Dr John Crippen
Absolutely horrendous.
Doc, I was in the hospital today, and I've never seen my seniors (SHOs, FY2s, SpRs, etc) look so demoralised or apathetic.
I felt so sorry for all of them.
I would like to echo the plea from Dr C. for doctors to share a little information about what is going on, for the non clinical amongst us. A wider audience means more support and hopefully some of it may fall on ears which have some influence.
I have just watched this evening's edition of Panorama, and am shocked at the violence which takes place in Hospitals to NHS staff. After reading David Copperfield's blog and book ("Wasting police Time") about the daily life of a policeman, I am NOT shocked that NHS policies of "Zero Tolerance" are a mockery, only 2% of attacks in hospitals are prosecuted and most of them getting only derisory punishments. I also read Mr Chalk, the blog of a comprehensive schoolteacher, and his book "It's your time you're wasting" - I am so depressed as to what has happened to this country of ours and how it has all come about almost without being noticed. Now is the time to shout it out from the rooftops and let people KNOW just what is going on, so yes, please do tell us what is happening - we need to know, you need our support.
Thank You, and best wishes all
Steve
I was at clinic today and saw one of the SHOs, lovely guy, he was sitting waiting for news. He did say that "big things are happening in the NHS today" when I pointed out he hadn't signed the script form. Then I asked if he was under MMC and it all became clear. I hope he gets a post as he was bloody marvellous today.
The absolute lack of any communication from MTAS / MMC all day despite the system lurching between complete meltdown and spewing complete nonsense is unforgivable. All day young doctors (myself included) have been terrified about the future.
Now many careers which have been progressing well for several years - with real dedication to the profession and our patients - have been dashed on the rocks, by an unfair, unvalidated and rushed system.
Our doctors deserve better
More importantly, the patients of this country deserve better.
Tony Blair and his NHS ministers should be ashamed. A Black Day indeed.
Is it unfair that doctors be spread by region and specialty? In most walks of life the way to obtain your "dream job" is by being the top applicant. If you don't get the job, don't begrudge the person who did- they probably deserve it more than you. Not all astronauts get to stand on the moon.
Sure,
I have a medical degree from london, a "golden london SHO rotation" disctinctions throughout medical school, 100% in my medical and surgical finals (i joke you not), all my postgrad exams, posters, papers in progress, a pan-london audit etc etc
And I have sat in front of the computer all day - waiting to see whether this incompetent system has granted me a future in medicine.
I'm still waiting.
All day the website had been plagued with problems, doctors rushing from one computer terminal to the other trying to pretend their looking at blood results when in fact they are looking for a glimmer of hope that they still have a career, or job in the NHS come August.
Do you want to hear the biggest joke. In 2009 the EWTD says doctors have to reduce their hours. A year ago official figures predicted hospitals wouldnt have enough doctors. When they make 6000 of us unemployed this summer and we all pack up our lives and move to america or australia - within a year they will be "flying in SHOs" from abroad to meet the staffing crisis. For a huge price no doubt.
Not very smart.
And now I will continue to stare into my computer screen to see if a dedicated intelligent doctor has to "sign on" in August.
Well done Blair.
Well done Patricia Hewitt.
How are you going to spin this one to the patients?????
It is a disgrace to treat humans like we have been treated. It is tragic to see careers and lives being destroyed by just looking at a computer screen. The whole thing reminds me of an execution that has gone badly wrong: they have to put us back to the electric chair and electrocute us again and again until we are finally dead...
Dr Flexible - it's got absolutely nothing to do with being "the top applicant". Are you a doctor? THIS. IS. A . LOTTERY.
Thank you, John, for the plug.
Please, PLEASE, everyone, help us out. Submit your stories, talk to the press, get your voice heard everywhere and anywhere. This is shit. If you don't give a toss about us then think about the patients. They are not getting the best care right now because the only thing on all of our minds is "is my life going to be destroyed or not?" I'm afraid we're not infallible and are incapable of being completely selfless. How would you feel if your whole world was about to be destroyed, regardless of some outsider's view of the "fairness" of it all.
This is horrible. Horrible horrible horrible.
I have to say that my junior staff like most others seem completely at sea with this system. I was in the position owf writing a "structured reference" for the best trainee I have ever had-fantastic academic credentials and a superb combination of clinical skills and empathy with patients. She does not know whether she will have a job. This is insane, and although I expect it will all "come out in the wash" I think it is totally unacceptable to treat people in the way that they have been. I sincerely hope all those high quality doctors who have decided to work in Australia or New Zealand remember to take their polling cards with them to tell the Government what they think of it.
I love my job. My patients tell me I'm a good doctor. I have done the correct training, attended all the right courses and worked really hard to make sure patients get the best they can from me.
Today a message on a computer screen told me that my career in this country is basically over.
I will not be staying in this country. I intend to move to another where I will be allowed to do the job I love.
The thing that most upsets me is that the public are losing some fantastic doctors - and they don't even have a say in it.
MTAS and MMC - all part of a shambolic, farcical and unjust implementation of a selection system for doctors in the NHS that will ultimately seal the downfall of this health system. Today has been a harrowing day for all junior doctors who's careers, livelihoods and aspirations are dependent on a system that is not only unreliable, but fatally flawed in many respects.
I have never seen or heard so many doctors so unhappy, demoralised and uncertain about their futures. More than half of the doctors I know are contemplating leaving either the NHS to work abroad, or even medicine completely.
I just CANNOT comprehend why anyone would think that using IT boffins and management bureaucrats to selectively employ doctors was a good idea.
Come August 2007, when a predicted mass exodus of talented, dilligent and conscientous NHS doctors leave the UK for either Australia, NZ, Canada or the US, I hope the British public will forgive us for jumping ship - in many cases, it will have been the case of being pushed, rather than jumping.
Surely MTAS breaches several caveats of employment law, not to mention racial discrimination laws (as recently upheld by the courts of law), and also age discrimination laws.
Being limited to only 4 job applications nationwide hardly represents a fair and competitive market policy. The lack of communication with junior doctors with regards to the MTAS selection system reeks of a hashed and rushed job.
With so many junior doctors carrying the burden of student debts accumulated over a long period of university training, will Tony Blair's government be willing to underwrite these debts for those doctors that effectively have their jobs taken away from them?
Well, I didn't go to the right medical school nor have a number of papers to be proud of. I do have a number of rejected papers, instead. It did take me a horrible amount of effort and endurance to get to where I am now. I did feel I was good at what I do (for now and until August). I am appreciated by patients, peers, staff and bosses. I don't know what to say, I'm thoroughly devastated.
It's very easy to speak of career change and emigration. I've been there, and it's terribly tough. I wanted not to have to go through it all again but it seems I have no choice.
I wonder how many people will show up to work tomorrow with a hangover. Or not show up at all.
I don't understand, I've missed something important.
The impression I'm picking up is that junior doctors can make 4 applications for hospital positions, and that if you try for 4 very popular positions that have about 50 applicants each then you'll have to be lucky to get offered one of them.
But is there really that much of a discrepancy between the number of junior doctors, and the number of vacancies?
And does it really result in redundancy? Can't you carry on in the job you've been doing for another year and try again next time?
Sorry if all this has already been answered.
My partner is an SHO.
From all I gather from her colleagues, her consultants, she is extraordinarily talented at her job.
I personally know she’s passionate beyond words about her job.
I know too that as she spent days agonizing over her application she was able to tick more boxes than most – her passion and professionalism over the years having ensured she’s participated in her profession way beyond the call of duty. Publications, teaching, audits and so much more.
I’ve admired this passion since day one.
Her focus as she’s readied herself for work each morning, the zest in her voice if we talk during the day. The dedication as she has worked through each day or long weekends on call and then still come home each evening and revised studiously for her exams – in her own time and at her own expense.
For the last couple of weeks, I’ve watched her change.
She’s still risen each morning for work.
Still come home each evening and studied.
Yet she has paled and the worry has become nigh palpable.
Why?
For the simple reason that atop of working day to day, trying so conscientiously to save lives, atop of revising each evening – let alone the normal strains of life (relationship, social life, etc etc) she’s had to complete a re-application for a career she has already dedicated almost a decade of her precious life and multiple thousands of pounds to.
Last week the pressure really kicked in.
The shortlist was due on Saturday.
Monday, Tuesday…. As the shortlist release date crept agonizingly closer, so too did she become more fragile.
We own our home.
Bought in the belief that her career was safe, true. Centuries old and trusted.
I, myself, on an income I admit is too small to save us if she is not shortlisted.
Late news.
The shortlist would not be out until Monday.
Today.
We lived an agonizing weekend.
Worse, we had discovered some shocking facts about quite how the applications were being vetted.
Those involved in the vetting process themselves, outraged.
It had become clear that there was truly no fairness, no real discernment in the process.
People have said it before and I reiterate it – it really is a lottery.
Last night, pale and anxious, she tried to sleep.
I tried to sleep.
The night ticked by, our heartbeats drowning out the slow seconds.
This morning, we beat the dawn chorus of birds.
The laptop on, the website checked.
As anticipated by us (why the hell not by the IT Techs??), the website crashed.
As feared, a second delay – the shortlist still not finalized.
I watched her this morning as she sat, hands visibly shaking and her pallor literally grey as she waited for news.
Tears overcame her at one point as silently both our stomachs knotted and cold dread filled our lives.
So our day passed.
Comments read on DNUK – emotive comments of anger and anguish, frustration and terror.
Please do not dismiss this emotiveness but consider the following.
These doctors, so calm in the face of lives fading, so calm in pulling lives back from oblivion – what does it tell us about them – about MTAS – if they are reduced to such blatant raw emotion?
Something has gone horribly horribly wrong.
Tonight we sit, as it nears midnight, no closer to knowing our futures than we did when we shared the dawn with the birds this morning.
Tonight we sit, both knowing that hospitals are already dangerously understaffed and patients – people like you and I, there but for the grace of God – are right here and now losing their lives needlessly.
Tonight we sit helpless.
The horrible irony being that with all she is, this situation should never be.
She should be part of a team, inspired and energized, proud and focused, saving lives with competence and trust.
Fortunately enough my Missus has an interview. Interestingly nobody has been told what salary ST3s will be paid.
Can anybody else think of another job or profession where you would have to apply without knowing your prospective salary?
The Goverment can only get away with this nonsense because they are the only game in town.
I've told a couple of people this already but I'll repeat it here.
I'm in the fortunate position of having 3 interviews from 4 applications. And I feel terrible. I mean, I feel pleased that I have hope of a future career, and I know that I deserve my chance, but there are a LOT of juniors out there who deserve the same chance and have not had it. They may never. And that is a tragedy.
I feel selfish saying that I deserve my interviews. I'm not a selfish person, but I do deserve them, I know I do.
I didn't get them because I deserve them however, I go them because I was lucky in the MTAS lottery.
I know it's down to luck because of the stroke of irony in my application. I'd been contacted by a Prof from one of my deaneries prior to shortlisting. The Prof was interested in my research and wanted to slot me into their academic programme. In any other industry that'd be called headhunting. But not in MTAS. Oh no. Because the deanery who wanted me badly enough to try to headhunt me was the only deanery who rejected me from the system.
It's a lottery. No other possible explanation.
Big hugs all round, and I wish I could offer more, I really, really, do.
"Can anybody else think of another job or profession where you would have to apply without knowing your prospective salary?"
Porn Star
GW aka Mrs SHP:
I seriously hope you're in journalism or some such business, because that post was beautiful. Words can't express how I feel about the subject matter, but you certainly have a gift for writing heartfelt prose.
Dr C - can you post a link so I can email you direct?
I was not picked out of the hat for a job in gastro. Now it seems my career is in ruins.
If you would like I will post you my CV, my MTAS application and the only communications that I have had from MTAS/MMC.
I wonder whether you would like to "peer review" my application and feel free to publish anything from my CV or application that had been suitably anonymised or (if allowed) MTAS "communication."
Dr Sniper
HP - at the risk of turning this into a putrid love-in, Mrs SHP was just saying how pleased she was for you that you'd done so well in the lottery.
As am I.
Funny how we build oddly strong bonds and affections for people we have never met.
Dr C - can you post a link so I can email you direct?
I was not picked out of the hat for a job in gastro. Now it seems my career is in ruins.
If you would like I will post you my CV, my MTAS application and the only communications that I have had from MTAS/MMC.
I wonder whether you would like to "peer review" my application and feel free to publish anything from my CV or application that had been suitably anonymised or (if allowed) MTAS "communication."
Dr Sniper
Dr Sniper |
+++++++
by all means.
click on email at the bottom of the post.
John
I've always thought the internet provided a medium for Cartesian separation of body and soul, and one might therefore consider that personalities are more effectively perceived online than in real life.
[putridness over]
Mary - you are right in that we are allowed to apply for only 4 positions, according to whatever level of expertise and experience we are deemed by MMC to be at. If we don't get a Specialist Training (ST) position in August, the chances of obtaining one next year has been described by the people in the know as "extremely slim". There will still be jobs termed Fixed Term Specialist Training Appointments (FTSTA), but these are essentially service jobs with little prospect of career progression.
What a lot of junior trainees are angry about is the lack of options and lack of fair opportunity to show what we can do and to further our careers in specialties that we are enthusiastic in. What the government wants has done is to take away the options, and to force people into taking up specialties that they have no interest in - what a waste of potential talent. You wouldn't dream of asking a budding heart surgeon to take up training in psychiatry just because there were empty spaces in psychiatry would you? (an extreme example to be fair, but you get my drift).
On top of that, the whole application process has been painfully confusing and an utter waste of resources. There has been an utter lack of communication with juniors, and a complete absence of support from government agencies.
We really need to get more doctors on this site to explain what has happened to them to the public - most people read the papers and just see things written about greedy doctors, lecherous and murderous doctors. When have we ever read anything about how good a doctor was? It's rare because in our profession, we took an oath to be conscientous and diligent towards patients and we don't seek active approval and compliments in the process - because of this we are sometimes not vocal enough in our opposition of potential damaging change. It's time we voiced our concerns with the future of medical training in this country.
docs like the patients need some free market economics and a move away from a monopoly state funded provider, its the only way to free them up
Ouch at the MMC thing and unsurprise at delays and technical problems.
To speak up for IT techs, they probably knew the system would fall over too but were told by their management that there was no money to pay for extra hosting for a 'one off' large hits event or that they were exaggerating the severity of problems. Or that there was no money so hard shit.
Not that makes anything any better for any of you. I hope something is done to change this stupid and evidently unfair system.
Ouch at the MMC thing and unsurprise at delays and technical problems.
To speak up for IT techs, they probably knew the system would fall over too but were told by their management that there was no money to pay for extra hosting for a 'one off' large hits event or that they were exaggerating the severity of problems. Or that there was no money so hard shit.
Not that makes anything any better for any of you. I hope something is done to change this stupid and evidently unfair system.
This remedyuk march:
march 17 is st pat's day- the doctors would get lost in the shuffle.
choose an alternative day and have the theme song "what becomes of the broken hearted"
I am heartbroken on behalf of the doctors - people at the cream of their A'levels and university studies - being treated in the cavalier way.
When I was at this stage, I had a husband (with job in one area), plus a child (with pending school). I simply could not have borne the uncertainty of location, let alone of career. Had I not got a job in my region, I would have simply resigned medicine and gotten a sensible, lucrative, day-only career elsewhere - a fine waste of a half-a-£mill education and 6+ years of my life, but better than having a complete breakdown.
I cannot believe this is happening...
Even those who have been offered interviews are being forced to choose between them, as different deaneries are running interviews for the same specialty at the same level at the same time on the same day, and so far refusing to compromise.
So for anyone who actually has 2 or more interviews, you can basically half that figure. They are being forced to choose between overlapping interviews.
This new system has turned all of the old indicators of what makes a 'good candidate' on their head. It doesn't matter any more which university you went to, what class your degree was, where or with whom you have been trained, how hard you worked, how much you impressed your senior colleagues, whether you actually care for your patients, how much love and effort you put into your work, how easy you are to get on with, whether you are a good learner, whether you have any spark, personality or ambition and so and so on.
All that matters now is your ability to bullshit the answer (in 150 words) to questions such as:
"Mistakes can and do happen in medical practice. Describe a specific example where the outcome of action you took in response to a clinical mistake/error (made by you or someone else) caused you to reassess how you subsequently dealt with similar situations. What action did you take at the time and how has your practice now changed?"
Read it carefully. What is it asking? How are you going to condense the answer into 150 words?
A good answer to this question is worth more points towards getting an interview than having spent 3/4 years completing a PhD in one of the world's leading universities, studying the speciality to which you have applied.
Who would you prefer to have treating you? A good bullshitter or a highly trained doctor who may well know as much about your disease than anyone in the world?
Anyone, sufficiently coached, can answer the above question perfectly. You don't need any medical experience, the scenario doesn't even have to be real. Who the hell could ever check?
What makes this even more galling is that the 'mark schemes' for questions such as the one above have been leaked to a chosen number of candidates in advance of the application deadline. They, but none else, knew that the question above could only score full marks if the mistake described was your own, not someone elses. Read the question again. Did it say describe your mistake? Or did say 'yours or someone elses'?
Add to this the completely shambolic manner in which the applications were scored. Website crashes, supposedly anonymous applications with names visible, an online system reverting to old fashioned paper print-outs, non-trained assessors dragged in at the last minute to shift through forms, consultants scoring hundreds of forms in the final hours before the shortlisting deadline, deadlines missed, people hanging in limbo, 'final data check in progress', people officially advised to apply for the wrong training level, people for the whom the right training level doesn't exist and available posts being a fraction of those in previous years.
In my speciality, in the hospital I work at the moment (Oxford), 100 people applied for 3 jobs. There were 8 available in "London, Kent, Surrey and Sussex", 1 in Bristol (60 applicants), 2 in Leeds, 2 in Newcastle. If you are prepared to take a job 'somewhere in Scotland' there were another 9 or so. Choose 4 of the above & good luck.
Currently we don't know whether there will be a similar number of jobs next year, or whether most of them will be ring-fenced for people who came in at a lower level this year. 'They' simply haven't told us. In reality this is because they haven't decided.
Training programmes in English speaking countries worldwide are about to be bombarded with very highly qualified medical graduates. Not wanting to go too far from home, I am seriously thinking about which European language I need to start learning while I'm doing my PhD over the next 2/3 years.
The best student from my comprehensive school in north Liverpool, 5 grade As at A-level, Cambridge undergraduate degree and medical training, raced through post-grad exams in minumum possible time, universally esteemed by my consultants, a bit quiet and serious but mostly get on with the nurses, research done, papers in, prizes won, courses attended, PhD in Oxford. Currently being trained by the country's (if not the world's) experts in the field I want to work. I know my patients like me and I like them. Dr Crippen would be impressed with my communication skills & empathy (I think, but very hard to prove in 150 words).
Today I realised that this country doesn't want or need me anymore.
I haven't got all that stuff. But what I've got is genuine ability to be a bloody good doctor. I've got something that carried me from A-levels to medical school to a competitive house job to an extremely competitive psychiatric rotation, and at every step I have been praised for having done a bloody good job.
The area in which I want to work has still not published its results, but I have lost hope anyway. It just feels like too much. Reading Dan's post has reduced me to tears. Again.
It's not fair, it's just not fair.
Yes, it's self-pity, but I don't care. I'm 26, and quite possibly on the scrap-heap.
Dan- best post on the subject so far. Stay strong man.
As a US physician in residency, I have to say that I find this mind-boggling. The US and Canada have already solved the problem of coordinating those at a certain level of training with the posts to which they would like to be attached; it's called the National Resident Matching Program, and apart from a very few mistakes, it works. Every year. Without fail. Why on earth would the NHS re-implement, from scratch, such a program rather than just buying it from the NRMP? Why limit the applications to four? WHY?
I'm glad I don't have to face it.
One of my friends has been luckier than Dan above and has been shortlisted for two posts (in the same specialty). One in Birmingham, and one in the north of the country. The Northern interview was on two days in March, but the second day was already full by the time he was able to log on to MTAS. Birmingam's interview for his specialty, unfortunately coincides with the first day. There is no way he can get to this big northern town from Birmingham in time. The Northern hospital won't even give him a time slot at the end of the day to make it possible for him to appear in their interview by some miracle on the roads or the railways.
