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NHS Education for Scotland

A skilled and sustainable workforce for a healthier Scotland

Protecting medical education during Covid-19

Protecting medical education during Covid-19

Protecting medical education during Covid-19

We worked closely with partners to deploy a new grade of doctor at a a critical moment - in the midst of the coronavirus pandemic.

In April 2020, amid growing evidence and concern that Covid-19 would impact clinical care, medical education and training, the Scottish Government established a policy to deploy graduated medical students early into the NHS workforce. Health services were facing increasing numbers of Covid cases. Staff absence rates were rising too, due to sickness, the need to isolate or caring responsibilities.

The UK statutory education bodies had issued guidance in March about medical education and training during COVID-19. This was in the expectation of increasing requirements for trainees to support NHS healthcare providers in managing the care of acute patients. The General Medical Council (GMC) also issued a statement. This described a UK-wide approach to allow final year medical students who had graduated to join the provisional register.

The challenge - a new policy at a critical time

At NES, our Medical Directorate was responsible for implementing the new policy and the Foundation interim Year 1 (FiY1) doctor role. Introducing a new grade of doctor into the NHS at such a critical time - with the right support and supervision in place - was no easy undertaking.

It involved a high degree of intense collaboration, communication and coordination among several stakeholders. There were also regional and national considerations around timescales and the processes involved. The stakeholders included:

  • The Scottish graduating medical schools
  • The Scotland Foundation school
  • Directors of Medical Education (DME)
  • Human Resources (HR) teams in NHS Scotland boards
  • The General Medical Council (GMC)
  • The UK Foundation Programme Office (UKFPO)
  • The graduated medical students themselves

We established a medical student (FiY1) workforce steering group to administer the implementation process. At the same time, regional groups comprising university education leads, DMEs and their teams and associate postgraduate deans (APGD) were set up. Regular meetings were well-organised and well-attended. The format and frequency supported good communication, collaborative decision-making and early problem resolution. Each stakeholder group present provided progress updates, for example, the numbers of applications processed. The meetings also acted as a forum for providing reassurance.

The application process

The Scottish FiY programme was open to all eligible UK medical graduates who had provisional registration with the GMC. The learning experience it offered counted towards a foundation doctor’s educational portfolio and places were to be allocated on a first come, first served basis.

Graduates were encouraged to apply for a post in the same region as their medical school or their allocated foundation School. To make it easier to choose, the UKFPO brought Foundation allocations forward to early April. 554 graduating students in Scotland applied to the UKFPO for FiY1 posts in Scotland.

As each medical school’s students graduated, details of those interested in a FiY1 post were shared with the local DMEs and AGPDs. At the same time the GMC processed the lists of graduates provided by the universities and entered them onto the medical register. The GMC accelerated the timeline and redeployed some staff to assist and speed up the processing of applications. However, the process remained unchanged.

Contributions from HR colleagues in NES and the health boards were critical to the work in this phase of the programme. Their support with pre-employment checks and issue resolution minimised delays and kept the project on track.

Meanwhile, NES, the Scottish graduating medical schools, the UKFPO and DMEs in the boards worked tirelessly and collaboratively at speed to identify applicants for the posts. DMEs indicated available capacity within boards for placement and supervision arrangements for this new grade of doctor. 

The outcome

Between April and May, 575 FiY1s were allocated across 15 health boards in Scotland.

Placements lasted until early-mid July:

Ayrshire & Arran 15

Borders 16

Dumfries & Galloway 13

Fife 31

Forth Valley 16

Golden Jubilee 4

Grampian 97

Greater Glasgow & Clyde 134

Highland 32

Lanarkshire 42

Lothian 102

Orkney 0

Shetland 6

Tayside 63

Western Isles 4

The new foundation doctors who had participated in the FiY programme were now better prepared and had a whole lot more experience. Many had had the opportunity to add to their portfolio of educational achievement while working as FiYs.

Fiona Cameron, Foundation School Director and NES Associate Postgraduate Dean, said:

“Helping newly graduated doctors participate in the Foundation interim Year programme in Scotland was so worth all the effort involved. While there were challenges along the way, what we achieved in such a short space of time was remarkable.”

Dr John Paul Leach, University of Glasgow’s Head of Undergraduate Medicine, added:

“The experience of facilitating undergraduate students to become interim FY1 doctors is proof of what we knew already – that the undergraduate and graduate systems work well together in Scotland.”


The deployment of almost 600 final year medical students into the NHS as interim FY1s at such short notice during the first wave of the pandemic was a success. The steering group surmounted numerous challenges and achieved ambitious timescales. This was largely due to the nature and spirit of the teamwork displayed by the stakeholder groups with whom NES worked.

Professor Clare McKenzie, Postgraduate Dean, Medical Directorate, NES said:

“It was a huge collaboration of extraordinary effort with people using up all their energy - both professional and personal. The can-do attitude adopted by everyone involved made it happen.”

Nicola Cotter, Head of Scotland Office, General Medical Council, agreed:

“The process by which Scotland made this happen was a real exemplar of best practice.”

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