Changes in selection to the Foundation Programme Professor Paul O’Neill Chair, ISFP Project Group Member UKFPO Rules Group Lead for Research and Evaluation Selection

Plan for Talk Background to change – robust & numbers Evidence around selection SJTs Evidence Piloting EPM Algorithm Academic FP

Best prediction of the right person to Selection (appointment) Best prediction of the right person to do the best job Should be done fairly

PON experience: House jobs (Foundation) CVs. application forms and letters References & ‘putting a word in’ Interview panels – numbers, questions Presentations Occupational pyschologists Personality testing

Now: Mostly national Application - anonymous, standardised and assessed against criteria Use of standardised tests (e.g. SJT) Selection centres – standardised, multimodal, some competency testing Interview panels more & more standardised

Evolution 2009 DH commissioned a review of selection methods. The Improving Selection to the Foundation Programme project was set up and overseen by the Medical Schools Council 2010/2011 New selection methods were piloted successfully FP 2012 Full-scale Parallel Recruitment Exercise (PRE) FP 2013 New selection methods implemented The Department of Health commissioned a review of the current selection methods, not because they didn’t work, but because there were concerns about the long term availability of suitably different ‘white space’ questions, and to ensure that the most current research evidence and selection methods are used. The review included academic literature reviews of high-stakes selection, extensive stakeholder consultation, advice from an international panel of experts and an independent cost benefit analysis. The new selection methods were piloted with 1100 students in 2010-11, in 15 UK and two non-UK schools. The pilots have demonstrated the evidence that the new selection methods are the most fair and effective method of selection to the Foundation Programme. Applicants to start the Foundation Programme in August next year will apply using ‘white space’ questions and quartiles; the new methods will be used for applications to FP2013 onwards

A collaborative venture between Scottish Foundation Board Foundation School Directors Key stakeholders have been engaged throughout the process. Their contributions have been hugely important in ensuring that every aspect of application to the Foundation Programme has been considered when devising and implementing the new methods of assessment. Educational Supervisors

Selection in Medicine Undergraduate Postgraduate Single School UKCAT Postgraduate Foundation Postgraduate – Birmingham Review Substantive – Consultant & GP

Literature Reviews 3 commissioned Overlapping Specify methods used Warwick Newcastle Durham Overlapping Specify methods used Identify gaps and where judgement will be needed

Durham: McLachlan & Turnbull 236 References Behaviour predictive of future behaviour Conscientiousness significant component of concerns

Warwick: Thistlethwaite et al 197 papers 1990-2009, medical school and residency. Most from USA Mostly looked at face validity and reliability NOT predictive validity Lack of consensus Non-medical literature – focus on employability skills (job analysis)

Newcastle: Illing et al 202 references Foundation programme – narrow range of applicants, very few cannot do the job Selection methods must satisfy their stakeholders (employers, students etc) Cognitive tests are moderately predictive of later cognitive tests Non-cognitive elements need to be considered to ensure that a doctor is able to perform well Assessment centres allow for a range of methods to be used

Selection Methods Combination of: Academic range very narrow Cognitive ability (academic) Non-cognitive Academic range very narrow High ‘justice’ Incorporate measures of big 5 personality applied to medicine Not IQ or general aptitude tests

Selection Methods Big 5 Model of Personality is predictive of job and academic performance Extraversion (outgoing, sociable, impulsive) Emotional stability (calm, relaxed) Agreeableness (trusting, co-operative, helpful) Conscientiousness (hardworking, dutiful, organised) Openess to experience (artistic, cultured, creative)

Assessment Criteria Reliability Validity Consistency Granularity Longevity Will the process pick the ‘best’ applicants across the UK? Will the process be good for many years?

Assessment Criteria Educational Impact Applicant Burden Clinician Time Will the process support or undermine educational objectives? Educational Impact Applicant Burden How onerous is the process for applicants ? Clinician Time To what extent does the process distract from service delivery?