He has been told that it is bad luck, but he will have to choose one interview out of the two. This is the pathetic situation after years of planning.
As an American physician 'listening in' I am somewhat puzzled by the details of MTAS/MMC. Would someone be kind enough to enlighten me on a few points?
The general course of training here in the States is undergraduate 'pre-med' for four years (usually to age 22 or 23), followed by four years of medical school (including two years of mostly classroom work, one year of mostly hospital work rotating in the 'major' specialties--Surgery, Medicine, and perhaps Psych, OB-Gyn, etc.--and one year of 'electives', which function as an introduction to, and preliminary job interviews for specialty training (called residencies). Graduation from medical school is usually at age 26 or 27. This seems to be the age of SHP above, but he seems to be several years out of medical school. Can you tell me how the process works in the UK?
In the States we have a process call 'The Match' at the end of medical school that seems similar to what you are undergoing. In the Fall of the fourth year (the 'electives' year) medical students interview for training programs in their chosen specialties. They enter their preference list online, as do the training programs, and are matched in March for training starting in July. It is a stressful time. Usually all the students in each school get together on 'Match Day' and everyone gets their envelopes. There are a lot of cheers and tears, but everyone is encouraged to share the experience. Students on hospital rotations are almost always given the day off.
A percentage (maybe 10%) of students do not match, and are notified the night before. They are assisted by the school staff on Match Day to call all the training positions that are unfilled and there is a great scramble (by both the students and the weaker training programs) to fill positions by the end of the day. Many students find themselves going to a strange city, in a less desirable program/specialty.
From my perspective, the MTAS/MMC process is similar, although there seem to be differences in the States that make it a bit more humane. First, there is no limit to the number of training positions a student can list; it is a matter of time and money to visit the programs. High level programs will limit the number of interviews, but an aggressive student can usually find someone to call somebody at most programs and slip in a special interview as a long-shot. People have been known to list several different specialties and just depend on luck to determine their training.
Second, there is a lot of support from the staff, both administrative and clinical. People who do not match know the day before and have help finding a position. Everyone else knows they got something on their list, even though it might be down near the bottom. Getting everyone together and making a party of it also prevents the private anguish I see here.
Third, there seems to be more opportunity to return to the Match the next year or later.
Fourth, there are always more positions than stuents, although there are specialties that are highly desired and filled quickly. Someone who doesn't match can always find another specialty, or just take one additional year of hospital training (here called an internship), and therafter go practice as a general practitioner.
Fifth, after training for four to seven years (or one for GPs), the resident physician looks for a practice, which is usually private, and can be anywhere one chooses. If someone wants it enough, they can move to a city with no job in hand, 'hang up a shingle' and start their own practice from scratch. My guess is that it is this ultimate freedom to choose (or lack therof) that drives the angst in the UK. Is this correct?
This may sound cruel, but what the hell. Ignoring the inherent unfairness of the system, if there is such a massive oversupply of candidates compared with available places then why not just halve the pay and double the number of posts? Also, I am confused about what you are expected to do. Is there some dead end work-horse position they are expecting doctors to take up at a reduced rate of pay?
IMHO the best way to fix situations like this would be to make undergraduates pay the full cost of tuition (with a goverment subsidised loan) and let the market decide where doctors are hired from. If the situation is as I understadn it from these posts then the taxpayer is being badly short changed (although through no fault of the junior doctors obviously).
My fiance & I are both SHOs. If we don't get jobs in the careers we want, then we're shipping off to Australia to join our mates who are already there.
So sad - the system here in the states is different, as described by a previous commenter, and seems more humane. This sounds like such a huge waste of training, and an example of bureaucracy run amuck! Hard to know how it can be fixed now....tho I wager that in a few months when all of the juniors have disappeared to other places or professions, the shortage of docs will become apparent...too late to help either the patients OR the docs!
"Can you tell me how the process works in the UK?"
A would-be doctor specialises in their last two years in high school in three or four science subjects. Then they go to university for five or sometimes six years. Then they are doctors, but have many more exams to take in their chosen speciality.
"This may sound cruel, but what the hell."
What the hell? It bothers me because it may impact on my future care. When I read what SHP writes, I want to cry. There are people who need help they cannot get because of unfilled psychiatric posts, yet someone who really cares about her job may be driven overseaso or out of medicine. This is no way to match candidates to posts.
Would we allocate anyone else to jobs this way?
Well, like many others I didnt get shortlisted for any interviews either...seems the already demoralised docs are due to have their lives ruined yet again...only in this stupid career do we get TOLD where to apply to, and forced into doing things we don't want to do...maybe its time to organise a proper effort, perhaps a march or demo to Downing street( that is if anyone ever has enough time off!!)
Anyways, I think at the end of the day it will be their loss...all that training they forked out for our med school will go down the drain when we all run off to places where we are appreciated...(and AUS and NZ are laughing...readymade docs at no cost). Good luck to everyone in the coming weeks, interviews or not 
I have been spared the trauma of today, as I am applying to General Practice, and this has a slightly different route of access via MTAS(although unfortunately seems no less perilous!) so I am spared my judgement day until the 5th March, but have watched as many fantastic Doctors wait in suspense all day, and many are still waiting now.
The matching process is nothing more than a lottery, with some of the most amazing and well respected Doctors that I have worked with today coming totally unstuck - more fool them for believing that having dedicated their lives to building an impressive career serving the NHS, that the NHS would appreciate their input and reward them with job security perhaps?!
I hope that it does "work itself out" as many are assuming that it will, but the fact remains that if you want your Doctors to work hard and excel, you need to reward that by giving the most hard working and talented Doctors the best jobs, otherwise they will find a healthcare system elsewhere in the world that does value them, or worse still, will resign themselves to fate and stop putting so much energy and enthusiasm into their work.
This is not about the thought of failing to achieve a higer salary, this is about families being uprooted, couples torn apart, and hard working and caring individuals getting no official recognition for the efforts they make, often above and beyond the call of duty.
It really is a sad day for the NHS and the UK today, and the government should be ashamed.
please try and email the bbc and other media groups with the information....try the feedback page, if enough people write then perhaps something will be raised on a national level...
you can post suggestionhs to the bbc website on this link :
http://news.bbc.co.uk/newswatch/...600/
4032695.stm
at least you guys have jobs to go to (albeit dead-end). many nurses and physio's are totally screwed.
sorry for multiple comments...
you can email channel4 news on
news@channel4.com
and the various "times" newspaper links are ont his page :-
http://www.timesonline.co.uk/tol...ces/contact_us/
I don't know about getting in touch with "those that have any power"...
I have previously written (last year) to Sir Liam Donaldson about the whole fiasco and got a very long winded letter in return which was essentially a fob-off (they even mis-spelled my name, ultimate slap in the face). Its actually worth writing to him en masse i suppose but I doubt that would do much. (I have the address should anyone want it) Think the bottom line is that medics as a whole tend to be apathetic partly due to the nature of the work and workload and general low mood....if anything is ever going to change for the better we need to stick together and stand up for our rights (its not as if we are a burden to society- and we deserve much more!)
IMHO the best way to fix situations like this would be to make undergraduates pay the full cost of tuition (with a goverment subsidised loan) and let the market decide where doctors are hired from. If the situation is as I understadn it from these posts then the taxpayer is being badly short changed (although through no fault of the junior doctors obviously).
Tim
+++++
Excellent Tim. A loan of about £250,000 to train as a doctor.
That will certainly solve all the problems of over supply of doctors.
John
Thankfully my sister saw the writing on the wall & decided not to wait around for this nightmare. She will be starting a 3 year rotation in Australia in 2 weeks. My commiseration's with all those affected & I am happy to highlight this stupidity.
--------------------------------
John
Would it be worth co-ordinating something now?
Am pinching these comments.
It's an appalling state of affairs. God bless any of the doctors who have been put through this, or are still being put through this.
It's no way to run anything, never mind something as important as the NHS.
What is so appalling? Is it that the jobs are not fairly contested or is it that there is not a perfect job for everybody? Demographic realities decide how many doctors of each type are needed, and where. It is necessary to shoehorn the doctors into these positions because they can't distribute themselves evenly.
@SteveC
Pending a doctor answering you:-
First, there is no limit to the number of training positions a student can list. Although it is not clear from the posts here, there is actually a second round to this process, in early May. It looks to me as though the reason for the silly interview clash problems is that everyone is required to work to a very tight timetable, since unfilled posts have to be readvertised in the second round, after the first round interviews. I don't know whether the limit of 4 applies to the second round or not. Presumably it applied to the first round because of the tight timetable.
Second, there is a lot of support from the staff, both administrative and clinical. Presumably that will get better in future years (this is the very first time the new system has been used).
Third, there seems to be more opportunity to return to the Match the next year or later. I don't think anyone really know how this will work out. The new system seems to be designed to "force" or "encourage" doctors to accept training positions in unpopular specialties and/or unpopular areas of the country. Your description of the US system makes it sound as though that is already an accepted part of how it works.
Fourth, there are always more positions than stuents, although there are specialties that are highly desired and filled quickly. Someone who doesn't match can always find another specialty, or just take one additional year of hospital training (here called an internship), and therafter go practice as a general practitioner. This is really the crunch point. The new system is being introduced at the same time as an "oversupply" of doctors compared with the number of funded posts, caused by an increase in training places some years back and the financial problems of the NHS now. Look at the numbers of posts mentioned in a comment above.
Fifth, after training for four to seven years (or one for GPs), the resident physician looks for a practice, which is usually private, and can be anywhere one chooses. If someone wants it enough, they can move to a city with no job in hand, 'hang up a shingle' and start their own practice from scratch. My guess is that it is this ultimate freedom to choose (or lack therof) that drives the angst in the UK. Is this correct? I'll leave the doctors to comment, but since the vast majority of doctors in the UK are employed by the state, it is difficult to imagine that freedom separately from all the other changes that would have to happen to make it possible.
Look, it might help if someone somewhere told the "public" what the hell is actually happening. I have read numberous posts on this and have managed to work out the following:
(a) young doctors, new system
(b) possibly involving some randomness, specialism-wise and geography-wise
(c) bad computer system causing delay and, therefore, stress
(d) erm... that's it.
It sounds horrific. But this is being badly communicated to people on the outside. If you want the sympathy you so obviously deserve, it might help if someone could actually lay it out what the hell is actually going on, how it is different to what happens in other professions and why that is bad.
Good luck all of you.
Dr C - I have tried to send you an email - I assume that you mean the small mail symbol at the bottom of the post. If so, it will only let me email you if I know your address. I assume that little symbol is an email a mate your NHS blog doc post, rather than an email to you.
I seem to be a little dense here am a touch tired was pulling double plus shifts to pay for flights for interviews! What am i missing? I would like to send you an email with attachments (word and PDF). Help me Dr C.
I was going to send you the info for you to use as you saw fit. Not for a pat on the back, there there old chap type thing. Currently, that role is being filled by work and beer.
Dr Sniper
Sniper, send him a message from here with your details. He can then get in touch via one of his (I hope) anonymous webmail accounts.
Dr Sniper, I can't work out what he meant either (the little mail symbol if of course meant to allow you to email the post to someone else, not to email the blogger). Since he specifically invited you to email him, I don't suppose he will mind if I tell you
drcrippen AT nhsblogdoc DOT wanadoo.co.uk
making the obvious corrections to turn this back into a valid address from my spam-avoiding version.
Thanks to potentilla and Katherine for some explanation. I hadn't realized that this was the first year of the process. It doesn't excuse the IT and scheduling problems, lack of communication, and general bureaucratic stupidity, but every first run is problematic and these physicians have just been caught in the grinder. You can piss and moan, or you can suck it up and do your best. If you are a doctor trying to save people caught in a hurricane, tornado, or earthquake, are you going to complain about the lack of sterile wipes, or make do with whatever you can?
You can't fix the system for this year. But you can band together for emotional support, help each other as best you can, and put together a plan of publicity, political pressure, etc., so that next year's class won't getted sucked into the same maelstrom. As a side benefit, you may get the system changed enough so that your class gets a second chance, since that would make sense, but if you focus only on your own cause, not next year's class and the public health as a whole, you will get less support.
If you don't get a second chance, its tough luck and your life is changed, but NOT ruined. It doesn't even begin to compare with surviving the Blitz, or the Christmas tsunami, or growing up in much of Africa, etc. You have a good mind and training. Life requires priorities. Pick what is most important to you (specialty, location, medical career, etc.) and go for it. In today's world everything changes in a few years anyway, and you will almost certainly find new avenues to pursue. Since finishing medical school, I have had seven different 'careers' (resident in training, private hospital practice, academic faculty, clinical research, research administration, business consultant, and now entrepreneur).
What did those of you who applied for ST positions in general practice think of the exam on Saturday?
I've heard rumours that the EMQ paper (which was widely regarded as straightforward by F2s through to post-membership SHOs) is a test of minimum competence and therefore doesn't count towards short-listing - has anyone heard differently?
I am still trying to make sense of it all and am finding it hard to accept that I may be rejected on the basis of a computer marked 'professional dilemma' paper which contained too many questions for the allocated time and can only be described as bizarre. An example question went something like this:
You are in clinic when a patient suddenly bursts into tears. Rank the following actions in the order you would do them:
(1) Give the patient a tissue and ask what's wrong; (2) wait a while then ask what's wrong; (3) hold the patients hand, wait a while then ask what's wrong; (4) wait a while waiting for her to tell you what's wrong; and I think there was one other option which I can't quite remember but you get the general idea...
The number of applicants for general practice far outweighs the number of training positions and to exclude a large number of potentially very good candidates on the basis of such an exam beggars belief. We are NOT in management or indeed, the FBI (where the revision websites inform me this type of exam is used as a recruitment tool), we are doctors for heavens sake.
I don't understand why it has become so untrendy to actually assess and credit candidates on what really counts: clinical ability and communicating effectively with patients. Isn't this especially important in the recruitment process for general practice? As we all know we live in an increasingly litigious society where GPs are amongst the most vulnerable doctors in the NHS - needing to rely significantly on clinical acumen without the luxury of immediate test results or assessments from colleagues in other specialities. I accept there is a vague assessment of the above in the selection centre/interview stage but you have to be lucky (not good) enough to make it through that ridiculous exam first.
Guess it's one more example of dumbing down...good luck to everyone waiting for GP interviews - I hope it's less of a fiasco than the events of yesterday.
Dr Sniper, I can't work out what he meant either (the little mail symbol if of course meant to allow you to email the post to someone else, not to email the blogger). Since he specifically invited you to email him, I don't suppose he will mind if I tell you
drcrippen AT nhsblogdoc DOT wanadoo.co.uk
making the obvious corrections to turn this back into a valid address from my spam-avoiding version.
potentilla
Thats fine
ButI am slightly puzzled. the email address is at the bottom of each comment I post and on the profile.
John
"ButI am slightly puzzled. the email address is at the bottom of each comment I post and on the profile.
John
Dr John Crippen | Homepage | 27.02.07 - 4:10 pm | #"
All I see is that "Homepage" links to nhsblogdoc.blogspot.com and "#" links to the comment itself. Likewise I see no email address on your Blogger profile.
Perhaps they are hidden because I am not logged in, or something is configured as not publicly viewable.
Katherine wrote that it might help if someone clarified, for the public, just what the complaints are about MTAS. I’m not a doctor either, but I am married to one and I have been with him every step of the way (we have matching ulcers…) so here are the major issues as I/we see them:
1. Lack of transparency. This whole MMC/MTAS was thrown together like an omelette in a cheap café, without proper consultation or aforethought, and no one seemed to be willing or able to give proper answers to doctors about basic questions such as “which level should I apply to?”, “which specific competencies are required at each level?”, “how EXACTLY can one demonstrate achievement of those competencies if one has not been through the foundation program?”, “what do each of the levels pay???”, “what are the short-listing committees actually looking for?” and the list goes on… Only very generic answers have been given to any of these questions, usually with a referral to another website ‘for more information’ but then of course that other website (deaneries, colleges, etc.) doesn’t have a clue either. Or if they do, they are unwilling to take the time to answer doctors’ concerns. One deanery even had the gall to refer doctors to ‘the medical press’ for more information! Which leads to the next issue:
2. Lack of respect. In this whole process it has been made very clear that the least important person in the NHS is the doctor. All of this was thrown together at the last minute, not leaving doctors enough time to prepare themselves for the application deadline. That’s the doctors’ problem. Doctors have to prove they have what it takes. How? That’s the doctors’ problem. Doctors have to submit their applications on time, no exceptions, but deaneries can submit their shortlists as and when they like. Oh, will that cause doctors some distress? Too bad – that’s the doctors’ problem. And (this is my personal favourite) if you aren’t short-listed in the first round, you are not entitled to any feedback until AFTER the second round is complete. So you go into the second round blind – no idea what (if anything) you did ‘wrong’ and no chance to try and do better. Oh and if you weren’t even long-listed (i.e. if you were under/over qualified for the level at which you applied) you won’t find that out either.
3. Lack of jobs. My husband applied for ST2 in orthopaedics. At his level there were around 15 jobs in all of Oxfordshire, Hertfordshire and Buckinghamshire (combined). There must have been hundreds of applicants. What happened to all of those SHO posts in all of the hospitals in those regions? I know they have been spread over ST1-5, but I still think hospitals will be sorely understaffed. Especially since…
4. Lack of planning. Deaneries are conducting interviews for the same specialties on the same day. So doctors lucky enough to be offered more than one interview are often being forced to choose between them. (Actually this is the only thing that offers me a glimmer of hope – surely there will be a fair number of posts available in the second round if only ½ the short-listed doctors turn up to any given interview?) And they seem to have overlooked the fact that they may not be the doctors’ first choice, so even after interviewing, they could wind up with an empty post. In other words, I think their shortlists are too short. Also, has anyone else noticed the irony in the fact that while MMC is slashing the number of training jobs for junior doctors, the NHS wants to start doing evening surgeries? Who are they going to get to staff those once all the ‘surplus’ doctors have fled the country? They will of course turn to locum doctors, who cost the taxpayer more but who are not rewarded with training opportunities. The workhorses. Another example of lack of planning is the repeated crashing of the website. They apparently did not anticipate that 30,000 doctors would submit their applications shortly before the deadline, so the website crashed. They were ‘good’ enough to extend the deadline in order to give people a chance to submit, but apparently did not learn their lesson. So when those same 30,000 logged on to see the short-list results, it crashed again. Imagine the agonizing wait, which was extended because the deaneries couldn’t get their acts together, you’ve been awake all night, watching the minutes tick by, then finally the hour arrives, 9am Monday morning, and then… blank screen, error message. (Did I mention the ulcers?)
5. Lack of substance in the application. The short-listing was based on answers to essay questions of 150 words max. Even though applicants had to enter their whole career histories into the online application, these were not seen by the short-listing committees. Is there any other profession where your education and work experience are not taken into account? Is there any other profession where it is more important??!!
There’s more, much more, but to be honest I’m so fed up of thinking about this that I’m going to stop here and let others fill in the blanks. Like so many other doctors, my husband did everything right and so far 3 out of his 4 choices have not chosen him. I guess the 4th will let us know in their own sweet time. Meanwhile we are looking at our options. Leave the country or leave medicine? Seems to be the theme of the week. Or wait it out, work as a locum and hope that things improve? Perhaps I’m too jaded, but I think if the government ignored public opinion on Iraq, on congestion charging, on road charging, then I doubt they’ll do any different on this. In fact our overriding concern is ‘do we want to raise our son in a country where his voice doesn’t matter’? He is 11 months old, started walking this weekend and we should be celebrating that and planning his 1st birthday party, instead of sitting here in a cold sweat wondering what the hell we’re going to do, where will we live and how can we give him the kind of life we have imagined for him? Will he be MTAS’s real victim?
Apologies
When I changed to "new improved" blogger, my email address did not go over.
I have corrected that (I think!!!)
