Brain Teaser
A 30-year-old woman who works as a computer programmer presents to the clinic with a request for referral to psychiatry. She has a longstanding preference for solitary activities and displays a lack of interest in forming close relationships, which has been apparent since her early teens. Despite performing well at work, she interacts minimally with others, and demonstrates limited emotional response when given feedback. There is no history of odd or magical thinking, unusual behaviours, hallucinations, or significant periods of mood elation or depression.
What is the most likely diagnosis?
A: Avoidant personality disorder
B: Schizoaffective disorder
C: Schizoid personality disorder
D: Schizophrenia
E: Schizotypal personality disorder
Answers
The answer is C – Schizoid personality disorder
Schizoid personality disorder is the most appropriate diagnosis for this patient given the options presented. It is defined by a consistent pattern of detachment from social relationships and a limited range of emotional expression in interpersonal contexts. Individuals with schizoid personality disorder often prefer solitary occupations, show little interest in forming relationships, and usually do not experience intense emotions. Unlike schizophrenia or schizoaffective disorder, they do not present with psychotic symptoms. The patient’s indifference towards her lack of social connections and her preference for solitary pursuits are indicative of schizoid personality disorder. Autism spectrum disorder should also be considered as a differential diagnosis in this case.
Avoidant personality disorder is characterised by chronic social inhibition, feelings of inadequacy, and an extreme sensitivity to criticism or rejection. Patients with this disorder generally have a desire for social interactions but are inhibited by their fear of being mocked or rejected. In contrast to avoidant personality disorder, the patient described does not express a wish for social engagement nor does she exhibit the anxiety about social rejection that typically accompanies avoidant personality disorder.
Schizotypal personality disorder shares some features with schizoid personality disorder but also includes unusual beliefs, magical thinking, and peculiar behaviours that may be mistaken for the positive symptoms seen in schizophrenia. These individuals might hold beliefs in special abilities such as telepathy or display excessive superstition, and they can experience transient psychotic episodes when stressed. This patient does not demonstrate either unusual behaviour or psychotic features.
Schizoaffective disorder is an incorrect option here. Schizoaffective disorder involves both psychotic symptoms (similar to those observed in schizophrenia) and significant mood disturbances (either major depressive or manic episodes similar to those seen in bipolar disorder). The distinguishing factor from schizophrenia is the presence of mood symptoms that are prominent and persistent over time. This patient’s history does not include any significant mood disturbances or psychotic features.
Schizophrenia comprises a spectrum of symptoms such as delusions, hallucinations, disorganised speech, severely disorganised or catatonic behaviour, along with negative symptoms like emotional flatness or lack of motivation (avolition). A diagnosis of schizophrenia requires these disturbances to significantly affect one’s ability to function socially or occupationally. The patient in question does not display these symptoms and appears to maintain occupational functioning.