Assessment Criteria Compliance Transparency Fairness (Justice) Will the process pick minimise cheating or malpractice? Compliance Can the applicants see exactly where the goal posts are? Transparency Fairness (Justice) Is there a level playing field? Public Opinion Person in the street thinks that it is fair

Summary of Results Lower 5-year cost Better score

Selection to FP 2013 Situational Judgement Test (SJT) SJTs will replace the ‘white space’ application form questions This is an invigilated, machine markable test in exam conditions The SJT will consist of 70 questions in 2 hours 20 mins Educational Performance Measure (EPM) The EPM will replace the academic quartile scores. The EPM score is comprised of three elements: medical school performance in deciles additional degrees academic achievements The EPM and SJT will each be worth 50 points from a 100 point application score The EPM reflects academic performance at medical school, and additional academic achievements – evolving from academic quartiles and Q1 of the ‘white space’. There are no points for extra-curricular activities – it would be impossible to compare care for a family member, with committee leadership, with volunteering - however the personal gains from taking part in extra-curricular should be apparent through answers to the SJT. The SJT assesses the attributes of the national person specification – as the current white space questions do The evidence shows that the SJT and EPM in combination assess the clinical and non-clinical knowledge, skills, and personal attributes to be effective in the role of an FY1 doctor The change is about evolution, not revolution. The EPM and SJT are changes to the way that the application score is produced; but applicants will continue to declare their preferences for foundation schools, make linked applications, special circumstances and so on.

The case for change Concern SJT and EPM ‘White space’ questions not sustainable as a selection tool Will become steadily less discriminatory between eligible applicants (limited range of new questions that can be generated) SJTs draw upon bank of items to be available for each application round Situations experienced in the Foundation Programme varied and complex New items built incrementally and continuously against Job Analysis ‘White space’ questions non-invigilated conditions , model answers concerns about risk of plagiarism and coaching SJTs in invigilated conditions in the UK (3 national dates) Not possible to revise for the SJT (scenarios complex, answers relate to judgement rather than knowledge) The Final Report of the ISFP Project Group highlighted a number of concerns with the current methods of selection, and found that the implementation of the SJT and EPM would ensure that selection to the Foundation Programme could be made more robust, reliable and cost-effective in the long-term. Because of the limited range of new questions that can be generated, reservations were expressed about the long-term sustainability of white space questions. New SJT items will be drawn from the varied and complex situtations experienced in the Foundation Programme, which will be built incrementally and continuously against the Job Analysis as agreed by the ISFP Project Group. New items will be available for each selection round. White space questions are not invigilated, and so the availability of model answers have created concerns, from medical students in particular, that white space questions are open to plagiarism and coaching. This will be addressed by running the SJT in invigilated conditions, and coaching will not be possible as the SJT cannot be revised for as it examines an applicant’s judgement rather than their clinical knowledge.

The case for change Concern SJT and EPM Long-term technical reliability and validity could be improved 30 year evidence for reliability of SJTs SJT pilots demonstrate the technical reliability, internal reliability, and validity for use for FP selection Academic quartile system - difficult to compare fairly between applicants from different medical schools (not standardised or subject to quality assurance across medical schools) EPM - standardised framework for deciles Medical schools and students decide ‘basket of assessments’ Schools will be required to publish their locally agreed deciles framework, which will facilitate transparency and quality assurance from the wider community. Deciles fairer to applicants at margins SJTs have been used as a selection method for a number of different professions for over 30 years. Additionally, the pilots have demonstrated the technical and internal reliability and validity of their use for selection to the Foundation Programme. The old system of academic quartiles made it difficult to discriminate between applicants on the margins, and it was not standardised or subject to QA across medical. Whilst also being fairer to these marginal applicants, the EPM introduces a standardised framework for deciles, and medical schools and students decide collaboratively on what ‘basket of assessments’ will be sued. In order to increase transparency, schools will publish their deciles framework.

Situational Judgement Test SJTs are an invigilated assessment of professional judgement and the attributes expected of the Foundation doctor. The SJT is not something students can revise for, but these are skills and attributes that they should exhibit, and that they will have been made aware of throughout their time at medical school, on placements and through e.g. Tomorrow’s Doctors. SJTs are used in selection to GP training, trialled for selection to five other specialties, and used by FBI, Fire Service, police, civil service

What is a Situational Judgement Test? SJTs are: a test of aptitude designed to assess the professional attributes expected of a Foundation doctor based on a detailed job analysis of an FY1 doctor SJT questions assess your judgement by presenting you with challenging situations you are likely encounter at work during the first year of an integrated Foundation Programme SJTs are an invigilated assessment of professional judgement and the attributes expected of the Foundation doctor. The SJT is not something students can revise for, but these are skills and attributes that they should exhibit, and that they will have been made aware of throughout their time at medical school, on placements and through e.g. Tomorrow’s Doctors. SJTs are used in selection to GP training, trialled for selection to five other specialties, and used by FBI, Fire Service, police, civil service

