Evidence of Foundation Competencies Signatories' Guide 2022
Guidance for signatories when providing evidence to demonstrate an applicants' Foundation Professional Capabilities
The national person specification for entry to all United Kingdom first year specialty training programmes requires applicants to provide evidence of achievement of Foundation Competence within the 3 1/2 years prior to commencement of the post to which the applicant is applying, in line with GMC standards/Good Medical Practice, including:
- good clinical care
- maintaining good medical practice
- good relationships and communication with patients
- good working relationships with colleagues
- good teaching and training
- professional behaviour and probity
- delivery of good acute clinical care
All applicants to specialty training at CT1/ST1 level must demonstrate all the outcomes described by the Foundation Curriculum, without exception, using the prescribed evidence as outlined below.
We are aware that you are making a judgement about your colleague that could have major implications for both them and the public, and we appreciate the time you are taking to perform this task accurately.
What is the Foundation Curriculum?
In the UK, doctors undertake a 2 year Foundation Programme once they have obtained their medical degree. After the first year of this training they register with the General Medical Council (GMC).
During the 2 year Foundation Programme they follow a defined curriculum.
Doctors are assessed during this programme against a list of outcomes, and only if they have demonstrated them all are they awarded a Foundation Programme Certificate of Completion (FPCC).
Why do they need to demonstrate that they have Foundation Competence?
The possession of all Foundation Professional Capabilities is an essential criterion on all CT1/ST1 person specifications because they are needed to help successful applicants cope with, and progress through the clinical experience that forms part of their specialty training. They are key attributes that ensure patient safety – particularly those relating to the recognition and management of the acutely ill patient, resuscitation and end of life care.
United Kingdom CT1/ST1 posts are not configured to assess whether each new entrant possesses these professional capabilities – a process which would take several weeks.
Instead they have to assume their new starters possess them. This is true even of posts not directly involving acute medical care as often the only person on such units with recent experience of resuscitating a patient is the CT1/ST1 postgraduate doctor in training. It is also crucial that the submitted evidence is current. It is not sufficient to have achieved each professional capability once. Professional capabilities must be achieved, maintained and demonstrated if our patients are going to be safe in our hands.
You do not need to have witnessed all professional capabilities in the last 3½ years, however, the applicant must have worked with you for a minimum of 3 continuous months in the 3½ years prior to the advertised commencement date for the post to which the applicant is applying, and you need to see evidence from others that they have maintained any professional capabilities that you have not witnessed recently. Provision of training certificates alone is insufficient to evidence competence. You must have personally witnessed the competency or where appropriate, rely on evidence from others that they have witnessed the competency within the 3½ years prior to the commencement of the post to which the applicant is applying.
What evidence can be used to demonstrate that they have achieved Foundation Professional Capabilities if they have not been on such a programme?
Applicants who have not undertaken a UK Foundation Programme within the last 3½ years prior to the advertised commencement date will be asked to submit a Certificate of Readiness to Enter Specialty Training signed by a consultant who has supervised them for at least 3 continuous months (whole time equivalent) in the 3½ years before their proposed training starts. This certificate attests to their achievement of the foundation professional capabilities. For the purposes of this documentation, consultant includes General Practitioners, Clinical Directors, Medical Superintendents, Academic Professors and anyone on the specialist register. The Certificate of Readiness to Enter Specialty Training must be completed by someone independent to the applicant. It must not be completed by the applicant’s spouse, partner or family member.
Applicants should only submit one certificate, even where competences have been achieved in multiple posts. The signatory does not necessarily have to personally witness the demonstration of every professional capability. Instead, you must be able to judge whether the evidence you have seen or had presented to you demonstrates competence, and the applicant must have worked for the you for 3 continuous months. This means that the evidence on which you are relying does not have to come from a post of that length, and you do not have to have personally witnessed them demonstrating all of the professional capabilities. The evidence upon which you rely must however be from within the 3½ years prior to the commencement of the post to which the applicant is applying. Use of a training certificate alone is insufficient to evidence completion of a competency.
Is the 3 months post during which they demonstrate the Foundation Professional Capabilities all they have to do post registration?
No. The CT1/ST1 person specifications state that applicants need to have had 12 months experience after full GMC registration or equivalent post licensing experience and evidence of achievement of foundation competence.
What are likely to be deemed appropriate posts for doctors working outside the UK?
Appropriate posts are detailed below.