JOhn
My partner is currently an SHO, fortunately with one interview. So the rest of our lives rest on half an hour in March.....that might sound over dramatic but it's true. I am not an angry person but I'm furious about this system that's completely screwing over people who have had to work their arses off night and day for years to get where they are now. I can't bear the thought of my partner having to change career when he has spent so many years in hard slog getting to where he is now. I'm a teacher and more flexible so I guess we're the lucky ones.
My heart truly goes out to all you doctors and partners of doctors out there, especially if you have kids that will be affected by all this.
Its just a shame doctors aren't generally the sort of people who would go on strike. Perhaps that would show them how much they've screwed people's lives up?!!
The irony is MTAS is a system whereby people have been asked to apply for jobs they are ALREADY in, and now they are being told they are not even good enough to interview for the job they have been doing for 6mnths,
The NHS is about to lose it's most experienced clinicians. The public need to know. this is bad bad news for them. this is bad news for everyone.
My support and thoughts are with my friends who are getting screwed over by MMC and MTAS, and they are all and should continue to be bloody good doctors.
Whoever is responsible for this catastrophe whould be named and shamed and sacked.
Why aren't doctors prepared to go on strike? I was all for it in '99 when the new contract was a glimmer on the horizon, still think we missed our shot. I still am for a strike now.
Don't even mention the BMA.
I suppose if you don't have a job, going on strike isn't an option. If the government decides it only needs x-number orthopaedic surgeons, why should it train more?
Asa third year student, we were on the wards today when the SHO opened her mail to discover that interview for her specialty were scheduled for the same day in the Yorkshire and West of Scotland areas. Its not a large specialty (Rheumatology) so this seems a little weird.
Neither is allowed to change it's dates due to a protocol, and due to the strange interview process, described as being rather like an OSCE where you rotate round interviewers so you all get the same questions. So the chances of a morning interview in Leeds, a 200 mile drive and an afternoon interview in Glasgow seem remote. She said she was not the only SHO in this situation.
Interview dates were published after the SHO's had ranked their choices, thus they did not know which interview dates would conflict.
It's crazy........
Doctors should go on strike, now.
Doctors should go on strike, now.
Nope. That would instantly lose you all public sympathy which would in turn put you at the mercy of the government.
This is not me being unsympathetic, it is just an appraisal of the realpolitik of the situation.
The comments in here just make me sick, I'm a 5th year student awaiting my programme choices later next month and all I get from here and my hospital is that everyone is screwed over regardless. Until recently I was unaware that ST applications used pretty much the same pathetic insulting application questionnaire which is subjectively marked by a local deanery(i.e no consistency)and given out without any indication of the marking scheme.
I hope the laws of probability help and that other students choose posts that I dont like but if I get screwed with multiple posts in dire positions and/or choices then I'm considering leaving the profession altogether. Luckily I have something to fall back on but it will be a struggle to manage my debts.
People's comments before are right. This needs more attention. Perhaps we should start an e-petition at http://petitions.pm.gov.uk/ calling for MMC/MTAS to be scrapped/heavily modified because it is fundamentally flawed and WRONG in its scope as people before have mentioned.
I would start it myself but I have recieved fire for those involved in the system for complaining locally and who still have precedent over me these last few months, I was called unprofessional for complaining about the system, so much for free speech!
I'm sure if someone started a link and spread it to DNUK forum then many doctors would sign it from which a % could be asserted. Hopefully this would also incur some press attention.
what do people think?
Oh Honestly, stop whingeing, job insecurity is the NORM in the private sector. Imagine if this litany of whining was posted by Pub owners or car salesmen. "Oh no my mortgage - my pension - my 150,000 a year for a normal working week -devotion to selling the best new car deal - all on the line" Clear off to Australia the lot of yer and don't come back!
I'm sure they'll be happy to clear off to Australia, mutley.
Just pray you don't get sick in the meantime.
The government is trying to remedy the doctor distribution (by specialty and region) crisis, but the doctors feel this tramples on their childhood dreams. Get real guys and lose the entitlement syndrome. The taxpayer decides who goes where and if you don't like it, find another government to scrounge off. Just do it, don't keep threatening it.
I feel that the only thing to do under the circumstances is to go on strike. We could continue to carry on the emergency work as before, making sure that the sickest of the patients does not suffer. Did someone say something about the loss of sympathy? We can only lose something we had in the first place.
All I know is that if I treated my patients with the same amount of empathy as we are being treated at the moment, we would rightfully be struck off by the GMC in no time at all.
Mutley the dog
Piss off you insecure small-penised twat.
If you can't see that spending £250K per newly-trained doctor and then having that wasted with the doc going to US, Aus etc is crazy, then you're even stupider than I think.
Wait til you get ill you fucking little bastard, then you'll whinge, like the ill-informed coward you are. These doctors are on £25-35K by the way for a 50-60 hr week. Ignorant twat.
Dear MR Your Wrong
So following your logic if we spend £500 000 training doctors then we have to let them rip us of even more to keep them.
I trained myself at what I do and create now more wealth for the country than the average doctor. So can I have a refund on the £250,000 that the tax payer has never invested in me?
If you were promissing to pay it all back with interest then robbing the countries poor tax payers even more would not seem so imoral.
Start living in the real world and stop threatening people with their own lives to fetherbed your own selfish ones.
I trained myself at what I do and create now more wealth for the country than the average doctor.
*****************
I wonder how many GPs and cardiologists and everyone in between have worked on high powered business execs who have lived to make a lot more money for their shareholders.
That is a silly comparison. Doctors are not there to create wealth but to create conditions in which a population is healthy so they can go on and make money and work at jobs and keep the economy turning. Public health care (socialized medicine) was supposed to allow that everyone had a generally accepted level of health care available to them in order that the economy could benefit. I honestly do not know how successful it has been, but I do know that the only doctors who ammass/create great wealth are usually the ones who end up on Orac's Friday Dose of Woo.
Whatever- just whatever.
I have a good idear why dont we just deport all you lot for threatening terrorism. Then we could just get some cheaper doctors from some starving 3rd world country to take your place. After all they dont nead doctors do they?
If you dont like what you are getting paid its quite simple. Do what every other normal person does, that is, those that cant threaten other peoples lives without getting arrested, and leave the job. Its not rocket science, go and work somewhere else. Then they will pay you more or replace you or people will die. Its not your problem, thats the governments.
However DOCTORS AND NURSES going on strike on mass is imoral beyond belief. Thats worse then BLACKMAIL. I am sure there are at least some people in the medical "profession" that understand why this is imoral. Unfortunately not many of them seem to have a PC.
The taxpayer will pay for your training as long as you go into the specialty he chooses (I say he because males pay the most tax). If you can't get into your desired specialty the pay for the training yourself, or otherwise, find a new career.
anonymous
The comparison is more then good because it is people like me that PAY YOUR WAGES. GET it you Marxist. I know none of you people understand simple economics your just doctors after all. But please dont be so arragant to sugest that anything I do is in anyway less important than what you do. You dont even know what it is I do.
However someone must think it is very important otherwise I wouldn't make any profit and you would have no wages at all.
Thanks to Potentilla and Moonlights - I will get on to it tonight.
Incidentally, Aviator you are a bit of a tool aren't you now? Childhood dreams? What I wanted to be, for example, a gastroenterologists as a child? Most kids want to be "a doctor, when I grow up." You discover your speciality as you go along in your medical training. You plum, different specialities have different requirements. A neurosurgeon with a tremor is not much use, neither is a physician with no people skills. It used to be that as you progressed through your career your obvious suitability for a speciality revealed itself, now you are expected to make a fantastic whatever you are told to be.
The care that you will be offered is now going to be given to you by someone who really does not want to do that job – and you not only seem happy with that but are encouraging the remaining docs to bugger off, when we are short already. Hope you enjoy your illnesses in future. Who is going to try and make you better?
Dr Sniper
Anonymous 3;55
So again we see the logic of the elitist "professional". "Because I save lives I am so special that quite frankly gods got nothing on me."
How about the plumber who claims that without him making sure your water supply is working you would DIE. Or the guy who delivers your food to the supermarket. Or the guy that built the house that shelters you. You would be dead without these people so why are you so much more important then them?
What they get paid is determined by the market. Doctors wages in Britian are not. This is a political matter. the NHS is a socialist throwback well past is sell by date.
Doctors earn more in countries that work in the free market. Instead of striking Doctors should be asking very politely to put an end to the NHS once and for all. Sell of the hospitals and just give the poor the cash when they are ill. Before doctors become complicit in murder.
Please remember you might be doctors but you still shit and piss and your going to die in the end just like everyone else. You are not special people just very lucky ones. That do a highly trained job that you mess up just as much as everyone else messes up theirs.
Dear Gary
I am not a doctor. I am not a socialist. I am not British.
No matter what kind of economic system you have put in place to pay doctors, there are weaknesses in the system - in socialized medicine countries, you have politicians and taxpayers hashing out who will get what. Some people lose.
In "free" economies where the doctor is a business man you have insurance companies who decide who lives and dies.
Either way, you have a middleman who serves to limit access to treatments OR facilitate access, depending on a bunch of factors. Money and location are two big ones.
But please do not hold up the insurance company model as more fair. You would be an idiot to do so, as story after story out of the USA would contradict your version of Utopia.
As well, you moron, doctors practice as PROFESSIONALS. They have codes and ethics that are peculiar to their PROFESSION. Most doctors are also of the mind that they SERVE those who they deal with- they don't suck them dry for a buck or a thousand. They actually are providing a human service to another human being.
BTW Most plumbers connected to the water supply are civic employees, and practice under strict civic codes made by evil business hating governments.
I have nothing else to say other than you are an idiot. A ranting, persnickity, "socialist under every bed" type of dude.
I hope that you never live to regret your hatred of doctors. Does it get foisted on teachers as well? They are civil servants who I am sure are deserving of your rage. (For the normal people here, sarcasm was intended)
Who else do you hate?
And honestly I don't give a f*&k what you do or how much you make. But if you want, we can play the "mine is bigger than yours" game . I am sure it will be fun.
Anonymous 3:55
Actually, you ought to rant at teachers- you spell very badly. How's your blood pressure???
(Not a swipe at teachers---- a swipe at a mad crazy person who is obviously blaming everyone else for his mistakes, shortcomings and station in life!!!!!!!!!!)
"Mutley the dog
Piss off you insecure small-penised twat."
Glad you're not examining me you would be in for a big surprise!
"If you can't see that spending £250K per newly-trained doctor and then having that wasted with the doc going to US, Aus etc is crazy, then you're even stupider than I think."
So lets place restriction orders on them, and they could all become medical orderlies!
"Wait til you get ill you fucking little bastard, then you'll whinge, like the ill-informed coward you are."
Because there will be no doctors? Or maybe because there is not a surfeit of them? You seem obsessed with size -why? - also I might be wrong, but I don't think Im a coward.
"These doctors are on £25-35K by the way for a 50-60 hr week. Ignorant twat."
You'd have to work 120 - 140 hours a week to earn 30 -35k on the minimum wage - and whilst these docs have a career ahead of them some one working 20 hours a day 7 days a week faces career progression to - oh -certain death. That'd be lots of people who drive things you know - things full of people - life and death etc.
But of course they didn't get a 250,000 education courtesy of the taxpayer.
The comparison is more then good because it is people like me that PAY YOUR WAGES. GET it you Marxist. I know none of you people understand simple economics your just doctors after all.
Yes, we are JUST doctors. As said in the Gerry Robinson program, we have more degrees that you have GCSEs (or are you one of those morons who failed basic English GCSE?)
hey dickhead, enough of the bashing, you don't know what the doctors are going through - doctors are central to maintaining a good health service. It's a public service which you'll use.
"However DOCTORS AND NURSES going on strike on mass is imoral beyond belief. Thats worse then BLACKMAIL. "
Why? everybody has freewill, we do what we bloody want you moron. if you don't like it go elsewhere.
Dr Sniper: So doctors should choose their specialty unhindered and also where they practice- no restrictions. And the taxpayer must fund these extravagances.
How do I explain perspective to someone with no sense of proportion? I may be a "tool" and even a "plum", but you strike me as a "zero". Good luck with that.
MMC relies on a 'divide and rule' mindset that can be applied to almost any group.
Create a system that has 'winners' and 'losers'. No matter how catastrophic that loss might be providing there are enough 'winners' the instinct to compete will overide the instinct to protest - a protest, of course, would require organisation and consensus, both very difficult in my experience.
Look at working conditions for many of our nurses, and the well documented problems on the wards, but as a profession we have been unable to bring about effective change.
And then there are the targets - many Trusts seem to operate in a climate of fear these days, cooking the books, or introducing daft short term measues that waste time and money.
I must admit, up until fairly recently, I did not appreciate how vindictive MMC was for each applicant - and I'm still not sure if it is driven politically or by the medical heirarchy.
The main options as I see them are;
* Industrial action, unlikely though, given the
working culture amongst docs/nurses.
* Non-compliance by medical leaders, again
unlikely according to many recent
commentators.
* Non-compliance amongst candidates [see
divide and rule paradigm].
Why should we not choose the speciality appropriate to our skill sets?
We have, most of us, already worked all over the country most often not in locations we would choose to work. But I really don't expect you to understand that. Now we don't even get that choice.
If you want a doctor to try and sort out whatever illness you have, most sane people would hope that the doctor would be interested in that speciality rather than having been forced to work in that speciality with no hope of onward career progression. If you want that lack of interest from your doctor, congratulations, you will suffer.
As to you being a tax payer, con-fucking-gratulations, so is every medical professional in the UK. Because you pay our wages you get to tell us what we do with our lives and where we have to work. You could say that we pay our own wages as well; do you do that with your (assumed) private sector job?
As to getting some perspective, tell you what, How about I fuck around with your life and then you try not to complain. Of course I have some bias. Idiot.
Really A&ECN, that's not worthy of your normal calm and reasonable posts.
MMC is nothing to do with "divide and rule" and it's not "vindictive". Competition for jobs arises naturally. Even if you had a 100% perfect crystal ball to know how many cardiologists you would need or be prepared to pay for in Manchester in six years' time, that would still mean disappointing some would-be cardiologists, wouldn't it?
It's a ham-fisted attempt to solve the problem of not being able to recruit (say) dermatologists in Penzance (and I apologise to any d's in P who think this example is unfair). In fact, I suspect it was originally an attempt to adopt the US system as described above. I don't know who "reinserted" the interview bit which the US doesn't have - any halfway competent administrator could have pointed out that the timetable as proposed was bound to end in tears. Add silly recruitment criteria and bad IT - result, misery and stress, especially when introduced in a year when the crystal ball produced a seriously wrong result.
Chaos, not conspiracy. The only conspiracy involved is in trying to ensure that the taxpayer money spent on medical education actually provided some d's in P at the end.
(PS not wanting to get into the exchange of ill-spelt civilities above, but you have to wonder about a doctor classifying someone as a small-penised twat. Even I know more anatomy than that).
Thanks Potentilla,
Maybe palpable anxiety from medical colleagues is contagious - remember numerous specialties spend considerable time in A&E - I hear those affected talking about MMC most days.
I admit straight out that I am no authority on it but I do know that NONE of the docs ever seem to anything positive to say about MMC - either at junior or senior level.
It's a fair point to highlight concerns about getting enough docs into less popular specialties [and in less popular locations - although I understand Penzance is rather nice] but as I understand it MMC will probably create more problems than it will solve.
The problems as I see them include;
* Docs with specific talents not being able to
pursue their preferred specialty due to
draconian selection procedures - we can't write
this off as prima-donna syndrome, it's a really
important aspect of career development in my
opinion.
* Disaffected medics shoehorned into jobs they
don't really want.
* Docs opting out of the NHS [choosing to work
abroad or in other sectors].
Surely, endless tampering with NHS processes is proving to be both costly and counterproductive.
Hewitt virtually admitted that we have come full circle when it comes to the internal NHS market or whatever other the name it will be called these days.
And what really gets to me is that there seems to be no long term or settled strategy, at least in the sense that the grunts on the shop floor know which direction we are meant to be pulling in.
Too often changes feel like a knee jerk reaction, and poorly thought out to boot.
For example, once the 4hr A&E target is quietly dropped, we will return to the bad old days of too many patients competing in a volatile environment where there are too few resources.
Perhaps my post was a bit OTT but as I say there is an unpleasant atmosphere hanging over our young docs and I just don't understand why they are being treated so shabbily.
As you know I always welcome alternative points of view but this time there seems to be very little support for MMC once we exclude those expressed by the free marketeers.
‘Why should we not choose the speciality appropriate to our skill sets?’
Of course doctors should be allowed to choose the speciality in which they are most interested, surely that’s a no-brainer? This is to the benefit of both doctor and patient – when I need to see a hospital doctor, I want to see one who specialises in my particular complaint because a) he’ll know more about it and b) he’ll be more interested in it (and, hopefully, me!).
‘We have, most of us, already worked all over the country most often not in locations we would choose to work.’
However, I think also to demand the right to work in a chosen area of the country is pushing your luck a bit. Very few of us have this luxury and if you really, really want a particular job you have to be prepared to move to get it. This, sadly, is the real world as most of us know it, involving a series of compromises between career, family, lifestyle, etc.
Though none of this excuses the completely outrageous way your careers are being administered.
I join as a member of the public not an NHS employee but I can't believe how this god-forsaken government has managed to make such a horlicks of the NHS. Broon has taken loads of extra money from us beleagured taxpayers (NI tax) only to waste it by handing most of it to his and tony's cronies (I wonder if garypowell is one of them?) through PFI. What a con on such an enormous scale.
Last summer it was the newly graduated physios and nurses, 90% of whom couldn't get a job, now its the doctors.
How I ever imagined that the NHS was safe in NuLab's hands is beyond me.
I am astonished and extremely disappointed with the vitriol aimed at doctors by some here. Have you actually listened to what is going on or have you just leapt to the conclusion that the doctors are just whinging?
If you actually find out what is happening, then you might see that what is worrying people particularly about the MMC is not that there is competition for jobs or that they might not be able to get the specialisation that they want (although I'm sure that is individually worrying), but that the system is entirely unfair and unfit for purpose.
It seems, from what I can see, to offer neither transparency for the doctors, nor good results and employees for the NHS/taxpayers.
When an ENTIRE profession is outraged by something, with no one having a good word to say about it, chances are then there is actually something broken, don't you think?
Dear Rob - I am happy to work elsewhere in the country and with my wife's support I will even uproot my young family to do it. We (docs) used to do it all the time. I lived in Surrey yet worked in Cornwall, Hereford, Sussex and so on. Now I/we cannot get jobs anywhere close to home, or at all. To relocate thousands of miles for a job you don’t want and have no aptitude for seems a little, well, pointless.
It is not quite the same as the private sector – in the NHS you cannot shift employer if the area does not work out. I understand it is not that easy in private sector land either - but the option is there.
For the next year I have no job, with no prospect of meaningful progression to the career speciality that I have been working for over the last 5+ years. Then next year I am even less likely to get a post as I have only being doing "making time" jobs. Hence, the death of my career.
It is difficult to write this and not get emotional, but I genuinely don’t know what to do with my training now. There is no where to put it to good use (and pay the mortgage). My father suggested “working for free to show willing.” There is no box for that on MTAS and claiming the dole seems very, very wrong given that there is need for me to do what I do, just no way to do it and advance my career.
By saying advance my career, I don’t mean that I aim all of my effort at climbing the ladder for better pay etc, but becoming a better and more experienced doctor.
There are always other options; go to the private sector world (not hospitals), work on a cruise ship and so on. They might not be what you planned, they are certainly a waste of a good budding “insert speciality here” doctor.
The old saw that life does not often work out the way you planned is true. But up until very recently, I could say that my career was defined by ongoing acquisition of knowledge and your care as a patient, when I gave it to you, would only get better.
There is no reason to acquire knowledge for a job in which you have no enthusiasm. The idealism that carried you into medicine does dry up in the harsh cancerous glare of reality. That idealism will not mean that, stuck in your dead end job, you will seek to improve. Think Wally from the comic strip Dilbert.
Dr Sniper
Rob, I should add that in moving around the country before I was building my career. So that I could get a good training rotation, anywhere.