Example SJT Questions There are two question formats:   Rank the five responses in the most appropriate order Choose the three most appropriate responses from eight You should answer what you ‘should’ do in the scenario described, not what you ‘would’ do SJTs are a test of aptitude and are designed to assess the professional attributes expected of a Foundation doctor. There are two question formats:  Rank five possible responses in the most appropriate order Select the three most appropriate responses for the situation (from eight possible options)    Students must answer what they ‘should’ do in the scenario described, not what they ‘would’ do. This is because research into SJT shows that questions asking an applicant what they ‘would’ favours the more ‘test wise’ – plus the GMC has an emphasis on probity

Example Question 1 – ranking Mr Reese has end-stage respiratory failure and needs continuous oxygen therapy. While you are taking an arterial blood gas sample, he confides in you that he knows he is dying and he really wants to die at home. He has not told anyone else about this as he thinks it will upset his family, and the nursing staff who are looking after him so well.  Rank in order the following actions in response to this situation (1= most appropriate; 5= least appropriate). Tell Mr Reese that whilst he is on oxygen therapy he will need to stay in hospital Reassure Mr Reese that the team will take account of his wishes Discuss his case with the multi-disciplinary team* Discuss with Mr Reese's family his wish to die at home Discuss Mr Reese's home circumstances with his General Practitioner

Answer to Question 1 B. Reassure Mr Reese that the team will take account of his wishes C. Discuss his case with the multi-disciplinary team* E. Discuss Mr Reese's home circumstances with his General Practitioner D. Discuss with Mr Reese's family his wish to die at home A. Tell Mr Reese that whilst he is on oxygen therapy he will need to stay in hospital This question is focusing on effective communication with patients. Ensuring that patients’ informed wishes are met in relation to their care is central to your approach to patient care and this needs to be communicated to the patient in a reassuring manner even in situations relating to end of life care (B). These wishes should have been sought when addressing the management plan for Mr Reese and once identified the multidisciplinary team needs to be made aware of them in order to ensure that as far as possible Mr Reese’s views in relation to his end of life care are implemented (C). The management of Mr Reese will require the active involvement of his GP and communication with the GP is therefore of importance (E). Any decision to discuss Mr Reese’s wishes in relation to his end of life care with his family can only be made with the full agreement of Mr Reese (D). It would not be appropriate to give the patient inaccurate information in order to engineer a different medical pathway (A). Correct answer (CEDAB) would receive a maximum of 20 marks – 4 marks per answer in the right order If answered ECDAB (only first two the wrong way round), would score almost full marks If answered B as the most appropriate (when it is the least) but all others in order i.e. BCEDA, would receive 0 points for answer ‘B’, but 3 out of 4 for each of the others i.e. a total of 12 out of 20 marks. n.b. the total marks available for an SJT paper will be scaled so that the SJT score will be worth 50 points on the FPAS application form, out of the total 100 points

SJTs (Literature Review 77 papers) Management, university, police, engineers Large scale selection – short-listing Construct validity not clearly identified Single construct (e.g. ‘practical intelligence’) Can be designed to measure differing constructs Predictive validity will depend on what criterion is targeted SJT designed to test interpersonal skills will more likely predict inter-personal orientated performance

SJTs Used nationally to select GP registrars and other ‘high stakes’ occupations significant validity in predicting job performance incremental validity over methods such as ability tests and personality questionnaires typically relate to general experience and ability, rather than job-specific knowledge or experience tend to show smaller differences between candidate groups (e.g. based on race) than cognitive ability tests

Job analysis of FY1 doctor Commitment to professionalism Coping with pressure Effective communication Learning and professional development Organisation and planning Patient focus Problem solving and decision-making Self-awareness and insight Working effectively as part of a team The findings of a detailed Job Analysis (including shadowing of FY1s, 50+ interviews with FY1s and colleagues working with FY1s, as well as literature reviews) has been published. The Job Analysis identified more than 100 behaviours which can be grouped into the nine ‘domains’ listed on the slide in alphabetical order – some of these are integral to the SJT such as decision making – others such as coping with pressure, working as part of a team, can be assessed through the SJT

Job analysis of FY1 doctor The individual SJT items are mapped against these domains, and the test will include questions across the breadth of these domains.