- 12 months satisfactory completion of either a pre-registration internship* or Foundation Year 1 post and 12 months full time satisfactory completion in posts approved for the purposes of medical education by the relevant authority.
- 12 months satisfactory completion of either a pre-registration internship or Foundation Year 1 post and 12 months full time experience at a publicly funded hospital in at least two specialties with acute medical responsibilities.
- 12 months satisfactory completion of either a pre-registration internship or Foundation Year 1 post and a 12 month full time Foundation Year 2 post.
*An internship is a period of pre-graduate or postgraduate clinical experience that provides an accepted foundation for future practice as a fully registered and licensed medical practitioner. Internships must be either:
- a 12 month programme that includ es a minimum of 3 months in surgery and 3 months in medicine
- a programme of at least 10 months duration that includes a minimum of 3 months in surgery and 3 months in medicine with an additional study period of up to 2 months
- the equivalent of 12 months full time post-qualification at a publicly funded hospital in at least 2 branches of medicine
Do I have to have witnessed the applicant demonstrate all the outcomes?
No. The signatory does not have to personally witness the demonstration of every outcome. Instead you must be able to judge whether the evidence that you have seen or had presented to you demonstrates competence, and you must have worked with the applicant for 3 continuous months (whole time equivalent). The recruiting organisations have no discretion in this regard.
What type of post will count?
The post the certificate refers to must:
- be of at least 3 continuous months in duration (whole time equivalent)
- have been completed (i.e. the 3 continuous months) by the time of the application submission deadline
- have been undertaken within the 3½ years before commencement of the post for which the applicant is applying
Clinical attachments/observerships/unpaid work do not count as experience.
Does the applicant need to demonstrate every professional capability?
Yes. Applicants must demonstrate competence for each and every professional capability listed on the certificate. If they cannot demonstrate each and every professional capability, they will not be eligible for specialty training at CT1/ST1 level. There are no exceptions to this rule.
Signatories should tick only one box against each capability on the form. This is required for each capability independently and capabilities should not be grouped together.
What do I do if I have not witnessed the applicant demonstrating all the professional capabilities?
You need to make sure that the applicant presents you with evidence from a source that you know to be reliable that they possess those professional capabilities. On the certificate you will be asked to sign a declaration that you have observed demonstration of all of the professional capabilities or that you have received alternative evidence of demonstration where you have not directly observed them. The source of the alternative evidence should be listed on the certificate.
This means that although you have worked with the applicant for 3 months, the evidence on which you are relying does not have to come from a post of that length, and you do not have to personally witness the applicant demonstrating all of the professional capabilities. The evidence upon which you rely must however be from within the 3½ years prior to the commencement of the post to which the applicant is applying. Use of a training certificate alone is insufficient to evidence completion of a competency.
Am I eligible to sign this form?
This certificate can only be signed by a Consultant or equivalent. For the purposes of this documentation, Consultant includes General Practitioners, Clinical Directors, Medical Superintendents, Academic Professors, and locum Consultants with a CCT/CESR who is on the GMC specialist register. Applicants are required to provide evidence that their signatory is on the GMC specialist register (or equivalent).
If you are a clinician registered with any medical regulatory authority other than the GMC, then you should also give the applicant current evidence of your registration with that authority. A certified translation should be included if this is not in English. Historic registration with the GMC will not be accepted. Failure to provide this will result in the applicant, being rejected.
What happens if I sign the certificate without such evidence?
If at any stage investigation shows that the certificate has been fraudulently signed (by you or by the applicant), then referral of yourself and/or the applicant to the relevant Responsible Officer or the GMC (or equivalent) will be considered, as will the instant dismissal of the applicant.
The applicant has had limited opportunities to demonstrate competence. What should they do?
If they have limited opportunities to demonstrate some of the professional capabilities (e.g. if they are undertaking PhDs or are on active service in a non-acute specialty) they should arrange to undertake keeping in touch days, locums etc. (but not pure clinical attachments where they only have observer status). This will provide evidence for you, the signatory to evaluate.
Alternatively, where you have not observed demonstration of one of the professional capabilities in the 3½ years prior to the advertised commencement date, you can sign off the applicant, as long as you have evidence that they have maintained the required skill level in this. Use of a training certificate alone is insufficient to evidence completion of a competency
I am not registered with the GMC. Does this matter?
Not necessarily. The applicant will be asked to provide us with adequate evidence of your current standing with a regulatory authority at the time of submitting their Certificate of Readiness to Enter Specialty Training. Where this evidence is not provided, their application will be rejected.