Dr Sniper
there seems to be very little support for MMC once we exclude those expressed by the free marketeers
No free marketeers would support MMC, since it is an examle of rigid socialist-type centralised planning. The fact that it produces some of the dis-benefits popularly associated with the free market does not mean it is actually anything to do with the free market. The free market might produce just as many people ultimately disappointed in their career expectations, but they would have a lot more ability to influence their career outcomes, and chances to try a second time (or indeed fifteenth time) if the first time didn't produce what they wanted, and so on.
I can see why working with all the poor people currently affected colours your views of the politics of the whole thing. But really, I don't think you can claim that it was imposed on the medical profession - see here, for example.
The immediate problem is exceptionally poor implementation - very NuLab.
Dr Sniper, I don't mean to be facile and I know "go-to-Australia" has become a cliche, but have you, in fact, considered it? I worked there for three years (in Sydney) and would have been happy to spend the rest of my life there had things worked out differently (I had a temporary residence permit and permanent residence would not be available to someone with metastatic cancer). I certainly didn't realise what a great place it can be until after I went there, despite having an Australian-owned employer in the UK for some years.
I think I would be inclined to start the process quickly though, to get in ahead of the possible crowds in late May. After all, you wouldn't have to go through with it.
I thought you might like to know that I have just fired off an email to the Department of Health, copying in a number of news organisations (you never know your luck) and my local MP. Full text follows:
Dear Ms Hewitt
I am appalled that a Labour secretary of state for health has presided over the introduction of a scheme as arbitrary, cold-hearted and short-sighted as the euphamistically named Modernising Medical Careers initiative.
My partner is an SHO working for an NHS Trust. Neither she nor any of her peers have so far been shortlisted for an interview in any speciality within any deanery. Save for the slim chance of securing an interview after the second round of applications, this has effectively put an end to their medical careers.
I wonder if you can begin to imagine the anguish that this state of affairs is causing countless thousands of families up and down the country. Even those lucky doctors who have secured interviews face the upheaval of moving home, finding new schools for their children and leaving behind support networks of family and friends if their applications are successful.
You need to be aware that through your actions you have single-handedly been responsible for the haemorrhaging of thousands of Labour votes.
Why was there no consultation process before these changes were so swiftly imposed?
Why was better provision not made for the many doctors who fall into the gap between the old and the new systems?
How can you justify the inevitable brain drain that will follow as doctors emigrate to countries where they can continue their training?
How can you defend the lack of patient access to properly trained doctors that will be the inevitable consequence of this reform?
In the coming months there will be a wave of protest against these changes and the general public will slowly become aware of the true extent of the debacle over which you have presided. Your response to Liam Halligan on Channel 4's 'Dispatches' programme on Monday evening was so self-serving as to be repugnant. The "absolute insult to NHS staff" is your disingenuous refusal to accept that both you and your government have failed the NHS.
Yours etc
I encourage everyone else who is angry to write to the Deaprtment of Health and their MP - this is surely the best way of making your concerns known.
Dr Sniper, believe me you have my deepest sympathy for the bloody shambles you’ve been caught up in. Although not in the medical profession myself, three of my children’s dearly beloved godparents are doctors, so I do have some awareness of the situation, which is nothing short of a disgrace.
I absolutely support your right to specialise in the area you want to and to be able to pursue a career in that speciality.
I was merely addressing the specific point that some doctors seem to think they should have the right to determine where they want to work as well and that, I feel, is a little unrealistic. I, and the rest of the population, have to go to where the job I want is located or accept a job I don’t want to do quite as much but which is more convenient for me/better for my family etc etc. I’m not convinced that doctors are a special case in this aspect. But of course you shouldn’t have to re-locate AND do a job you don’t want.
Hope something works out for you.
Nice letter Dan
Interesting that Ms Hewitt is my MP.
When applying to see her at her weekly surgery i was asked and subsequently informed appointments would not be made with NHS staff(i am a surgeon).
.... with over 5 years postgraduate experience and my surgical RC membership....and no MTAS interview.
angry surg
Hewitt refuses to make appointments with constituency members on the basis of who they are employed by?
Unconstitutional!
Anyone want to lay a bet that she'll still be in her job come the summer? I'm offering odds of 100 to 1...
MAKE YOUR VOICES HEARD PEOPLE
MARCH IN LONDON NEXT MONTH
WRITE TO YOUR MP AND THE PRESS
It really is appalling. I'm exploring
another approach at present...
According to the MMC's website MTAS will provide "a clear and open process for recruitment" http://www.mmc.nhs.uk/pages/med1. Yet the scoring of MTAS
applicants is not an open process, MTAS forms are currently scored using
confidential marking guidance.
The department of health is currently considering a freedom of information act (2000) request for this information under section 36 to which the public interest test applies.
I believe that there is a strong case for a truly open application system and that it is in the public interest to have one. In any case I think that the matter warrents proper consideration and so bring it to your attention here.
For what it's worth.
Reading all of this has just broken the camel's back. It's finnaly convinced me not to apply for medicine. Shame.
Well done NHS, you win.
Mutley the Dog
Enough said. No need to argue with a tool with a shrunken head.
As I said, piss off. Back to your polyester suited grunt-job pushing paper, or whatever non-valuable waste of time task you do. Find another forum to serve your Daily Mail-style sense of outrage, illogical reactionary outbursts.
And your cock is small. Your ex-girlfriend has been circulating pictures of it under the headline "micropenis".
Dr. Crippen, I'm puzzled by all this, looking at it from the outside.
From the perspective of this side of the pond. In the USA.....
You graduate medical school, assume satisfactory performance.
You take medical licensure exams, in my day it was called the National Board, now I think it's USMLE, which I think is US Medical Licensure Examination.
You decide what part of medicine you want to enter, medicine, surgery, pediatrics, etc.
You apply to the residencies. There's a matching program, the training programs rank their choice of candidates, the students rank their choice of programs, they try to match everyone in that system.
Assume you're happy with your match. You take some sort of postgraduate training. Some people do general internships, or at least they used to be called internships. Some go straight into specialty postgraduate training.
If there are candidates and spaces available after the Match, programs with empty spaces can negotiate with candidates who did not match.
Assuming satisfactory performance, you graduate the program, you get to sit for the specialty board exam.
Getting a job, practice opening, you're on your own. Set up your own practice, negotiate with hospitals or established practices, etc.
Or at least that's how it looks to me. It's been a while, so some of the subtleties I may have forgotten or misunderstood.
Where's the problem in your version of this, where these docs are without a job?
Dr Crippen is advised that the system is weighted so that the “new” doctors are not disadvantaged by their lack of experience. Think that one over.
++++++++++++++++++++++++++++++++++++
ah you mean 'new' doctors are cheaper.
I try to stay calm and concentrate on getting through medschool but every day I see more of this bullshit. I see apparently good doctors like SHP and our gastroenterologist 'Dr Smith' being shafted by an application and assessment process that finds out how well you can squeeze buzzwords into a computerised form rather than if you are any good as a doctor. What the fuck incentive is there to finish medical school if I'm going to find myself being left unemployed by a computer algorithm in a few years? I came into medicine with clear ideas about what I want to do and where, but under MMC I'll be lucky to get a job at all, let alone have a say in what I do and where I go to do it.
Potentilla, as you know competition for posts amongst junior docs is not new, but the arbitary selection process is.
I looked at the MMC link - fine words indeed, but honestly I think most of us would actually prefer it if the core elements of training and clinical practice was left alone for a little while.
In my mind the processes of becoming a doctor, nurse or other health professional [see scientist's comments on recent 'liar liar 'thread] involves learning x-amount of theory.
We are then cut loose in the clinical area with seniors keeping an eye on us [with varying levels of supervision and support, admittedly].
Eventually, we specialise - to a greater or lesser extent - and, hopefully, after many years in our specialty we learn a bit more, including how imperfect our understanding might be a lot of the time.
I don't hear docs are complaining about the competition, just the unfairness and randomness of the selection process, and if this approach was to be universally applied to other groups of workers I'm sure they'd be just as pissed off.
Now all of this [MMC] might be worth it if we are merely dragging a bunch of recaltriant whingers to the promised land, but I really dont think that's the case here.
And surely the acid test for MMC will be its ability to deliver new all-seeing, all-curing docs who are twice as happy and work for half the price.
But it wont, we'll still get exactly the same proportion of ordinary Joe's, semi-autistic geniuses, sociopaths, charmers, martyers, risk takers, and wanna-be stand up comedians.
In other words MMC is just another blatant exercise in pointless NHS upheaval without any tangible benefits for patients.
Arf:
I have relatives also practicising in the states and your residency matching program is indeed a good thing (similar to what our matching system in medical schools is for 1st year jobs after graduation).
After your 1st year (pre-registration) you are on your own. Jobs used to come up at different levels, in different geographical areas throughout the year. If you were unsuccessfull one month, you knew there would be a similar job somewhere else the following month.
The new system only allows a two week window to find a training job in the entire year - Wait till next year if you cant get in is the message.
It is also restrictive in that only a maximum of 4 choices are allowed in total (it further limits this by area and speciality in a very silly way)
Basically if the US system were adopted it may well make sense but the government are using a very retrictive system and not have not put in any transition arrangements for doctors in the "old system"
A case in point - the winner of the gold medal in my year of the postgraduate surgical exams has not been shortlisted at all. (sadly i wasn't the winner!!)
Re: Dr Peter Smith who wants to be a gastroenterologist.
Should the government be forced to train more gastroenterologists than it thinks it needs because PSmith wants it really, really bad. The slots available may have been filled by more talented applicants. Just an idea. My heart still goes out to the doctor but there is a stigma of sour grapes to all of this.
Re: Dr Peter Smith who wants to be a gastroenterologist.
Should the government be forced to train more gastroenterologists than it thinks it needs because PSmith wants it really, really bad. The slots available may have been filled by more talented applicants. Just an idea. My heart still goes out to the doctor but there is a stigma of sour grapes to all of this.
concerned
+++
Hmmm
Not really fair. He is 5 years down the road of higher professional training. That is all going to be wasted not.
He will have no difficult getting employment abroad, and we will lose him, and the investment we have already made in his training.
He is human. He is disappointed and pissed off, as I would be. And he does not even have an explanation.
And he may not have a job. At all.
It's crazy
John
Dr C, I've emailed you my responses to the above questions. I was offered 4 interviews.
Just to point out - I'm the same age as Peter Smith and applying at the same level but in a different specialty.
If they choose the candidates based solely upon those dopey questions, I agree it's crazy. Surely they look into grades.
The positive for Mr Smith is that he can get a job abroad. That's more than many people can claim. I wish him all the best.
I still think the person who pays for the training has the right to place constraints on certain courses, locations however. This is not unreasonable.
There are two problems here - is that right?
The first problem is that there are rather fewer available training posts than qualified applicants. This needn't be a particular problem if the expectation was that doctors would hang around being SHOs until they got a training post, but that appears to not be the case.
The second problem is that MTAS is a pile of crap. It does not usefully identify the best candidates for a post. This wouldn't be a complete disaster if there were enough training posts to go around - in that case, everyone that was expecting to move up would be able to move somewhere, even if it wasn't exactly what he wanted.
On this last point, there have been a lot of posts from doctors along the lines of "you wouldn't force a budding heart surgeon to go and train as a psychiatrist just because there was a spare slot".
Obviously that would be absurd, but it would be equally absurd to employ 50,000 heart surgeons and no psychiatrists. The number of jobs available at each level of seniority in each speciality must, in an NHS, be set by the relative need for those occupations. It makes no sense for the NHS to train surgeons it doesn't need rather than psychiatrists that it does. You can hardly offer the depressed man a triple bypass to cheer him up. (This is an example. I make no statement about the actual relative need for cardiac surgeons and psychiatrists in the NHS.)
MTAS appears to be a capricious and cruel way of selecting candidates for training posts, but with or without it, wouldn't the numbers work out the same? There would still be the same number of posts available.
Dr C, I don't mean to sound unkind but I think Peter Smith's excerpts are evidence that poorly answered questions don't score marks.
I didn't have any secret answer schemes, but I worked out for myself that I was required to be honest about my mistakes and reflect upon them. Peter Smith appears to be in denial of having ever made a mistake.
Also, it was made perfectly clear on the guidance instructions that specific examples were required to illustrate points. I do not believe Peter Smith has done this effectively.
'I still think the person who pays for the training has the right to place constraints on certain courses, locations however. This is not unreasonable.'
Of course. Nobody would disagree with that. Mind you, you have to ignore the fact that in the modern NHS 'manpower planning' is an oxymoron. When it was local it was possible, you created the posts needed and people applied fro them. Now it's all dictated centrally.
There has always been intense competition for jobs. I am proud of the fact that the post fellowship job I got when I was training had 54 applicants, and I got it. No problem with that. The reason why applicants HATE MMC is the totally arbitrary nature of it all.
It is well illustrated in 'Dr Smith's' case. He cannot and does not expect a job as of right. But he DOES deserve the chance to have his day in front of a proper committee so he can be assessed by his peers. Committees thank God still have a majority of Doctors on them, although no doubt the seriously confused will make their way on to these as well.
I think we're all fucking doomed. I have seldom been as depressed about my career as I have been this week, not because I am under threat (although they have just taken away my parking permit as being on a 1:4 acute rota is not deserving enough, work that one out) but because I value my trainees as the future, and at this rate they have not got one.
It is sad that there are people who are willing to knock doctors down at this stressful period of transition in their future training. This is precisely why the government will win on this issue, and why they will continue to create and spin change to suit their own bureaucratic needs.
You don't hear doctors chastising the other professions on here. You also don't hear doctors complain about the fierce competition for jobs - that has always been the case, and shouldn't change because that is the only way that you weed out the unsuitable applicants to every job and select the most appropriate candidate.
The issue with MTAS and MMC is that we are being pigeon-holed unfairly. The group of doctors that stand to lose out the most are the SHO's, who are either in the middle or towards the end of their basic training under the old system. Under the new system, SHO's don't really fit into any comfortable category that the new system specifies - they're either not experienced enough, or in most cases, TOO experienced. The real shame is that so many (thousands) of these SHOs will not get jobs in August 2007 - these group of doctors are the main group who have kept the NHS running in so many specialties.
Before any of the public rant off and belittle our concerns, please try and get all your facts right and try and understand our plight. We're not complaining about competition, we're complaining at the unfairness of the selection system for jobs. If you were a plumber/accountant/lawyer going for a job interview, would you not your prospective employer to employ you on the basis of your skills and suitability for the job? Rather than employ you on the basis that you "look the part" or that you filled in an application form with the correct buzzwords that was stipulated on a marking scheme.
As for paying taxes, doctors pay taxes as well. There is just too much misconception on doctors' wages - this has been perpetuated by the media over the years. I am sick of people bitching about how greedy doctors are, and how lazy they are as a profession. If you want to rant, why don't you have a go at footballers/reality TV celebrities/politicians - these people get paid above and over what they deserve, and for not even attempting at enriching our lives.
You may feel that doctors are arrogant and have an "entitlement syndrome". Well, until you know the shit and stress that goes with medical training, and the feeling of dealing with a dying or ill patient, you will never appreciate what doctors go through. If anything, a vast majority of doctors and surgeons I know and work with have an overwhelming sense of their own frailties and fallibilities as human beings, and most of us are only trying to be good at what we love doing best, irrespective of how intolerant, ignorant or obtuse some people that we treat can be.
To RJS,
if you really think you can tell how good a doctor is by how they fill out a form, you must be mad. Or deranged. Or a manager.
I didn't suggest MTAS was a valid way of telling how good a doctor is. I don't think that by any means.
I do however think MTAS was an exercise which involved following the rules. If asked to take someone's BP in an OSCE, the student who proceeded to dipstick the urine instead would score few if any marks.
I would just like to make this comment to the likes of Gary Powell and Mutly the Dog. Doctors do not want to and I believe will not strike. That is not the issue. The are not threatening to strike. They work in a caring profession they care for the welfare of their patents and the vocation they have chosen is not one where strikes would be acceptable to them. As for the £250,000 Yes that is what it costs to train them but there is also a considerable personal expence. My husband qualified with £40,000 worth of debt. He has been working towards this for 15 years, half his life and to be told it is over, not because he is not good enough (because he is) but because of a flawed computer system is gutting. So no doubt he will end up in some city job, probably earning more than he was ever likely to on the NHS, however I'm not sure if he'll have as much satisfaction. The real loosers are going to be the patients. They can expect to be treated by a bunch of demoralised staff grades - intellegent folks who are never going to be allowed to progress beyond staff grade. I am hoping that neither I or my children are going to get ill before I've sorted out the private heath insurance.
This needn't be a particular problem if the expectation was that doctors would hang around being SHOs until they got a training post, but that appears to not be the case. Sam, I think the problem is that you can't "hang around being an SHO" any longer. That was how it used to work, before you managed to get a registrar position. Now, there aren't any SHO posts to hang around in.
A&ECN - yes, you're preaching to the choir. The point of the studentBMJ link was to suggest that all the upheaval originally started because the medical professions thought that the SHO role was bad for doctors.
well said AA
Of course, the only way to stop the process for this year is if all consultants refuse to sit on the interview panels.
Dr C, I don't mean to sound unkind but I think Peter Smith's excerpts are evidence that poorly answered questions don't score marks.
I didn't have any secret answer schemes, but I worked out for myself that I was required to be honest about my mistakes and reflect upon them. Peter Smith appears to be in denial of having ever made a mistake.
Also, it was made perfectly clear on the guidance instructions that specific examples were required to illustrate points. I do not believe Peter Smith has done this effectively.
RJS |
++++
Well, maybe.
But nontheless, this still means that this is a GCSE "source" question, an exercise in creative writing, and nothing more. Do you really believe that the answer to these questions is worth more than having passed MRCP?
JOhn
"You may feel that doctors are arrogant and have an "entitlement syndrome". Well, until you know the shit and stress that goes with medical training, and the feeling of dealing with a dying or ill patient, you will never appreciate what doctors go through."
BING!!! That extract proves exactly why others feel that doctors are arrogant. I spent 25 years in the British Military. I underwent more shit and stress in training than you will ever conceive of (funnily enough, the military and the medical profession are the 2 careers that spend more time in training than any other - 30% for military officers, to be precise), and then enjoyed a career in which I had to see people I was responsible for die/get injured, whilst I was shot at, gassed and shelled. During that time, the government decided, arbitrarily, that we were too big. So guys with no qualifications that allowed them to emigrate to Canada/Australia/wherever, but with wives and children, were out on the street, in the middle of their careers, with a lump sum payoff that paid for a new Ford Mondeo.
So what? Well, as one of the posters above pointed out, this is not the end of the universe. If you think that having to emigrate to another country that people fight to get into, to be paid a very good wage, is a terrible event, you perhaps need to consider your world-view a little. By all means complain that the particulars of the system are crapulous Nulab incompetence (and who did you vote for last time around?) but don't look for sympathy from people who have to compromise their principles every day to put food on the table. The system is obviously broken - it will be modified within the year. Anyone worth practising medicine will endure the stress of the interim period, and be rewarded in due course.
J, as one with a military background you should understand this is like being told Yep your great but you can only ever stay as a captain you are colonel material but sorry the computer says you must stay as captain for ever and by the way you will receive no further training / support to help you stay up to date with medical progress
Do you really believe that the answer to these questions is worth more than having passed MRCP?
++++++++
They're looking for qualities in addition to MRCP. Everyone has MRCP or its equivalent. Not everyone has the moral substance to admit to their mistakes and reflect upon them, as perhaps Peter Smith is evidence?
Anyhow whats the point telling us about one doctor's anecdotal experience? Sure he has a few plus points on his CV but perhaps the competition were even better.
J, I have no doubt that someone with your background has gone through a hell of a lot of stress in your time with the military. I am not questioning your commitment or integrity, in fact, I salute you (excuse the pun).
If so many of the military were shafted by HMG, was there a class action taken out in response? My concern is that by accepting this flawed system as it is, as you seem to be advocating ("Anyone worth practising medicine will endure the stress of the interim period, and be rewarded in due course."), a large majority of the current group of doctors will leave the NHS, leaving the likes of yourself bereft of appropriate professionals to treat you in your time of need.