Item development Item writing workshops (43 items) Review, concordance, piloting Previously piloted & refined (89 items) Item writing workshops (43 items) CIT interviews (78 items) CIT – Critical incidence technique = telephone interviews

Complex process, several stages:

Example Question 2 – multiple choice You have been prescribed codeine for persistent back pain which has become worse in the last few weeks. You have noticed that during shifts you are becoming increasingly tired, finding it difficult to concentrate and your performance, as a result, has been less effective. Choose the THREE most appropriate actions to take in this situation Ask a colleague to assist with your workload until you finish your codeine prescription Make an effort to increase the number of breaks during your next shift Stop taking the codeine immediately Make an appointment to see your General Practitioner Seek advice from a specialist consultant about your back pain Arrange to speak with your specialty trainee (registrar)* before your next shift and make them aware of your situation Seek advice from your clinical supervisor* regarding further support Consider taking some annual leave Ask a colleague to assist with your workload until you finish your codeine prescription Make an effort to increase the number of breaks during your next shift Stop taking the codeine immediately Make an appointment to see your General Practitioner Seek advice from a specialist consultant about your back pain Arrange to speak with your specialty trainee (registrar)* before your next shift and make them aware of your situation Seek advice from your clinical supervisor* regarding further support Consider taking some annual leave

Answer to Question 2 D. Make an appointment to see your General Practitioner F. Arrange to speak with your specialty trainee (registrar) before your next shift and make them aware of the situation G. Seek advice from your clinical supervisor regarding further support This question looks at how you demonstrate commitment to professionalism and self-awareness. The essential problem is that as an FY1 doctor the level of your clinical performance is dropping. This constitutes a risk to the patients you are caring for and will impose a greater workload on your colleagues. In this circumstance you should inform and seek the advice of the senior clinician responsible for your work (G) and alert your colleagues (F). This matter is most likely to be related to your prescribed medicine and you should therefore consult with your GP (D) rather than any other specialist (E). It is not your place to re-allocate workload (A). Increasing the number of breaks is unlikely to improve a situation that is likely to be due to an adverse effect of a drug (B). You should not make any unilateral decisions about your medical treatment (C) and should seek the advice of others (D). You should not be seeking to use your annual leave (H) to compensate for a medical problem. This question looks at how you demonstrate commitment to professionalism and self-awareness. The essential problem is that as an FY1 doctor the level of your clinical performance is dropping. This constitutes a risk to the patients you are caring for and will impose a greater workload on your colleagues. In this circumstance you should inform and seek the advice of the senior clinician responsible for your work (G) and alert your colleagues (F). This matter is most likely to be related to your prescribed medicine and you should therefore consult with your GP (D) rather than any other specialist (E). It is not your place to re-allocate workload (A). Increasing the number of breaks is unlikely to improve a situation that is likely to be due to an adverse effect of a drug (B). You should not make any unilateral decisions about your medical treatment (C) and should seek the advice of others (D). You should not be seeking to use your annual leave (H) to compensate for a medical problem.

Scoring of the SJT Scoring key, determined through: Consensus at item review stage (item writers, SMEs) Expert judgement in concordance panel review Review and analysis of the pilot data Scoring not “all or nothing”, but based on how close to scoring key SJTs are an invigilated assessment of professional judgement and the attributes expected of the Foundation doctor. The SJT is not something students can revise for, but these are skills and attributes that they should exhibit, and that they will have been made aware of throughout their time at medical school, on placements and through e.g. Tomorrow’s Doctors. SJTs are used in selection to GP training, trialled for selection to five other specialties, and used by FBI, Fire Service, police, civil service

Scoring of the SJT – ranking Up to 20 marks available Up to 4 marks available for each response (points for “near misses”) No negative marking SJTs are an invigilated assessment of professional judgement and the attributes expected of the Foundation doctor. The SJT is not something students can revise for, but these are skills and attributes that they should exhibit, and that they will have been made aware of throughout their time at medical school, on placements and through e.g. Tomorrow’s Doctors. SJTs are used in selection to GP training, trialled for selection to five other specialties, and used by FBI, Fire Service, police, civil service

