The Edinburgh PRAMS Scheme (Pre-Registration Appointments Matching)

Overview

In the UK every young doctor on graduation must, before becoming fully registered complete six months practical training in an approved Medical unit and a similar period in an approved Surgical unit. These are paid Pre-Registration House Officer appointments and as such are the responsibility of the Area Health Boards. The posts must have been inspected and approved by the University, which is responsible to the General Medical Council for certifying that students have properly completed their practical training before they can be offered full registration.

There is keen competition, both by students for posts in University hospitals or for posts whose Chief is a well known and respected teacher, and by consultants to get the best students for their units. This competition has in the past led to pressure on students to agree, sometimes even in the pre-clinical years, to take particular posts on graduation. There were consequent frustration, recriminations or both, when they subsequently discovered that their interests had changed or that the student’s career would have been better served by a different choice.

The first suggested solution was to arange that all appointments should be made effectively simultaneously just before graduation. All students were asked to provide a telephone number at which they could be contacted on a particular day. On the designated day each consultant telephoned the students to whom he wished to offer a post. Verbal agreements were then made between the parties. Not surprisingly this idea did not prove practical when it was tried!

A computer system was then proposed which assigned preference weights to the choices of both consultants and students. Posts were allocated by an algorithm which aimed to maximise the combined preferences of consultants and students. This system was an improvement, but in a few embarrassing cases particular consultant/student pairs had very low combined preferences and it was not possible to demonstrate in any simple way to the parties involved the justice — or even rationale — of the assignment.