The other point about your post is that you assume that doctors don't struggle to put food on the table as well. What makes you think that doctors are exempt from the daily pressures of life?
If we were all to sit back and accept that the "system is broken", are we not contradicting ourselves by compromising our principles? It is very easy to say that we have the option of uprooting and moving abroad to work - yes, many of us are lucky to have that option, but what if I wanted to stay in this country because I want to help the people here? I can now understand why the government have been thinking of implementing classes for children in "British civicness and patriotism".
They're looking for qualities in addition to MRCP. Everyone has MRCP or its equivalent. Not everyone has the moral substance to admit to their mistakes and reflect upon them, as perhaps Peter Smith is evidence?
I see from HospitalPhoenix that there is evidence that some candidates had the marking scheme in advance.
So, if you hold the qualifications equal, maybe the very best candidates genuinely did have true examples of how they had learned from their mistakes. The next-best ones worked out by themselves what hoops they were supposed to jump through and creatively presented a real situation in the "proper" light. Some of the others had the marking scheme. Some of both lots may have made up their examples completely.
How do you tell the difference?
The Peter Smiths didn't manage to work it out for themselves, and weren't lucky enough to be given the marking scheme. But at least we can be fairly sure that Peter Smith didn't fabricate his answers.
even if you did have the marking scheme it seems that different deanerys have followed it in different ways - scoring highly in one deanery would mean scoring lowly in another. How is that fair?
Dear RJS,
Having read the question it says:
D1 Mistakes can and do happen in medical practice. Describe a specific example where the outcome of action you took in response to a clinical mistake/error (made by you or someone else) caused you to reassess how you subsequently dealt with similar situations. What action did you take at the time and how has your practice now changed?
I think the bit you missed was "made by you or someone else."
I have to say that if had I had to answer that question. If you are being asked on a form to get you employment about things you or someone else has done wrong - surely you would try not to paint yourself in a bad light and rather explain how you dealt with an error, without casting blame, and use it to highlight learning points.
The main thought behind that comment is; for the first time, I had to present formally at an M&M meeting the other day. I had to critically examine a case that was a "near miss" under another team and try and get some learning points across to the meeting WITHOUT casting some blame. It was bloody difficult. How do you do that to yourself?
Dr Sniper
Of course, spaces in specific specialties are not unlimited in the USA either.
Orthopaedics, urology, various specialties fill up to 100% They're very competitive, and some applicants, clearly qualified, still have to train in something else.
I'm still trying to figure out where the problem is.
These docs that are out of a job....which I believe means out of a training position. Are there no training programs at all for them? Is it just that they can't get into the specialty of their choice?
Sniper - everyone makes mistakes. That doesn't mean you're a bad doctor.
The thing that makes someone a bad doctor is making mistakes and then concealing them / blaming someone else for them / refusing to acknowledge from them or learn from them.
'I have never made a mistake' is most probably a lie. Either that, or a complete failure to recognise, acknowledge and learn from one's own weaknesses or faults.
Incidently, I suspect that Nott Trent will remove the booklet from their website PDQ Especially as it has the interview marking criteria in it. Suggest that some bright spark saves it and then uploads it on Dr.net (i have no access)
Incidently, I suspect that Nott Trent will remove the booklet from their website PDQ Especially as it has the interview marking criteria in it. Suggest that some bright spark saves it and then uploads it on Dr.net (i have no access)
Arf you're quite right, spaces are not unlimited, neither were they in the 'old' system. It could be that MMC will turn outto be a model of fairness, and like the USA system of matching will eventually settle down to something that we can work with.
The problem has been an across the board implementation of a new scheme which has been badly planned, poorly executed and is manifestly unfair in its application. That is what all the fuss is about.
Im very concerned.
Im hoping come my shot, MMC is being talked about in British medical history.
Change isnt always the best idea. Some things work nicely the way they are.
Although, tbh to get into medical school and hence become a doctor, its simply an excercise in ticking boxes/jumping through hoops.
the link for the document is on doctors.net.
Sadly, I am willing bet that his answer to C1 (communication misunderstanding with a patient) was his undoing. These sort of algorithms assume that if you haven't had a failure, you obviously are either telling an untruth or you haven't realised there was a problem. If a question like this is asked, and you don't give an example, it's as if you hadn't answered the question at all. Extremely depressing for those who pride themselves on ensuring that all patients fully understand.
With regard to the question about clinical error; those in possession of the marking scheme would have been aware that to describe another's error had a maximum score of 3. Describing your own error could score 4. Just one small example of the utter crap used to decide someone's future.
Well if the non-medical commenters are any indication then Brits will get exactly the crap service they deserve.
It's all very well whinging on about the difference between 3 marks for someone else's error and 4 marks for one's own error, but the question has to be answered properly.
You're not reflecting on the error, but on the action you took in response to the error.
I'd be willing to bet there was a 'negative indicator' which involved denial of blame etc etc.
Probity involves reflecting on your own mistakes and learning from them. Jenniferpa - nobody, but nobody, no matter how conscientious and communicative, has a practice which is free from mistakes.
Both Peter Smith and Dr Sniper fell into the trap of I'm-a-perfect-arrogant-twat-I-never-make-mistakes. it might have worked in the old days, but thank fuck you arseholes are being seen for what you really are now.
People make mistakes.
Admit to them.
Learn from them.
Humility and honesty are far more admirable than arrogance and blame-dodging.
The problem is not that there are limited spaces for certain fields, it is that the selection process is now being made arbitrary and based on ridiculous criteria (essay questions?!?!). Truly absurd - most of the best physicians I have known would do terribly on these essay questions because they do not excrete the sort of oleaginous BS that these questions call for.
In the US training positions can be even harder to get because physicians have a vested interest in keeping their specialty in high demand - matching into dermatology requires one to truly excel. But the criteria are objective and if you did not match into derm then you know that it is because your scores and grades were not high enough, not because your essay question was deemed poor by a computer. That is truly the morale destroyer, the arbitrary nature and pointless insecurity about the future that it brings with it.
Gary Powell disappeared? And the comments got even more heated?
Cool.
BTW--- I wish you all the very best. I cannot even imagine how hard this has been for so many of you, and I cannot understand how on earth this is positive.
I remember about 15 years ago, a relative had to move countries in order to pursue their career as a nurse. The government had cut back everything, and there were NO jobs available. The next year a letter was sent BEGGING a return. They paid expenses and everything, if I remember correctly. In the meantime, a whole cohort of nurses had been lost overseas and round the world to stupid government cutbacks and restructuring. Long term, this resulted in a shortage of nurses and doctors that has lasted well over a decade.
It makes no sense.
In the meantime, we are now exploring all the things that John speaks against as alternatives, because we are desperate. Freaking crazy.
One thing a nurse I know said that resonates- "When we graduated, we knew what we did not know. We were the guinea pigs in a "new and improved" way of teaching nurses, with an emphasis on learning on our own and our instructors were unhappy with the new curriculum and told us that we were not nearly as prepared as we should be. Now, the nurses that graduate think they know it ALL- because they have not been told any differently."
Ignorance is the new normal.
I thought of that when John made the comment about how the lesser trained doctors are being granted a level playing field with the more seasoned ones.
It scares the crap out of me because I have explored our med schools curriculum as much as I can online, and they are using self directed module learning. This is apparently best practice, as it is deemed more important to know how to find out information than actually know stuff.
Are there parallels in your universities?
I looked at google halth and what did I see??
This little treasure looking at me...
Lure Ontario-trained doctors back, OMA urges
http://www.theglobeandmail.com/s...tional/Ontario/
Same as what happened where I am from, and what I talked about in my last post.
Apparently Ontario is hiring...
I think it's time for us to see some answers from other applicants, compare them to Dr Sniper's and see just how unfairly hard-done-by (or not) he appears to have been.
MMC really is fantastic - I can only say that it hasn't gone nearly far enough...I suggest we extend it to every other career - administer a bullshit test as soon as you finish school and slot everyone into a career - never mind if they're qualified or not, or even whether they want to do it, just as long as we fill the jobs. The upside of this proposal, of course, would be that the quality of politicians would undoubtedly improve.
In all seriousness, though, this seems to have turned into another excuse for doctor bashing and some pretty nasty things are being said from both sides. Whilst I think the idea of MMC is good in its very basic form, suggesting as it does a variation on the American system (which seems to work OK), nobody can deny the implementation has been fucked up. This may not seem bad to someone whose career does not depend on the shoddy two-bit system the government paid bottom dollar for, but to have jobs going to less qualified, less suited candidates on the basis of a form that was both unfair and unlikely to give a true picture of what things are important must be absolutely infuriating for many doctors as we have seen by the comments.
Whatever you say, doctors have been treated like shit through this entire process, and it is an absolute mystery to me how they put up with it. There is no other profession in this country that is, on a daily basis, reported to be greedy, incompetent, dangerous, arrogant and corrupt, and now people have the nerve to come on here and criticise doctors for wanting a fair competition for jobs and an applications system that works in a humane fashion. To those of you who were unlucky in MMC, leave the country - go somewhere where you will be appreciated, and can have a chance of getting a good job - we will miss you, but I, for one, will understand.
Well put Anonymous. I just don't get why so many people in this country and on this forum are so quick to jump on the wagon of the likes of the Daily Mail in denigrating doctors.
Why do we not have a culture of nurturing local talent (in any field)? Why do we always persist in looking forward to the downfall of our own, and rub our hands in glee as soon as news of someone's failure comes to light?
It saddens me because it shows lack of insight and vision. When the NHS finally crumbles and there not enough competent local graduate doctors to continue to prop it up, will they then have to resort to employing more overseas doctors? Wouldn't that be a wonderful paradox, seeing that the Department of Health has already instigated a mass exodus of foreign doctors by essentially denying them equal rights to job opportunities within the medical profession in MMC.
Thank you for helping the cause Dr Crippen. You are safe and secure in your job and yet you continue to fight on behalf of the rest of your colleagues. I wonder if you would be able to use your media connections to publicise the protest march in London on 17/3/7 being organised by Remedy UK (google their website for details).
I still think the time has come for a national strike.
I've just had a read of the guidelines Dr. C posted a link to in his last post.
It's incredibly disheartening - from what I can work out, 10 points out of 46 are for hard, verifiable facts (i.e. academic & research achievement). The remaining 36 points are gained through writing answers to these questions. What is going on? What has happened to a system where being intelligent and driven was rewarded by being invited to an interview where, presumably you would be asked questions to determine your 'Professional Integrity', or 'Vigilance and Situational Awareness'.
I am in complete dispair - god alone knows what the system will be like by the time I qualify.
Oh dear, oh dear, oh dear
having suffered through the F1 MTAS where the dean of my medical school audited the forms and said there were gross inconsistencies and hugely erroneous marks, I now read all this.
So I have 2 years till i'm in this situation. I'm using those years to do the USMLE, build up research, audits etc and also consider alternative careers
what people fail to realise is that it isnt about being "a doctor" and that the vocation extends to a given specialty - hardly likely someone would want to be a cardiothoracic surgeon or a child psychiatrist. In a way you cant lump us as "doctors"
MTAS is effectively saying the equivalent of "no you cant be a criminal barrister, you can be an accountant instead" except the pay isnt as good and you'll have to work in the UK where we tell you.
2ndly stop thinking that because the tax payer payed for our uni education that you can dictate where we work and what we do - you payed for everyone's uni education - from the historians to the architects, from the bio chemists to the philosophers - I dont see anyone taking a keen interest on telling these products of tax payers funds where to work and what to do.
I dread having to do this form in the future and i dont know whether to spend more time making a stab at getting a good CV for this form or spend time investigating other options. Management consultancy anyone?
I think I'm starting to wrap my mind around this whole thing.
Selection for residency slots (postgraduate specialty training) in the USA is done at the level of the training program. The surgery department selects their surgical trainees, medicine picks theirs, etc.
Although I suppose it might be possible for someone higher-up in the hospital/university to overrule the training program's decision, in reality that virtually never happens.
Certainly no one outside the hospital is making the choice for them.
Well, I suppose the Match is doing the final deciding, but that's just a computer algorithm trying to maximize everyone's highest-ranked choices. The program ranks its candidates, or can choose not to rank an undesirable candidate.
Who is actually choosing the training slots in the UK now? It sounds like some agency separate from the programs is doing the selecting, do I understand correctly?
And I get the feeling that they may be selecting based on criteria other than medical skill.
@ thomas | 01.03.07 - 12:43 am | #
"....In the US training positions can be even harder to get because physicians have a vested interest in keeping their specialty in high demand - matching into dermatology requires one to truly excel...."
That may well be true, I don't know if competition is better or worse here. Nor do I necessarily doubt any ulterior motive, as in, keeping numbers low and demand high.
Not saying it actually happens, but I can understand the temptation.
Thing is, why would that motivation NOT exist in the UK?
Or anywhere else in the world, for that matter?
Seems to me, that motivation would be universal; why would the training programs be able to throttle the market here but not in, say, the UK?
Incidently, I suspect that Nott Trent will remove the booklet from their website PDQ Especially as it has the interview marking criteria in it. Suggest that some bright spark saves it and then uploads it on Dr.net (i have no access)
Another Mrs Sho | Edit comment Delete comment | 28.02.07 - 11:22 pm | #
+++++
They may well, and we will all be much amused if they do.
But, I have saved a copy, and will put it back up.
This one is not going to get away
John
You knwo the sad thing is, I'm not even qualified yet, and I could have written a better SpR MTAS application than that gastroenterologist. I was reading through those few examples and cringing as i counted off in my head marks lost.
I remember writing out my form, and feeling jolyl happy with myself, showing it to this one rather special girl who has a unique gift for being able to see a form through the eyes of a non-medical form reading gimp machine. she totally slated it, all but re-wrote it (All same examples, but wored completely differently). I ended up with one of the highest marks in the year despite having done sad all in medical school, no sports or activities etc, no prizes.
It really sucks that the system is like this, and that so so many people are completely unaware at how to 'play' mtas and yet are probably the best people for the jobs.
"J, I have no doubt that someone with your background has gone through a hell of a lot of stress in your time with the military. I am not questioning your commitment or integrity, in fact, I salute you (excuse the pun).
If so many of the military were shafted by HMG, was there a class action taken out in response? My concern is that by accepting this flawed system as it is, as you seem to be advocating ("Anyone worth practising medicine will endure the stress of the interim period, and be rewarded in due course."), a large majority of the current group of doctors will leave the NHS, leaving the likes of yourself bereft of appropriate professionals to treat you in your time of need."
Thank you for a reasoned response. I'm genuinely not trying to be silly or rude to the many doctors in here who are obviously deeply concerned by what appears to be a stupidly implemented system. What I was trying to do was point out 2 factors that are worth bearing in mind:
1) There is - as I suppose in all walks of life - a certain proportion of the medical profession that can come across as resistant to any change that threatens their way of life. Please don't take this as a ranting insult - but read back through some of the frankly childish 'flaming' above, and ask yourself if, as a layman, you would be re-assured about the temperament of some of the people you trust with your - and your family's - lives. Not too reassuring really, is it?
If I were a cynical NHS MTAS administrator reading this, I'd be sending some of those posts to the Daily Mail, as proof that MTAS weeds out exactly the sort of intemperate nutters we don't want treating 'our nation's kids'... You are handing the 'opposition' a stick to beat you with.
2) I'm not advocating accepting it as it is: what I'm saying is that if it's as badly flawed as seems to be the case, it will - like all statist attempts at overcontrol - collapse under its own weight. The most sensible course is probably to encourage this by a co-ordinated campaign of wrongly filling in everything to do with it, refusing to answer any queries in response, and crashing all servers with constant e-mails - I'm sure a bright bunch like you can see what I'm driving at 
.
In the interim, a few less apocalyptic 'it's the end of the universe' comments, and a co-ordinated campaign to get it modified will force a re-examination of the process. In my experience, the end of your universe comes when you stop breathing - but I do acknowledge how irritating faceless, Orwellian governance can be. (oh, and no, there was no class action, because we were all too loyal - how times change, eh?...)
So Jamie, the person with _No medical training_ would have got the job but the medic would not, says it all really...
RJS - I have not put my answers up. I merely pointed out the question in the article had another option. The thing seems to be an exercise in creative writing. Yes, I also fell foul of the MTAS lottery. I have no idea why either. Speaking to my mates I suspect I did not use the proper key words. Although I am pretty sure I got holistic care in there somewhere.
Now you degenerate into name calling. Out of interest what is your problem? How do you know I am an arrogant aresehole? Have I met you somewhere and somehow hurt your feelings?
I would apologise if I were not so arrogant.....
Dr Sniper
Given my rather nasty family history, I'm sure I'll be having gastroscopy/colonscopy at some point in my life.
I'd much rather a Dr Smith type was the one to do them. A form-filling whizz might reflect superlatively on how he'd perforated my oesophagus with the scope (generally requiring major surgery to repair) by being a cack-handed incompetent, but I know which of the two I'd prefer.
IMHO you couldn't do much better than Dr Smith's credentials - I have worked in several different countries and he would rate highly in all of them. Given that his department in Canada wants him back, I doubt he lacks people skills either.
It's a shame that a non-tested, non-validated, unproven, unreliable selection scheme has passed him (?) over for gastroenterology training, in favour of less experienced doctors with no endoscopic skills/research/examinations. You have my sympathy.
It's a shame that a non-tested, non-validated, unproven, unreliable selection scheme has passed him (?) over for gastroenterology training, in favour of less experienced doctors with no endoscopic skills/research/examinations.
- To be fair to the successful aspirants, we know nothing about them. They may make the benevolent Dr Smith look like an incompetent moron.
Aviator,
I do not know if your job entails interviewing but mine does.
I have learnt that a silver tongued candidate with the best CV does not AUTOMATICALLY equate with the most reliable practitioner on the shop floor.
During any given era certain buzz phrases are trotted out, recent favourites include 'evidence based practice' or 'reflective practitioner' or 'holistic and patient centered care'.
I'm not knocking these concepts, in fact they can all be used to improve standards when applied authentically - the danger arises when they are reduced to cliches to satisfy the anticipated needs of an assessment process.
How demeaning to be forced to play this game knowing that any given paradigm may be little more than flavour of the month.
My instincts about Dr Smith are the same as antipodean doc's I would pick him because he's qualified, straightforward and clearly enjoys putting expensive bits of kit into the GI tract.
By the way, nowadays FE2's have to nominate senior A&E nurses to me fill in a questionairre on how well they performed during their 4-month placement in A&E.
We [the senior nurses] have received no specific training, nor have we received any marking criteria, and quite frankly we are all too busy dealing with the nursing stuff to want to take on the additional responsibility.
I always fill the form in when requested, because the docs tell me it help's them - but it would be crazy to use this sort of format alone [form filling] to make decisions about a candidates suitability.
Remember how essential non-verbal communication is, we need to see Smith in the flesh so to speak, I'm sure his passion for gastroenterology would soon be recognised by any interview panel - why can't he be given this opportunity ?
Well I'm sure Dr Smith is a fine doctor. He clearly thinks so and his friends and colleagues agree. But he doesn't know how to fill in an application form.
For example: B6 What experience of delivering teaching do you have?
"I have a broad experience of teaching House officers, SHO’s and medical students. I teach theory, practical skills and etiquette. I thoroughly enjoy teaching and find the challenge a constant spur to my own learning. I am an associate lecturer at the University of Toronto*"
This is vague and wishy-washy, there is nothing unusual about it, nothing distinctive, the cat could have written it. What about mentioning some innovations, some special personal achievements?
And here is the notorious communication question:
C1 Provide an example of a time when a patient has either misunderstood or not understood what you have said. How do you think your actions contributed to this misunderstanding and what did you do to resolve it? What did you learn from this experience that has helped you to avoid similar situations?
"With reference to an application in gastroenterology: I have, as yet, not had a failure of communication. I go out of my way to make sure that patients have a good grasp of our plans. I make sure that in high (and low) stress situation all parties can ask questions."
Well that's marvellous, a paragon, but couldn't he have perhaps worked out that that was NOT the answer required and if you don't answer the questions as required you tend not to be short-listed...