Scoring of the SJT – multiple choice A B C D E F G H 4 Points for each correct answer No negative marking 4 points for each correct answer Up to 12 points per item SJTs are an invigilated assessment of professional judgement and the attributes expected of the Foundation doctor. The SJT is not something students can revise for, but these are skills and attributes that they should exhibit, and that they will have been made aware of throughout their time at medical school, on placements and through e.g. Tomorrow’s Doctors. SJTs are used in selection to GP training, trialled for selection to five other specialties, and used by FBI, Fire Service, police, civil service

Parallel Recruitment Exercise (PRE) New selection methods trialled alongside the normal selection methods during 2012 FP application round Aims: logistics, awareness, pilot new SJT content All 31 medical schools involved SJT – 1 hr, 30 questions EPM – each medical school consulted study body on ‘basket of assessments’ to be used Parallel Recruitment Exercise – ran in all UK medical schools during 2011/2012 academic year. The PRE was an opportunity to trial the SJT and EPM on a national scale, and to provide additional evidence that the SJT and EPM are the way forward. Final year medical students only. Took part in a shortened SJT and their academic achievements were calculated using the new EPM framework following consultation between medical school and students. The PRE was an opportunity to trial the SJT and EPM on a national scale, and to provide additional evidence that the SJT and EPM are the way forward.

Parallel Recruitment Exercise (PRE) 90+% of FP applicants participated in the SJT Valuable learning experience ahead of live implementation Feedback to inform live implementation: Applicants Medical schools Was the final step in ensuring the selection methods can be consistently and robustly applied for implementation for FP2013 The PRE was a great success. Over 90% of Foundation Programme applicants participated in the SJT, and each school successfully agreed which basket of assessments would be used for the new EPM framework. This was a valuable learning experience and feedback from both medical schools and students will inform live implementation for FP 2013.

PRE - SJT 30 item, one hour SJT 6,842 medical students took part in the PRE Participants included: Final year medical students Students who had been pre-allocated to the Defence Deanery Students who had chosen to take a year out post-graduate International students returning overseas after graduation 30 medical schools (plus two centres for Eligibility Office applicants) delivered the SJT in 72 venues Psychometric analysis shows that a 60 item SJT is a reliable measurement Sheffield SJT pilot

Descriptive Statistics Internal Reliability: Adjusted for a 60 - item test that included only robust items (such as would be used in an operational paper), all papers had an estimated reliability of α = 0.80 or above (α = 0.80 to α = 0.87) Demonstrates that the SJT is a reliable test in this context with items testing different things

Histograms showing the distribution of scores for Paper One (left) and Paper Two (right)

Descriptive Statistics Mean: Overall Mean = 79.5%; Range from 78.0% to 80.6%. So not too easy – differentiating appropriately Standard deviations: Mean SD = 18.6; Range from 17.3 to 20.0. Distributions: 305 to 468 (out of a maximum of 512) – as expected given length of paper Appears to be slightly negatively skewed, (more people towards top end) although results do show a close to normal distribution

Item Facility (difficulty) Ranked Items Maximum score 20 Score 18 = ‘very easy’; Score 11.6 = ‘very hard’ Mean facility similar across all papers (approx 16) Range of facility values differed across papers SD range similar for all papers, except for Paper 1 where one item had a very high SD Multiple Choice Items Maximum score 12 Score 10.8 = ‘very easy’; Score 3.6 = ‘very hard’ Mean facility across papers ranged from 7.9-9.0 Range of facility values differed across papers SD range was similar for all papers

The scenario content seemed appropriate for my training level Student views The content of the assessment seemed relevant to the Foundation Programme A sample – more will be available in the Final Report of the PRE to be published on the ISFP website. The scenario content seemed appropriate for my training level

Educational Performance Measure SJTs are an invigilated assessment of professional judgement and the attributes expected of the Foundation doctor. The SJT is not something students can revise for, but these are skills and attributes that they should exhibit, and that they will have been made aware of throughout their time at medical school, on placements and through e.g. Tomorrow’s Doctors. SJTs are used in selection to GP training, trialled for selection to five other specialties, and used by FBI, Fire Service, police, civil service

Why change to EPM? A clear framework with agreed principles used to calculate the EPM, ensuring that it is fair, transparent and consistent across the schools of the UK Splitting cohorts into deciles rather than quartiles provides a wider spread of scores, which makes it easier to differentiate between applicants, and will be more fair for applicants at the margins It makes more sense for all the academic components of the application to be one part of the application It is not possible to compare performance of students in different medical schools, as schools offer different assessments at different times throughout the course – and the FPAS application is completed before finals. The most fair way to recognise achievements at medical school is thus relative to applicants from the same medical school. The way that quartiles are calculated does vary between schools; in future all schools will be required to follow an agreed framework, and to publish the way that they calculate points for performance at medical school. The EPM will improve consistency and transparency. Deciles instead of quartiles – more fair Brings together points for additional academic achievements, which is currently Q1 of the ‘white space’ questions Recommendations on the best way forward, using evidence gathered from pilots during the 2010/2011 academic year.

