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Allocating pre‐registration house officer posts

We write to report an unforeseen consequence of the merger of two schemes for allocating preregistration house officer posts in London. Until recently, pre-registration house officer posts at Guy’s Hospital and associated hospitals in southeast England were allocated using an end-of-course accumulation of consultants’ assessments of medical students. The students were ranked on the basis of cumulative scores and each submitted a list of posts that he or she would like, in order of preference. The highest ranked student was then assured of his or her preferred post, the second would be appointed to his or her preferred post as long as it had not already been allocated, and so on. The consultant had no direct control over who applied to work in his team and indeed might never have met the appointee. Only one other British teaching hospital used this approach in 1987 (Gillard & Dent 1988). This method of allocation proved significantly less satisfactory to house officers than matching schemes, in which the preferences of applicants for posts and consultants for applicants are matched to maximize the contentedness of both groups (Dent & Gillard 1990). Guy’s pooled its house officer posts with those at St Thomas’s Hospital and associated hospitals in 1990, following the merger of the two hospitals’ medical schools to form the United Medical and Dental School (UMDS). We predicted in your journal at the time that this would lead to the disappearance of the ranking scheme because the St Thomas’s matching scheme would prove more popular. Unexpectedly the opposite has occurred. The new UMDS scheme was a hybrid development of its predecessors, with an expanded scheme of ranking based on consultant assessments, which was then adjusted by a House Appointments Committee on the basis of both academic achievements (degrees, prizes, etc.) and ‘nonacademic’ achievements and contributions, which might be cultural, social, athletic or several of these. The consultant assessments themselves include knowledge, skills and attitudes as discrete components, and are drawn from all areas of the clinical curriculum. The final rank order list is available to appointing consultants who may, if they wish, write their own order of preference, but they may alternatively opt to use the House Appointments Committee’s order as their own. The matching between applicant’s and consultants’ preferences is then made by computer, equal weight being given to both parties. The number of consultants choosing the House Appointments Committee option has increased each year that the new UMDS scheme has operated. No consultant at Guy’s has decided to write his own list; 40% ofthose at St Thomas’s and an increasing proportion of peripheral hospital consultants have ceased to do so. Some consultants have remarked that because of the greater number of students in the merged medical school and a deliberate move towards smaller teaching firms, they no longer know students well enough to express preferences. Many are uneasy about the potential for biased preferment, the original reason for the introduction of the ranking scheme. There is a risk that a ranking scheme will produce an undue emphasis on academic achievement as opposed to other aspects ofstudent life, and it is only as good as the assessments which fuel it. The UMDS scheme illustrates the robustness of an optional ranking process which is broad in its coverage and fair in its application.