I'm sad if good, decent doctors can't get the jobs they may deserve, but I'm astonished that some of them can't quite work out how to display their talents a little more effectively. Get advice, for goodness sake!
- To be fair to the successful aspirants, we know nothing about them. They may make the benevolent Dr Smith look like an incompetent moron.
I agree, and I made the same point somewhere above.
I'm also pleased to see someone here agreeing with me that Peter Smith's answers are extremely poorly written. If he does have desirable qualities he hasn't demonstrated them in his answers, on the contrary he's tried to make himself out to be faultless which is a fault in itself (and not a fault I'd want any doctor of mine to possess)
So Dr Crippen are we going to get to see some better answers than Peter Smith's?
They're supposed to be selecting Doctors FFS, not writers of romatic fiction!
As it is, those few example questions look more like they're selecting bloody social workers.
Sure Jeff, but wouldn't you have thought a doctor could write an application slightly better than a socila worker? I suspect MTAS has rooted out the arrogant fuckwits who think they know better than the system, and who don't even bother to read the question before answering it, and those who don't bother stopping to reflect on their own practice; those who are too pig-headed to accept they make mistakes
Just in case it is not known to all readers: the number of undergraduates admitted to each medical school in the UK is fixed by the government. No medical school can decide to expand - the govt tells it precisely how many medical undergraduates to admit.
And the new system is clearly madness, by the simplest of tests. If I were running a hospital as my own business, my recruitment scheme would be utterly different.
I've sat on the interview panel for an administration officer position earlier today.
A standardised set of interview questions, with notes as to what an ideal answer would contain, is used, in order to avoid any allegations of bias. We don't use them for medical appointments.
For example,
Q.1 The position xxxxxx often requires managing conflicting deadlines. Please describe an episode when you had to do so and how you managed it.
Q.2 Please describe an episode when you to deal with an interpersonal conflict, how you dealt with it and what you learnt from it.
Q.3 Describe how the use of your clerical skills helped to deliver a quality outcome.
My concerns are that:
British doctors are being judged using the same standards as australian clerical workers.
Australian clerical workers actually get to an interview before they are required to answer these kinds of questions. They get invited to an interview on the basis of their CV and how they meet the relevant criteria for the position.
Dr Smith is obviously from a generation of doctors who weren't taught how to talk and write bullshitese at medical school, unlike many of the new lot.
I'm sorry, I still don't understand.
There are lots of people who seem very upset. They applied for jobs, they didn't get them. I fail to understand why this is the end of society as we know it.
I empathise, I really do. But lots of people have been through a similar process. University, get a great degree, post-grad education, more training. Applications to jobs - maybe 10-20 ridiculous forms, with very similar questions. Forms that didn't make sense. Processes that didn't work.
I didn't get interviews to most of the positions. I was disappointed. I didn't get ulcers. I went and did some contracting. I applied some more, went off on a tangent, got a better job than I hoped, and am happy at the end.
This happens all the time. It is normal. It is a fact of life. No job is secure any more. Sure, doctors are more specialised and might try something else, but there are people with 8 years of degrees and doctorates who can't find a job. All subsidised by the government.
Why is this different? Why should I write to my MP?
Sorry, I meant doctors might not be able to try something new.
Apologies I was somewhat misleading before, the freedom of information request I am aware of pertains to the marking guidance for FY1 MTAS applications.
I am not aware of similar requests having been made for ST application information. If any of the relevant information is not already available (ask a marker) I suggest those concerned consider making a request.
Why is this different? Why should I write to my MP?
I don't know what you do but imagine this for a second.
Everyone in the same profession as you, irrespective of age or grade, is told to apply for a job at the same time.
You can only apply for one job in four different parts of the country or four jobs in the same part of the country (but three of them are not what you've been training to do). A little bit like asking a teacher applying for a teaching position to apply for the janitor's, dinner lady's and groundskeeper's job at the same time.
You are selected for an interview, not on the basis of your CV and references, but on what someone who doesn't know anything about your profession believes, using standards tested and proven on a completely different profession. e.g. airline pilots answering questions designed by Masai warriors, which are proven to weed out the crap goat herders.
So you get an interview for the job you wanted, or you get an interview for the job you didn't want. But hey, a job's a job!
If you don't get a job, you are told that you'll never get to work in your chosen profession, unless you are willing to be casual staff without entitlements or benefits.
Oh and you can't apply again because all the positions above and below you have been filled.
MMC=Medical Musical Chairs
Aviator,
I would guess that Dr Smith is competing for a place at ST3 (short for specialist trainee year 3) level in gastroenterology. Given his qualifications and experience, he would be barred from applying to ST1&2, by MMC/MTAS rules. People with less or no experience in gastroenterology are allowed to apply for these more junior grades. However, once they've got the job, they're assured of training until consultant level. There are more ST1 jobs than ST2 & 3.
So you have the situation of more junior doctors with no experience of scoping etc being in the running to be gastro consultants if they get a place, while Dr Smith, with the proven track record is surplus to requirements. That's partly why he's so hacked off. I would hazard that the whole "computer says no" part is pretty irritating too.
If I understand this correctly, EVERY single training position in the UK is part of this exercise in musical chairs? It is bad enough in the US on the first of July each year when every medical trainee moves up to the next year, but at least most of them are staying in the same institution and know the administrative routines. Attendings (equivalent to consultants in the UK, I think) and senior residents are extra alert to typical newbie goofs, but many people stay away from teaching hospitals in July (reminds me of one of my classmates, who through no fault of her own was nicknamed the 'Angel of Death' during her first hospital month, but that is another story).
When is this fire drill happening so I can stay away for the month, at least?
The New Labour NHS:
William Osler would never have been invited to an interview for ST3. too authoritarian and paternalist, you see.
Magdi Yacoub would have been told to leave the country to make way for Josef Mengele, the EEA doctor.
Shipman would still become a GP because he was a good liar.
Some good points raised above.
"British doctors are being judged using the same standards as australian clerical workers."
This is precisely one of the problems we have with the selection system under MTAS and MMC. The NHS is increasingly producing doctors and nurses who are wasting their time with form-filling, red tape, paperwork. This is because a lot of the important decisions within a hospital are now made (or at the very least influenced) by a manager at some level. Just ask any Consultant (especially surgeons) - they're all fed up of being dictated on who to operate, when to operate, size of clinics etc...
Would you rather be treated by a junior doctor who spends his time at work honing his skills, or by someone who can fill out a form in his sleep but cannot for his/her life help you when you or your loved ones are ill?
I am seeing with my own eyes a generation of younger doctors ("Foundation doctors") who are less skilled and competent in many aspects of clinical care. This is obviously not their faults, they are after all a product of the system. The full implications of this on the health system can only truly be appreciated by the public in the coming years.
"I didn't get interviews to most of the positions. I was disappointed. I didn't get ulcers. I went and did some contracting. I applied some more, went off on a tangent, got a better job than I hoped, and am happy at the end."
The point with MTAS and MMC is that we DON'T have another chance of applying again (if we do, it's near impossible of getting a specialist training job after this year because of the numbers of juniors in the foundation programme that are due to slot into these positions automatically). I agree that we all have the option of moving abroad or changing fields completely, but for many of us, this is what we spent at least 10-15 years of our lives training for. Medicine, as you say, can be a highly specialised field, and whilst we would have some transferable skills to take into a different profession, in my mind it is a waste of clinical talent. Many of my friends have left medicine, but not because of MTAS or MMC (not yet anyway!), but the majority of them left because they either fell out of love with medicine, or they just didn't enjoy it in the end.
What then, for those of us who have a natural aptitude for the profession but are pushed away by an unfair selection process? Do we all up-sticks and move to Australia, NZ, Canada or the US? Where does that leave the already stricken NHS? There are some of us who would actually like to put something back into the system that trained us, and I think this is important for the public to realise.
HMG is essentially creating a potential brain drain from the NHS. Instead of having a health system staffed with competent doctors who will think for the benefit of their patients, under MMC you will end up with automatons who work according to centrally regulated protocols and are
chastised for thinking out of the box.
I've been away for a fews days. Some of the vitriol being directed at the medical profession here is frightening.
If Dr Smith has any sense, he will clear out and never return. Even if he succeeds in getting back on track he will soon come up against more bullshit. He should go and work in a country where there is as little political interference as necessary in the running of healthcare.
Sorry, but I'm amazed at your thoughts that the first application (2 days ago) is as good as this.
Today's answer is exactly how you should answer the questions.
The author two days ago COMPLETELY misses the point of the application and I would not want him to treat patients under my care.
Anyone who says that they are an associate lecturer without expanding on the point, or what they DO in their other teaching (when they have plenty more words to do so) is NOT a safe doctor as they will make as poor decisions when they treat patients as when they decide to write a few brief sentences instead of a carefully formulated answer.
Sorry if you don't like this! Today's answer good. Two days ago was HOPELESS You have reinstated my faith in MMC/MTAS. The examples that you give suggest that without interviews DO deserve to fail and I am at a loss to understand why this is not obvious to all (anymore). Of course, this may be your fault by choosing to include the hopeless answers from two days ago. There may be some GOOD answers that also failed...
I've got to say I was really struck by the difference between the two sets of answers: you can (and probably will) argue forever about whether this is a valid selection tool, but there is absolutely no denying that the surgeon was infinitely better at it than the gastroenterologist.
The gastro seemed to me to be rather cocky - reeling off lists of achievements with no explanation, refusing to accept he'd ever miscommunicated or made a mistake etc. The surgeon seemed to have an air of confidence but also of self-awareness and consideration.
Of course the gastro may just not know how to present himself, or the surgeon may be lying, but I don't know how this can be picked up - you'd have exactly the same problem at interview, and references are almost invariably useless.
I've also had my faith in MTAS restored by today's answers.
And I imagine we could split applicants into 4 broad groups:
1) Excellent candidates who saw the mark scheme - GOT INTERVIEWS
2) Excellent candidates who didn't see the mark scheme but understood what was being asked - GOT INTERVIEWS
3)Crap-mediocre candidates who saw the mark scheme - MIGHT HAVE GOT INTERVIEWS BUT WILL BE ROOTED OUT AT INTERVIEW
4) Crap-mediocre candidates who didn't see the mark scheme - NO INTERVIEWS
I've had enough. People get the politicians they deserve & by the looks of it, they want their medics to be of a similar category. They did vote for Bliar after all.To infer competence from answers to idiotic questions is an exercise in lunacy of NuuLaborish proportions & if the above posters prefer their doctors to be of the "kiss ass" variety, I would like to leave them to it.
My sister decided against even applying for this MMC horror & has a training scheme waiting for her in Oz that she is starting in next month. May I suggest that others consider doing likewise?
When I go to see a doctor, given the choice between one who is good at filling this form in with the right buzzwords, and the one with the extra training and qualifications, I'd rather have the latter.
And as for the ridiculous system of how many jobs in which combination of specialities, how many other professions would put up with this? How does it benefit the patients to do things this way?
Nutty, you've missed the point.
The doctors who are 'good at filling in the form' have all the same training and qualifications as the ones who didn't bother reading the questions and thought themselves too perfect to admit to a mistake.
There's no black-and-white dichotomy. And let's face it, a good doctor would read the question and make sure they filled it in properly instead of quickly jotting down some second-rate response. The latter doesn't illustrate a good doctor, on the contrary it illustrates a doctor who doesn't follow instructions, and doesn't care enough about his future to put work into his application.
These guys knew what was coming, and if they didn't play the game that doesn't make them a better doctor, it makes them a fool.
Yes, the surgeon's answers are better than the gastro person. To the questions. But it depends how you define a 'good candidate'. This scheme seems to prioritise ability to bullshit over ability to cure people.
In any other job application process, the first step would be to identify the candidates who best met the essential criteria - so, had won prizes, worked in prestigious groups, etc. If there are several equally good candidates then at the interview stage they can be discriminated on the basis of fluffy questions about reflective practice. This system seems to be arse about tit in that it first selects the docs who will hold your hand nicely while telling you they've messed up, and only at interview looking for ones who are least likely to mess up in the first place.
Docs, you have my sympathies. I sounds like a silly system ineptly implemented.
When I go to see a doctor, given the choice between one who is good at filling this form in with the right buzzwords, and the one with the extra training and qualifications, I'd rather have the latter.
Are the two incompatible? Presumably a well qualified doctor will have had to write things, like answers to exam questions, in order to become well qualified. Such a doctor ought to be perfectly able to learn how to write a decent job application form - according to whatever specification the prospective employer requires.
RJS,
I can think of of at least one vibrant and dedicated junior doc, who has contributed to this site numerous times, who is incredibly disappointed by the MMC lottery.
Perhaps you are being a bit unfair on your colleagues labelling them as 'crap-mediocre'.
Overall, how many 'crap-mediocre' candidates do you think there are - and how did they manage to get into medical school in the first place ?
And if so many are 'crap-mediocre' after 5 long years how does this reflect on the educational environment and the quality of training they have received ?
Despite an arduous road it seems young Smithy is not entitled to the benefit of the doubt because he appears to have failed a creative writing exercise - lets face it, none of these touching little vignettes are ever subject to any authentication or proof.
As a minimum, candidates should at least be afforded the courtesy of an interview [provided they have attained the relevant academic credentials, references and so on] - otherwise what is the next stage, psychometric testing to root out idiosyncratic personalities ?
I agree that the surgeon's questions are better structures and more detailed, giving the selectors more to go by.
One important point to remember is that this method does not guarantee that the right candidate is shortlisted for interview, it merely distinguishes someone who has a better aptitude for writing skills.
I think it is important to point out on the MTAS application form, the shortlisters do not get to see the employment history of the candidate, and so would have absolutely no idea of how to verify the candidate's answer - the only to verify these answers is by getting these candidates to interview.
And herein lies the injustice - these candidates with better answers will get called to interview. If they had lied or been creative on their answers, they won't be offered the job. The injustice lies in the fact that these candidates will effectively have taken the place at interview of a more deserving candidate who had average answers on his form. You have to remember, this is a one-stop-shop for many of these doctors in securing a post for their future survival in medicine/surgery.
The system of selection is thus inherently flawed and illogical. Is it not better to make sure that you shortlist the best candidates based on every possible criteria available? i.e. good at answering questions on paper, good employment history, good references, discernible career aspirations and progression etc. Then at interview you can at least be sure that your preliminary filtering of candidates has been fair and critical.
How can you be so sure, RJS? Why are you naming everyone else who didn't get an interview as "arrogant fuckwit"? Have you realised how ironic it is calling everyone that whilst you sing your own praises? How do you know no good candidates weren't left outside? And if you're so morally superior why are you celebrating, taunting and baiting people who might have had their careers destroyed? Aren't you at least a little bit refective, a little bit ashamed of this behaviour? Have you no insight? Have you no compassion? Of course! That wasn't asked in the form, it's "communication skills" they're after. Not compassion, too old fashioned.
To others, especially Arf,
I think the most terrible thing about this system is that it forces you to compete for places after you have already started training in a specialty. It's like you are an American resident year 2 or year 3 and you're told that you can't keep training in that specialty anymore. Of course, having devoted your postgraduate career to such specialty you become a failed [specialist] and so less competitive for another specialty that might be suited to your skills and interest so you'd probably go to the bottom of the pile. And you're not 25 anymore.
But as RJS has already illustrated us, we probably deserve it.
Another one - your point about people already started the training is valid this year, but in subsequent years it won't be the case. It's an unfortunate glitch, but one which will have gone by the next time around, as everybody will be applying directly out of generic foundation training.
You know i don't think anyone who hasn't filled in one othese applications can ever fully appreciate how difficult they are.
The ability to compress an anecdote into 150 words and retain all the salient points is really tough and has rather little to do with medicine.
I was lucky i had a friend who is really good at the sort of stuff who helped me out.
Anyone who thinks that a 75/150 word limited MTAS question is a fair way of assessing someone's communication skills is barmy.
that said, what sort of idiot thinks they have NEVER had a communication error. I mean for gods sake, its almost a statistical impossibility.
In 5+ years of medicine - no communication errors at all?
And to not use the words 'team' or 'seniors' at all is just liabalous.
but again, if i hadn't been 'coached' in how to answer these questions, how would i know?
Having read both Dr Smith and Mr Jones' answers I'm afraid I can see why potentially there is a gulf in the marks they would have been awarded and thus the shortlisting outcome.
I know that we are only seeing extracts of Dr Smith's answers, but he seems to not be fully addressing the questions. In the audit/research question he gives an example of a project followed by how it has helped in vague generic terms, but nothing to connect why that particular study helped. Reading it, it just seems like randomly connected words.
His multidisciplinary team answer comes across as borderline offensive and with a superiority complex. Worst of all is the miscommunication question - EVERYONE has had times when a patient hasn't fully understood what has been said. No matter how minor the error, or even a humorous one corrected immediately, it comes across as hugely complacent and ultimately a lack of insight to say you have never had an error.
What scares me is that no one who peer reviewed these answers pointed this out to the poor man. I have no doubt whatsoever from the points raised regarding his CV and experience that he is a fantastic gastroenterologist, and if I were ever to require to see one, I would be happy if he was my doctor, but it does seem that he has come unstuck with the 150 word questions.
On the other hand, Mr Jones' answers seem to address all points raised in the question and display insight into one's own foibles but also a determination to continuous self-improvement and an air of confidence. I can see why he has been successful.
incidentally, how many brit docs are going to this 'anti-mmc/we're all peeved march' in lodnon on (i think) the 17th of march
Yeah, Nurse, I'm afraid I've become an infortunate glitch together with thousand others.
If I was told I had to do something else 2 years ago (but guaranteed a fair opportunity) it would not nearly be as bad. Hell, I did Medicine, not [specialist] mechanics. I'm not so sure I can brush up on my [other specialty] skills anymore but it surely looks like I'll have to try. Well, there're always the pharmaceutical and medical device industry / MBA / emigration options. Who knows? I might end up selling RJS the tracheostomy kits he uses to save his patient's lives!
Can I just point out that Mr Jones isn't RJS, he's me. Confusing, I know.
Their response to enquiries citing the DPA will not wash.
DPA gives an organisation 40 days to respond, so just telling you to re-submit the query after the second round could result in a complaint to the Information Commissioner.
I would suggest all involved submit such a query, and make their complaints after 40 days if no satisfactory provision of the relevant data has been made.
The FOI act has only a 20 day response time, but these queries would be more easily rebuffed than DPA ones citing data held on an individual.
It will be interesting to see how well their smoothly-oiled computer system deals with lots of enquiries, and how the IC responds to potentially hundreds of complaints under the DPA !
Dear Dr Crippen
I seem to be unable to access this whole document of MTAS standard responses from your link on the homepage. Is there any other way of accessing it?
So WHO is actually making the decisions in this process?
Who decides which applicant gets the surgical training position at St. Elsewhere hospital?
Is it the surgical faculty at St. Elsewhere? Someone else?
The prospective surgical trainee who answered those questions? Pray tell, were any of the questions related to, say, anatomical variants of the biliary system? I didn't notice any questions along those lines.
arf,
No such questions relating to anything clinical/technical/theoretical. I guess they're leaving this for the interview stage.
I think this is why so many of us are frustrated - we're being shortlisted by our answers to questions that are akin to psychometric evaluations, rather than based on what we've actually learnt or achieved in our respective fields.
I have mixed feelings at the moment. I have been shortlisted for four interviews. Obviously I am very happy about this. Obviously, as I'm not a total bast@rd I feel heartfelt sorry for those who have not been shortlisted for posts.
However, there is ample room in the questions to mention your clinical abilities and qualifications in addition to answering the questions asked. I'm offended by the assumption made by many that as I got shortlisted I must just be good at answering these sorts of questions. Nonsense. I have also passed exams, had tremendous appraisals by consultants in previous posts, and have a genuine passion and enthusiasm for my specialty that obviously came across in my answers.
I'm sick of the negativity towards people who had success in the shortlisting process. Where I work, 4 out of the 6 SHOs received shortlisting for 100% of posts applied for, 1 for 75% of posts, and the other no shortlisting, but has presumably been unfortunate to fall foul of the IMG rules. This has (with that notable exception) been great as there is none of the backbiting and begrudging that is going on in other departments where people feel they should have been shortlisted over others.