How is the EPM calculated? Score produced by applicant’s medical school to reflect achievement and performance compared to rest of cohort EPM = 3 parts (maximum 50 points): Medical school performance in deciles (34 – 43 points) E.g. Top 10% = 43; Top 20% = 42; etc Additional degrees (max 5 points) Educational achievements (presentations, prizes and publications (max 2 points) Schools have consulted with students about how the decile points for the EPM will be calculated. The EPM reflects a student’s performance at medical school on summative assessments, with all schools (UK and non UK) using the same framework which outlines the rules that each school must follow when calculating the EPM decile score. Schools will publish the way that they calculate deciles according to this framework, specifying the assessments and weightings used locally. Deciles will be worth 34-43 points from the 50 points for the EPM As with the current application form, applicants are each eligible for additional points to recognise degrees, presentations, prizes and publications – up to 7 points in total, from the 50 points for the EPM There are no points for extra-curricular activities – it would be impossible to compare caring for a family member, with committee leadership, with volunteering - however the personal gains from taking part in extra-curricular should be apparent through answers to the SJT.

PRE - EPM 27 of 30 medical school initiated a new consultation and review of framework (3 schools consult annually and framework aligns) Other schools do consult annually – but undertook new consultation with students for the PRE Majority of schools pleased with student engagement, especially amongst later years Benefit of raising awareness with students & staff Students felt sense of ownership Leeds, Liverpool and Imperial – no need to consult as do so any way as a matter of course

Consultation on frameworks Some schools used as many as six of these tools – variety of engaging with student representatives or opening up discussions with the whole student body

PRE EPM – Decile Points Decile/ Quartile 4th 3rd 2nd 1st 2 604 1 3 18 646 5 341 334 13 649 27 5th 10 52 606 8 6th 625 50 7th 37 629 19 8th 337 348 9th 680 30 10th 671 7 Data provided for around 7,000 applicants to FP2013 As expected, with 22 schools following largely the same framework as before, 95% of applicants placed in the corresponding decile Some movement in the 8 schools who did make substantial changes to their based of assessments 4% moved by 2 decile places 0.5% - 50 students Bear in mind that movement of those in the 4th quartile can largely be explained by those who failed finals – last year were automatically placed into the bottom quartile And that it is not comparing like with like. Cohort is those starting final year together – not finishing fourth year together.

PRE EPM – successes All medical schools have agreed a ‘basket of assessments’ in consultation with students All medical schools aligned with EPM framework All medical schools calculated EPM deciles, with around 10% in each decile (some ties) All medical schools confident they can calculate EPM deciles in line with common principles

Academic Foundation Programme 2012 Same timetable as for standard application Apply to 2 UoA Have to sit SJT Appointed – application, EPM, interview (+/-) If not appointed, then revert to standard process

Algorithms Was initially triggered by student preferences Unstable, unfairness Worse if increasing number applicants/school Changed for FP2012 Now triggered by application score Has changed patterns of applications

Selection to the Foundation Programme – improving and evolving FP 2005 Foundation Programme introduced FP 2006 National timetable and application process FP 2007 Online application – white space & quartiles 2009-2011 Improving Selection to Foundation Programme FP 2012 Full-scale Parallel Recruitment Exercise (PRE) FP 2013 New selection methods implemented

‘The greatest forward step in the baking industry since bread was wrapped – Missouri, 1928

What’s Wrong with SJTs Lawrence Clinical Pharmacology Wonderful Useful in some situations Not fit for my dog

More information UKFPO - www.foundationprogramme.nhs.uk FP 2013 Applicant Handbook Introductory videos SJT monograph SJT practice paper FAQs (FP 2013, SJT, EPM) Archived ISFP website – www.isfp.org.uk

Any questions?