If, and surely when, a national newspaper prints a letter saying that people have been shortlisted for being touchy-feely rather than clinically skilled I will surely be responding with a letter partially agreeing but also taking offence at the suggestion that patients should be concerned that they will be seeing physicians with lesser abilities in the future.
OK, flame me. I'm ready.
The responses Dr Crippen posted are part of a job application, not an exam.
The thing about doctors is that they've all proven their knowledge through examinations. However, I believe last week's government white paper on revalidation mentioned the 5-yearly assessment of doctors' knowledge and skills.
Doctors applying at different levels will have approximately equal levels of examinations. So everyone applying at ST3 has their MRCS, and probably some other relevant qualifications.
In spite of this, some of the deaneries will be running clinical examinations at interview, involving both basic sciences and clinical skills.
"There are lots of people who seem very upset. They applied for jobs, they didn't get them. I fail to understand why this is the end of society as we know it."
These doctors invested £750,000* and squandered their young adulthoods locked away indoors, only to have their career turn into a smoking crater. A considerable fraction of them will also lose their families and homes over this.
People are intensely scared by risks of this size, and build those fears into into their life and career planning. The ranks of future British doctors will therefore be heavily enriched in people who are (1) psychopaths who are not susceptible to mental conditioning against predictable adverse outcomes, or (2) able to arrange monstrous signing bonuses to compensate them for the expected cost of their risk of ruin.
If that's what you want, then by all means keep your head down and let this system continue.
*Lost income from nonmedical job (£50,000/year, 10 years) plus time value of money (8% APR compounded). Realistically, many of them would earned much more than £50,000/year, spent more than 10 years in training, and had investment opportunities greater than the public stock market, putting their losses well into the millions.
1) The globally empowered bullshot utiliser gets an interview. Natch.
2) "The BMA have alleged that some deaneries have selected their short-list at random from top scorers, where they had more top scorers than interview slots." To break a tie, you toss a coin. The deaneries are being sensible there.
I have great sympathy for everyone involved in this fiasco.
However there are other options. Medicine is a vocation and an immensly rewarding one. But it life does not always follow your plans.
I spent 15 years in the NHS and had an NTN in a very competitive specialty. Unfortunately that specialty has self combusted. The majority of colleagues I worked with as SpR are no longer in clinical practice in the UK. USA, Australia, Italy have all profted. As have two mangement consulting companies. One is still in the NHS, but has been told he has had his 6 month post 6 year SpR programm grace period and that his NTN is withdrawn. No consultant posts, no job.....
Its shit and the life adjustment required to understand your new place in the world is agonising. But most medics are smart enough to be successful at something else. It is a useful background in many fields and as a friend said to me once:
"you have saved your quota, now do something else"
Good luck, unfortunately the world is not fair.
Anyone who thinks that a 75/150 word limited MTAS question is a fair way of assessing someone's communication skills is barmy.
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This does happen elsewhere though too. I recently applied for a post with FCO and you had one side of A4 to address the 4 key competancies as well as why you wanted the job plus any other useful info. It was damm hard to write enough detail to show things, without going over the space limit. This is done to weed out those that are unable to write clearly and concisely. (and those of us that can't spell too!)
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Having read both Dr Smith and Mr Jones' answers I'm afraid I can see why potentially there is a gulf in the marks they would have been awarded and thus the shortlisting outcome.
I know that we are only seeing extracts of Dr Smith's answers, but he seems to not be fully addressing the questions. In the audit/research question he gives an example of a project followed by how it has helped in vague generic terms, but nothing to connect why that particular study helped. Reading it, it just seems like randomly connected words.
On the other hand, Mr Jones' answers seem to address all points raised in the question and display insight into one's own foibles but also a determination to continuous self-improvement and an air of confidence. I can see why he has been successful.
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I totally agree with this. The answers from Mr Jones were excellent. They clearly answer the question in hand, spell out the key "what I did, how I did it and what I learnt from it".
What is the BMA's attitude to these shenanigans? Is it happy with the procedures, was it consulted at all, or does it concur with Dr C's views?
On another point, the last two generations of schoolchildren have not been taught to write - oh, they've had opportunities to write free-form poetry and write 'imaginative' stories about being a down-trodden peasant in the time of Henry Vlll - but unless they've had the luxury of a private education, they haven't been taught how to write simply and clearly for everyday purposes. Is it surprising then that people who are exceptionally good at 'science' and have spent huge amounts of their lives concentrating on learning medicine do not have the required skills to give fluent answers to bog-standard questions? (That is not meant as a sneer at medics - I certainly couldn't do your jobs, even with 10yrs training!)
Anonymous SHO,
I understand and see your point. I suppose I'd feel the same if I'd been shortlisted. I also congratulate you and wish you success. I have no way of knowing whether you're a good doctor or otherwise, I asume you're good by default. I'm not sure this form was the best way of knowing. I'm obviously very sore for not being shortlisted and that makes my objectivity suspect, I did protest albeit in a very low voice when I first saw it. It's a rhetoric contest, it really is. I'm of course not going to begrudge you for your success, more likely than not you deserve it. At any rate, I'm not qualified to judge you or your succesful colleagues.
Yes, one guys' answers are clearly better than the others'. Would I disqualify the guy who answered poorly, at his stage in the career, based on this? No, I wouldn't. Politicians don't care. And it seems our own profession doesn't either.
I'm hurt and offended by people that imply that I deserve to fail without knowing the merits of my case.
Take the USMLE, the American exams that have the highest weight in deciding whether you match to a programme. (Am I right, Arf? I took them because I was originally thinking of going to America. Romantiscism won me over to Britain. Will I ever learn.). Part 1 is about basic science and Part 2 about clinical knowledge and now also communication and clinical skills. They take 8 hours each. They produce a score that is used to compare you to your peers with loads of the statistical methods the Americans love. Based on that evidence is that your potential employers decide to give you an interview. Don't you think it's a lot fairer that way?
Of course I have made mistakes and wrote one of them in the form. It apparently didn't convince my judges. I also spoke about my rejected publications and all the effort I have put in cutting edge research in a basement lab as research fellow in a Uni, so cutting edge that it gave negative results, unfortunately. But also of the other ways in which I have succeeded and excelled in my career.
I just don't know what happened to my application. It was obviously not good for the system. Is the system I question, not you, not the other succesful ones.
Of my 9-strong department 5 have no interviews whatsoever, including those who I thought were the strongest candidates. The others have 1 or 2. They're good doctors too.
Ultimately, doing this to anybody who is already well into their specialty is terribly cruel. Having different classes of doctors, Untermenschen, is immoral.
Should've gone to America...
Another one, it sounds like you've been unlucky. That'd be a trite thing for me to say if it weren't for the fact that I know exactly what that 'unlucky' label means. I'm truly, truly unhappy that good docs have been 'rejected' and for that reason I'm continuing to lobby and do what I can to make the situation fairer. There may be those with interviews / jobs who back off because they're safe, but I won't be one of them.
Regarding the application form, I didn't have any crib sheets, and I didn't get any input from my departmental supervisors - one shrugged and rolled his eyes, the other told me to get lost. I did however spend days and days paistakingly going through the questions and the person spec, trying to work out exactly what I had to write in order to meet the (supposedly) mystery criteria.
Perhaps I'm an eternal optimist, but I don't think this is the end of peoples careers by any means. They may well push on with the current MMC plan but it's not going to work long term. There will be a way back into the system for those who missed out, albeit with huge upheaval in the meantime.
I have to say the answers in Mr Jones' application make me feel slightly ill. I mean, this guy is incredible, showing judgement, maturity and performance way above that of his colleagues (not often an aneashetist 'panics' when a trache tube falls out, but never mind)
But sadly, that's the point. A colleague once told me how to fill out a discretionary points application form, years ago.
'How much do I write?' says I.
'Unless it makes you physically sick to read it, you haven't written enough' was the answer.
And how do we know any of it is actually true?
It's all daft, really.
PS My deanery has decided to interview EVERYONE as it's the only way to ensure people are not thrown on the scrapheap. Bloody hard work, but worth it.
Experienced juniors have been prevented from competing with inexperienced juniors. This has been done by preventing the more experienced ones applying for most of the jobs. The few remaining jobs that they were allowed to apply for were in some cases 10times as competitive.
The result - the cream of junior doctors have been left with nothing - no hope, no interview, no career. How will healthcare in this country ever recover if we lose several thousand of the brightest and best that medicine has to offer. March on March 17th 11am Royal College of Physicians of London and show the Department of Health how important these poor bastards are to the future of patient care in the UK
Re answer to question that reads:
"Everybody involved in assessment received training to ensure that there was a consistent approach across the country".
I know for a fact this is not true. In our deanery the number of people properly trained was woefully inadequate so people with no training were drafted in halfway through the process with no notice to help out. Unsurprisingly my colleague involved felt that this shot any prospect of consistency across the marking completely to pieces
I just don't get why so many people in this country and on this forum are so quick to jump on the wagon of the likes of the Daily Mail in denigrating doctors.
But there aren't "so many people". I've just read the entire thread, and the only two Daily Mail nutters are Mutley the Dog and Gary Powell, who now seem to have pissed off anyway Various other people such as Aviator and J and Confused and Katherine and me have asked polite questions and dissented politely from some opinions. Is that not allowed?
Crippo said above something that about seems to sum the whole thing up:- Arf you're quite right, spaces are not unlimited, neither were they in the 'old' system. It could be that MMC will turn outto be a model of fairness, and like the USA system of matching will eventually settle down to something that we can work with. The problem has been an across the board implementation of a new scheme which has been badly planned, poorly executed and is manifestly unfair in its application. That is what all the fuss is about.
On top of the administrative mess this year, the transition means that a lot of current SHOs have been caught in the wrong place at the wrong time. Some have managed to come of it OK so far. I think the others deserve sympathy, not because they had an entitlement to any particular sort of job, but because they were in a system with one set of rules about how you might progress you career and then suddenly had the rules changed on them in a very final sort of way. I think describing their plight as an "unfortunate glitch" is goddam stupid and considerably lacking in compassion - but maybe the person concerned just misspoke as the Americans say (we don't have a good equivalent - let's adopt the American phrase).
On another tack; it seems to me that evidence-based selection techniques to go with evidence-based medicine would be good. I am out of date. I know that there was pretty good evidence to say that interview ALONE is about the worst way of selecting people (judged by later success/tenure in the job). But I don't know of anywhere in the private sector that would screen by these sorts of questions, probably at all, let alone mainly. Screening by fairly hard criteria (eg exams, ability to write English) and then doing structured interviews (which are better than completely unstructured ones) would be more like it. antipodean dr, maybe you misspoke too, but compalining that British doctors are being judged using the same standards as australian clerical workers. strikes me as pretty snobbish, and in any case the process you described is NOT the same as MTAS. Answering such a question at interview rather than in 150 words on a piece of paper gives a lot more scope to spend time on what the panel is interested in/ask subsidiary questions/assess for lying, and also I would bet my bottom dollar that there is no rigid marking scheme attached to your admin i/vs (and yes I have had considerable experience in interviewing in Australia).
Does anybody know more about scientific assessment of recruitment echniques?
J,
I too am ex-military, I can say with some certainty that (with the exception of the more "robust") the stress within the forces and medicine is not comparable.
Comparing the current mess to pilot training... "Ok lads now your all basically trained pilots apart from some advanced combat training"...
"actually we are a bit short on ground crew, so write an essay as to why you should be a pilot".."Those of you who don't do well enough will become ground crew...or have to leave the forces".
It really is like that (oh and it's the best I could come up with as an ex-observer).
Crispin, perhaps it was an anaesthetic SHO who hadnt had much involvement with surgical airways?
"These doctors invested £750,000*"
That's like saying "I saved 10,000 lives over the next 1000 years by not getting run over by a bus today*
*based on the hope I shall have children, and they shall have children themselves etc.
This selection process has been a fiasco I agree, but there are going to be unhappy people no matter how the jobs are decided. If I understand correctly, this first year is going to be the most traumatic.
much as I think the way the nhs treats its staff is terrible, i am much more concerned about the absolutely staggeringly useless service suffered by the patients
Crippo, if your deanery is going to interview everyone, it shouldn't let this opportunity for research to get away. You could see how many you decide to appoint that MTAS didn't short-list (and who would never have therefore been interviewed). Then after x years, you could see how well the two groups ended up doing.
I don't know what the sample size is, but it's an almost unique opportunity, becuase of course normally the people who don't get short-listed can't be followed up to see how well they did in the job; so you can't do prospective studies.
I have watched over the past 6 years in frustration as the NHS is slowly pulled apart and ALL the professionals involved become more and more demoralised.
Finally we have a chance to make people aware of what is going on - if enough of us march in london we have to hope that the media at least will pay attention, and we all know that that is the only way to get this government's attention.
We're all intelligent, articulate people, we all know that the government is consistently and knowingly lying to the public. We have to try and stop what is happening. Tell everyone you know, don't just sit and moan, don't just give up - although it is tempting - at least we can then say we tried. I'm planning to fly from N Ireland as I have never felt so strongly about anything else before in my life. We have to stop this government from destroying us and the system we work for, simply for the sake of short term political point scoring.
Why doesn't one of you put a blog post on webcameron and then all of you vote for it to be one of the top 3 he promises to answer? You need to get the Opposition involved, not just the government.
The difference between the two selections appear to me to be merely literary. I know of no evidence to link literary merit and clinical nous, acumen or skill. We have no way of knowing if the second selection has any basis in fact or is a work of fiction. I do not feel there is any useful discrimination between the two for what is after all a clinical training post; not an attempt at the Man Booker Prize or a job in journalism
The difference between the two selections appear to me to be merely literary. I know of no evidence to link literary merit and clinical nous, acumen or skill. We have no way of knowing if the second selection has any basis in fact or is a work of fiction. I do not feel there is any useful discrimination between the two for what is after all a clinical training post; not an attempt at the Man Booker Prize or a job in journalism
Recently I have had two hospital appointments postponed at short notice. I also have had to sit for hours in waiting rooms. Against this background it is hard to feel sympathy for doctors moaning about short delays to their job applications. Some of the stories on this website are really heart-breaking. I know that many doctors are really devoted to their job, and patients are lucky to benefit from their dedication. But at the end of the day you can't be guaranteed a job- there needs to be some selection process. Ok, so a process based on answering questions on a form might be biased towards people who are good at writing answers- but by the same token a process based on CV's will be biased towards people who write good cvs; a process based on interviews will be biaised towards people who are good at interview, and so on. I think we need to grow-up as a profession and stop feeling so sorry for ourselves. MMC and MTAS are new, so they are bound to have faults, which presumably will get sorted as time goes by- but at least the NHS is trying to make things better. I think it is beter to have my form scored anonymously that to have someone checking what school I was from. OK, so the computer was slow on Monday- big deal. It wouldn't be a good use of tax payer's money to buy something really big just to cope with the peak when we all logged on to see our results, when it would sit idly for the rest of the year- by the same logic you would size all A&E depts to cope instantly with the Saturday night rush.
@ AA | 01.03.07 - 5:08 pm | #
>>No such questions relating to anything clinical/technical/theoretical. I guess they're leaving this for the interview stage.
Then what stage are you at, at this time? What I mean, when you are answering the fluff questions cited in these posts, have you even selected the specialty you wish to pursue?
I'm still confused over all this.
@ Another one | 01.03.07 - 6:13 pm | #
>>Take the USMLE, the American exams that have the highest weight in deciding whether you match to a programme. (Am I right, Arf?)
It is probably not fair to say there is any "system" to how training programs select their trainees. The programs can do whatever they want to do in this regard. Orthopaedic residents at "St. Elsewhere Hospital" are selected by St. Elsewhere's Department of Orthopaedics, not by the hospital itself, certainly not by any agency outside the hospital. Though I'm still confused about all this, I'm getting the feeling that your trainees are somehow selected by some agency outside of your hospitals or medical services.
Surely they place great weight on medical school grades and USMLE grades. At the same time, the programs often have seen these applicants as medical students on the particular service. So they are also placing a lot of weight on the medical student's "on the job" performance, at least for the competitive programs. Not to mention recommendations from colleagues.
"not what you know, but who you know" probably applies in this line of work as much as anywhere else. The student will get elective time working on those services, and make sure they look really good to the faculty.
How much that applies, I'm sure varies all over the place. The very competitive programs and very competitive specialties (dermatology, urology, orthopaedics for example), I'm sure there's some of that, as most of the applicants are already highly qualified.
So I suppose there's still "soft" criteria applied, as in, how the student performs on the orthopaedic service may determine whether he/she gets selected to the ortho residency.
But still, there's far more validity to those "soft" criteria than the questions mentioned in these posts.
Why do people keep directing their anger at patient waiting times towards doctors? As can be seen from the MMC/MTAS fiasco they don't exactly have much control over how things are run. I have the joy of both worlds at the moment, I'm a medical student awaiting major surgery which has now been delayed until the new financial year meaning a possible year out of uni. The slight positive is that it will be longer until I join the job lottery. I wish the patients and professionals would stop sniping at each other and unite against the idiots who have caused the chaos in the NHS. Everyone is suffering, patients and healthcare professionals.
http://thumbsnap.com/v/dGFHJDT8.jpg
It is an overarching, underpinning principle that Straight A pupils are very bright!
Straight A pupils, even the most taciturn, modest, understated, and self effacing, will quickly learn how to crack a facile selection system. They will be po-faced and have their tongues in their cheeks as they do it.
They will ensure their newly up-skilled selectors become all of a dither.
There will then need to be another course to re-train the up-skilled selectors so they can determine which of the po-faced, tongue-in-cheek candidates best suit their requirements. This will be challenging. And add to the expense.
Middle grade medics, in general, have cascaded from straight A pupils.
And their referees will tick all the structured "A" boxes.
Because they were once Straight A pupils too!!
When all of this happens, I have a very special spell that might help the dithering up-skilled selectors.
When the time comes, just ask!!
arf,
We were restricted to applying to 4 deaneries (or regions) for whatever specialty we wanted, at the level of training that was specified by a central government body, based on what we had achieved - our "competencies".
I applied to 4 deaneries in orthopaedics. The questions on the application form were all generic to the LEVEL of training that you were applying, and not specific to the specialty that you applied for. There were no questions based on the technicalities of a hip replacement, but simply generic psychobabble questions such as "Describe a time in your career when you had to cope under stressful conditions."
The shortlisting for interviews (as far as we are being told) HAS been carried out by Consultants within the deanery, so from that point of view, I guess the selection is implemented by medical staff. There are, however, anecdotes surfacing regarding the last-minute recruitment of non-medical staff to shortlist applicants in order to meet the deadlines. This METHOD of selection, and its implementation is what we take issue at, not at the competition for jobs.
I haven't time to read all the above.
Having marked ST application forms I can confirm that the system is unfair as it is very difficult to tell one good 'example of a mistake' from another - they've all said just about the same thing. Trusts must be weighed down with the numbers of risk management forms from people who wrote out an antibiotic that someone was allergic to and crossed it off minutes later before anyone had actually given it!
On the numbers game - it is probably better to change career at an early stage than find no consultant job at the end. The actual number of training programs has increased - in O&G there is currently massive consultant unemployment and that will be twice as bad when this intake is fully trained (unless the govt does decide to increase consultant posts).
From the SHOs I work with I don't see a huge correlation between number of interviews and my view of quality.
Anonymous,
I am sorry to hear that you have had to endure hours in waiting rooms for your appointments, and also for the cancellations.
I suspect what you and thousands of NHS patients don't realise, is that these delays have nothing to do with doctors or nurses.
Our clinics are DICTATED by management in terms of frequency and size. The booking system for appointments is such that on many occassions (if not always), as many as 4-5 patients are booked in for an appointment at the same time e.g. 0900. This implies that all these patients turning up at 0900 will be seen at exactly 0900. Depending on the specialty, each appointment/consultation would take between 10-15 minutes on average. Now, where is the sense in this? The main reason management do this is so that they are seen to meet the waiting times for new appointments to see a consultant in hospital.
Apart from this, there are obviously other reasons such as having a junior doctor in clinic - this will inevitably slow things down but in the long run is absolutely vital for the training and education for that junior doctor.
If more patients understood how management massage every single nuance of the NHS, I don't think we would have this much vitriol aimed wrongly towards us.
Anonymous,
I am sorry to hear that you have had to endure hours in waiting rooms for your appointments, and also for the cancellations.
I suspect what you and thousands of NHS patients don't realise, is that these delays have nothing to do with doctors or nurses.
Our clinics are DICTATED by management in terms of frequency and size. The booking system for appointments is such that on many occassions (if not always), as many as 4-5 patients are booked in for an appointment at the same time e.g. 0900. This implies that all these patients turning up at 0900 will be seen at exactly 0900. Depending on the specialty, each appointment/consultation would take between 10-15 minutes on average. Now, where is the sense in this? The main reason management do this is so that they are seen to meet the waiting times for new appointments to see a consultant in hospital.
Apart from this, there are obviously other reasons such as having a junior doctor in clinic - this will inevitably slow things down but in the long run is absolutely vital for the training and education for that junior doctor.
If more patients understood how management massage every single nuance of the NHS, I don't think we would have this much vitriol aimed wrongly towards us.
See front page of the telegraph
http://www.telegraph.co.uk/
The year I was up to match into training programs, there was a lot of corruption in the system. Program directors were making deals with students, offering positions in advance, outside the match.
They were not supposed to do that, of course. That's the whole ides of the match.
What happened, though, was the better programs considered themselves filled well in advance. As a more ordinary student, they would not consider me even for an interview.
I found myself destined for less desirable programs.
Then it dawned on me, the program directors were shooting themselves in the foot. The better students had agreements with multiple hospitals. They may not be as diligent about telling the hospitals they had made better deals and backing out. Especially since they were not supposed to be making these deals in the first place.
So I got an idea.
I deliberately mismatched.
I deliberately listed hospitals I had never applied to. So when the match came out, I had matched with no hospital.
Thing is, the better programs found many of them had all listed the same resident. So, despite being more competitive programs, they had open spaces after the match. Students who had already matched elsewhere could not change their choice.
So the programs found themselves limited to chasing the students who remained "free agents" like me.
A risky way to approach it, but it worked that year, because so many of the programs were choosing to flout their own rules. Since then, they cleaned up their act.
Hi arf,
My local program director mentioned that the same thing is likely to happen with MTAS (ie the top candidates will likely have 3-4 interviews and be offered 3-4 jobs) leaving plenty to go into the second round.
I must say it's impossible to see how it'll pan out but this looks likely considering how many good candidates don't even have one interview.
http://thumbsnap.com/v/dGFHJDT8.jpg
There you are, arf - You're a Straight A doctor doing what you had to do to crack the system!
There's a lot more like you out there, too!
Turn it upside down and inside out, that's the way!!!
RJS, AA, Arf, Dr C.. et al
1. The best way to describe the implementation of MMC/MTAS is the application of market forces of the medical training system in the UK. With normal recruitment along these lines the best candidate would go into the best job (decided by, in most industries, a shortlisting and subsequent interview). In any industry this is never perfect, and this seems to have been accepted by most of my profesion.
2. The system implemented thus far has never (publicly) been audited or scrutinized by any other independent body prior to its introduction.
3. Shortlisting panels were not provided with any previous employment history. (In any other field of employment this is an almost mandatory requirement for a shortlisting panel)
4. Strict criteria were provided according to a nation wide scoring system. Individual Deaneries (states) were given little or no leeway in adjusting the scoring of applicants.
5. 4 choices were given in total. Across all specialities, across all levels. As previously indicated this is further restricted.
On a purely personal note - i have practised medicine for a number of years since graduating. I have obtained the neccessary postgraduate exams (surgical) and accessory CV paraphenalia that enabled me to be shortlisted for Higher Surgical Training jobs in the last 6 months.
Even before I attended these interviews I knew I had been shortlisted above others that were " better" candidates than I.
What made the process acceptable was that we were being chosen by our peers in that region and not by a central arbitary scoring system.
Life is unfair and the laws of the jungle will always prevail in any walk of life but the medical profession must stand together as a whole.
Sadly this does not seem to be the case.
compalining that British doctors are being judged using the same standards as australian clerical workers. strikes me as pretty snobbish, and in any case the process you described is NOT the same as MTAS. Answering such a question at interview rather than in 150 words on a piece of paper gives a lot more scope to spend time on what the panel is interested in/ask subsidiary questions/assess for lying, and also I would bet my bottom dollar that there is no rigid marking scheme attached to your admin i/vs
Potentilla, you are right that our recruitment processes are not similar to MTAS.
We wouldn't be stupid enough to use these questions as a screening tool to determine who gets an interview. And we don't use this format for our medical interviews either.
The candidate is given 15-20 minutes before the interview to read the questions and prepare his answers. The questions serve no purpose if the candidate has all the time in the world to write and rewrite a 150 word answer which contains all the right buzzwords.
The public health system here has pretty stringent guidelines about interviews. The interview panel has guidance notes as to what an ideal answer would contain and how to score the answer from 1 to 10. Everyone on the panel fills in the score card and the results are averaged out. It provides some objectivity to an otherwise very subjective process and we do stick by the results of the score sheet. The CV is scored beforehand as well using similar guidance notes.
So it does boil down to an exercise in creative writing and I'm concerned that many good quality clinicians have not been offered a chance to shine at interviews because MMC wanted to reduce its workload.
And yes, the successful candidate had better answers than Dr Smith but that doesn't mean that Dr Smith is a crap doctor. It could mean that Dr Smith is an honest, no bullshit clinician while Mr Jones is a lying toad who had access to the "ideal answer" guidance notes and wrote and re-wrote his answers until they contained every medical education buzzword (no offence meant to Mr Jones). The sad thing is that we'll never get to find out.
Oh,I doubt that any interviewer would keep straight face if Mr Jones' answers were given verbatim in front of the panel.
But it could well be a generational thing: I would be interested to know if Mr Jones graduated after Dr Smith.
Well I can see why the successful Mr Jones got an interview and Dr Smith did not.
I can also see why I did not get an interview. Bugger. Next time, if I stay in medicine, I will buzzword up my application and invent some stuff that sounds good. I will also get it looked over by multiple, multiple people. So it won't really be my answers, but it will hopefully get me an interview........
Dr Sniper
Good Lord.
Before these posts I had no idea what horror MTAS was. I was comfy sitting in my ivory tower, reading all the hullabaloo about MMC and dropping a warm reassuring comment where I could.
Then you posted this. In language I could understand, because I have exams like this too. And after finally understanding the depths of horror MMC has forced the entire profession to go through, I've blogged about it.
Thanks for putting these posts up and clarifying for us med students just what a pile of bullcrap New Labour has turned our future into.
How come the BMA, which so brilliantly negtiated the loadsamoney contract for GPs, let this load of intellectual excrement through for the hospital docs? What do these youngsters pay their union dues for?
I've read through many of these comments and the answers submitted by Drs Smith and Jones. I am not medical, but it was obvious to me that Dr Smith did not answer the questions. I accept that he is probably an excellent Doctor - however, I assume that the situation across the country is that there are more Drs than posts (ie more 'bums' than 'seats'). Therefore, there has to be some way of differentiating between all the candidates. Rightly or wrongly, the current system is what you have to deal with.
I worked in Public services broadcasting for over 10 years - I got stuck in my role. There was nowhere to go apart from out - so I took voluntary redundancy. I was made redundant around 3 years ago from a large UK employer - I was an easy target - woman, worked part time as I had a young child. Life out there in employment land is NOT FAIR! The company offered me very little support, despite having fancy policies which promised it. I know of many individuals within this company who have lost jobs because their face didn't fit, someone didn't like them etc etc etc. The higher up the tree you go, the more precarious your position. Imagine coming into work one day to be told that you don't have a job - with immediate effect and that your desk has already been cleared. It happens.
Employers select candidates on the quality of their application. I re-wrote my CV hundreds of times before I got it to the stage where it was good enough to send out. As a candidate you have to be able to sell yourself.
It seems to be that candidates need professional support when it comes to filling in their application. Yes, it sounds pretty daft that after investing lots of money in quality training there are doctors out there without jobs - presumably in time less will be trained to avoid the situation where there are too many 'bums' and not enough 'seats' or is that a bit too 'joined up'?!
I hope this doesn't offend anyone - it just struck me after reading all the comments that I've been where you are and it's not a nice place - you're not alone.
So the NHS leaves doctors dangling in career limbo, just as the NHS leaves patients dangling in treatment limbo.
Why does anyone still believe in the desirability of state run monoliths?
MMC=Medical Musical Chairs
Antipodean MedAdminDoc - thank you. That makes more sense. I suppose it is the lack of second chances and finality of it all that causes the problems.
But could you not (like many people outside the medical industry) apply next year, 'temping' in the mean time? Could you, for example, go work for BUPA for a few months?
These doctors invested £750,000* and squandered their young adulthoods locked away indoors, only to have their career turn into a smoking crater.
I'm sorry, but I don't accept this. Many, many people have as much devotion to their careers, and get paid a pittance for their future prospects.
I also know extremely talented, highly qualified people getting paid far less than your quoted figures. By your example, everyone with straight A's at A level (or people able to go to med school) will earn 50k a year immediately after college, not even going to university. Nope. Sorry. Please don't confuse the issue by quoting unreal and unhelpful numbers.
Antipodean medadmindoc,
And yes, the successful candidate had better answers than Dr Smith but that doesn't mean that Dr Smith is a crap doctor. It could mean that Dr Smith is an honest, no bullshit clinician while Mr Jones is a lying toad who had access to the "ideal answer" guidance notes and wrote and re-wrote his answers until they contained every medical education buzzword (no offence meant to Mr Jones). The sad thing is that we'll never get to find out.
You can find out now if you like. I'm Mr Jones. No part of my application was a lie. I did not have access to the marks scheme. I did however spend a long time scrutinising the person spec and guidance notes until I'd worked out exactly what I thought the shortlisters were looking for.
No offence taken (though I admit it's starting to grind, being repeatedly accused of cheating and lying when all I did was put a helluva lot of work into putting together a successful application!)
But it could well be a generational thing: I would be interested to know if Mr Jones graduated after Dr Smith.
Since you ask, I graduated in 2000 and completed MRCS in 2004. I can't speak for Mr Smith, but since he is not yet 30 I'd guess he's the same age as me or younger.
Since anonymous mysterious person seems to know me, and I would be grateful if I could also stay anonymous and mysterious, I still don't like a system where an interview is allocated on what is essentially a creative writing demonstration, no matter how true it is. Having shortlisted on CVs for dozens of jobs, at least I can find out what people have done, where and how long they have worked and therefore gauge the kind of experience they are likely to have had, before I get to the touchy feely stuff.
angrysurg The best way to describe the implementation of MMC/MTAS is the application of market forces of the medical training system in the UK. Noooo!!! Exactly wrong! MTAS is a centralised socialist-type system! The old system was more like a market, although still a very constrianed one. A real market would allow hospitals to recruit doctors in whatever grade and speciality they needed when they needed by any recuitment procedure thye chose, and paying whatever they needed to to atract the right candidates, constrained only by whether they could afford the the position and also probably some nation-wide training standards (ie they would have to prove to someone that if they were recruiting doctors in a training grade, they could provide suitable training). This is not the case in the UK. If St Elsewhere's decides it would really like another junior anaesthetist, it can't just decide where to save money to afford one.
As far as I can see, the reason that the US "Match" is not a socialist-type etc is because the HOSPITALS decide which positions to advertise, and presumably at what salary.
Anthea Yes, it sounds pretty daft that after investing lots of money in quality training there are doctors out there without jobs - presumably in time less will be trained to avoid the situation where there are too many 'bums' and not enough 'seats' or is that a bit too 'joined up'?! It's not too joined-up, it just requires a crystal ball. Nobody has the faintest idea how many doctors of what speciality the country will need in a few years' time (the lead time would be about 10 years). The number that are just coming through training were based on a forecast made sometime before they started training. The forecast was wrong. The forecast will ALWAYS be wrong. It is not a possible thing to forecast with any accuracy. Any correlation between forecast and actuality is purely fortuitous.
That's why MMC is silly. It is too rigid and allows too little for people moving through the grades at different speeds, which helps smooth out peaks and troughs of supply and demand caused by the forecast always being wrong.
As far as I can tell, the US system seems to deal with this by constraining the supply - SteveSC commented that there are always more jobs than doctors. Good for doctors but not so good for patients with unpopular diseases in unpopular places?
AA The main reason management do this is so that they are seen to meet the waiting times for new appointments to see a consultant in hospital. No, the main reason is the high number of DNAs. The point is to make sure that an expensive consultant is never left with a gap in his/her clinic. Block-booking clinics was around long before NuLan targets.
Witch Doctor - your spell needs to deal with the fact that the selectors, up-skilled or not, as all consultants and therefore, according to your logic, all very bright too.
I've watched my partner go though this process, and am fascinated (and horrified) by many of the posts here. So many of them are heartbreaking.
The game may be crooked, but it's the only game in town. The MTAS form is just part of the way that doctors are being assessed - membership exams count for ST2 onwards, publication, work history, references, all count. And so does the interview. Yes, the MTAS form is the route to the interview, but the bullshitters can be weeded out at interview leaving places in the second round.
These forms are "frozen" interviews and should be treated as such. Questions are used to probe attitudes and find out how well you summarise complex information. They also check your reading skills: At least one of the gastro's responses didn't actually answer the question asked. Are we supposed to assume that he was distracted by something more important at the time? C'mon.
Doctors write notes and letters, so clear, concise and detailed written communication skills are vital. The examples given are concerning, to be honest. Someone mentioned the fact that we aren't taught to write simply and clearly any more. So now we've got to the point when a form which requires complete but consise answers is considered to be a request for "bullshit" or "creative writing".
The MTAS questions were not bullshit questions requiring bullshit answers. Au contraire, they cut like lasers and required well thought out responses. They terrified me, and I wasn't applying. Yes, it may be possible to fake low to mid-grade answers with buzzwords, but that is what interviews are for, weeding out the fakes in real time. Truly good answers based on examples of your own practice are unfakable and the truth of them can be tested at interview.
A system as huge as this must be auditable. The MTAS form reminded me strongly of the form I had to fill in applying for the company I work for, which is an International with 70,000 employees. Such a system is very auditable, and when applied propperly (which MTAS wasn't) with appropriate training (which MTAS didn't provide) such systems are fair. MTAS is not an example of a fairly applied system.
The wicked thing was that the MTAS system was that it's a closed system being used to cut numbers which was introduced without training. There's a right way and fluffy wrong way to write a paper for publication or summarise audit data. No "creative writing" skills there, and you are taught how to do those things properly. Training which gave examples such as the two forms posted here would have helped many doctors immensely. You aren't stupid people, you'd have got it from those two examples alone.
Potentilla said that she did not know of anywhere in the private sector which would screen using these techniques. Hello! Have you forgotton your friends who went through the milk-round when leaving university? These sorts of systems are very common for large and international employers. The students' unions are beginning to realise that students need non-academic training to get jobs, though the Universities are in denial about it.
Since we aren't taught to write well at school, training is vital and large-scale commercial employers know this already. Mine for example is spending 18 months rolling out an internal asssessment system for 70,000+ staff. We've received one-to-one and group briefings at each stage. We are being taught how to present ourselves in the best possible light, and this is what makes the system fair. This is what is missing from the MTAS implementation. Potentilla mentions "evidenced based selection technuques", and that is exactly what these systems are when they are implemented properly.
My heart goes out to everyone involved in the whole sorry, shameful, dehumanising process. You should have been trained, and this system should not be used to cut numbers as well as to recruit.
Incidentally, the telegraph link is here: http://www.telegraph.co.uk/news/...03/02/
nhs02.xml
I wish you all well. You deserve far far better than this.
Astrea.
Just saw thsi on the BBC site refering to how bad the nes system is
http://news.bbc.co.uk/1/hi/healt...lth/
6411481.stm
Anon at 12.03 pm is me.
Astrea - I went through the accountancy milk-round myself, and also did a lot of milk-round interviewing and screening for graduate-entry management consultancy during the mid-late 80s (which was extraordinarily competitive).
The difference between that and MTAS was that our first level of screening was based on academic qualifications. The second level was based on the answers to questions a la MTAS PLUS more open-ended questions of the "other information to support your appllication" kind.
Training people how to answer MTAS-type q's levels the playing-field for candidates, sure. It doesn't help recruiters much, though. All it means is that you get more word-perfect answers (see emmsy's comment above) which means you have to weed out the liars at interview, thus wasting everyone's time.
Potentilla mentions "evidenced based selection technuques", and that is exactly what these systems are when they are implemented properly. I didn't, of course, mean "evidence about why you chose x candidate over y candidate". I meant "evidence that these selection techniques work better than other selection techniques to identify the best candidates". Scientific evidence, published in peer-reviewed journals and based on decent statistical methods. Is there any? I genuinely don't know.
I'm not sure what evidence base there is on recruiting techniques Potentilla, but given the academic urge to publish in Management disciplines I'll assume there's a lot there. I'm afraid I don't have time to check it today though. I may be able to do a search later in the week. Post here if you want me to do that, because it'll take a couple of hours even to skim the surface.
The difference between what the medics are living through now and what you describe in the 80s is that this is very nearly a closed system. Milk-rounds are a chance for many employers to meet and screen many candidates. It is arguable that the fact that the doctors are doctors is evidence of their academic qualification. It's a pretty weak argument, I'll admit.
I think levelling the playing field for candidates is a good starting point, even if it makes it tougher for recruiters. Better a fair but expensive system than an unfair cheap one. Of course what we have is neither fair nor cheap.
Astrea.
Astrea - only if you have time/inclination. I may have a Google myself. I though someone might know without needing to do much research, as we have a few academics here form time to time. I am not so sanguine as you, given the considerable practical difficulties of doing a well-designed study.
I agree that levelling the playing-field for candidates is very important; but doing it by setting up a hurdle which encourages them to cheat and then trainng them how to cheat effectively, thereby creating a knock-on problem for interviewers which didn't previously exist, is silly.
It doesn't matter so much in the private sector, because, as you point out, it's not a closed system. Maybe some people who would have been really good are "incorrectly" screened out, but they will have another bite at the cherry, or a related cherry. And it is a perfectly logical decision for a company, faced with a high application rate for a few jobs, to satisfice rather than optimising when creating a short-list.
I'll see what I can find.
People can lie on CVs too, of course.
Oh, it is a complete bolloxy mess. The real problem is the cull, and that non-training posts are a dead end. Interestingly, teachers don't have to become head teachers or department heads to have a good teaching career. Why not make it the same for doctors?
This country does make me despair.
A.
Mr Jones – Dr Smith here. We have the same demographics re year of quals and year of post grad certs.
I have watched, with much interest, the furore surrounding my application. I have avoided comment deliberately. I let Dr C put up my application answers in the interest of transparency. I have learnt a lot of very valuable lessons from the comments posted. I absolutely agree that Mr Jones’ answers were far, far better than mine.
The point I had hoped to make in putting up my details was that the questions I had answered were not reflective of me or my CV or my experience. Dr C did not put up all my details in the interests of maintaining my anonymity, there was other stuff in there that would have got some ticks at least. I met the criteria in the person specs and failed to get an interview. I wanted to know why. Now having being held up to some critical appraisal I have got more feedback from NHS Blog Doctor than MTAS. Scary really. But my thanks to you for your views.
What I wanted, perhaps, was for Dr C to publish the person specs for an ST3 in gastro and then my abridged CV and then my answers and let you, Dr C’s readers, judge whether or not the questions were reflective of job suitably. In the end my answers were crap, but not fairly representative of me and my skills.
I want to work in the UK, despite having experienced a better working thing elsewhere. I want to come back; now after I fail in the next try for the mythical unfilled posts, I have to emigrate, change speciality or even change career. This is quite a big thing really.
To go into full details of why I answered the way I did would take a long, long post. I will try and explain some of my reasoning, because for some reason the opinions of Dr C’s readers matter to me. Put basically, I was naïve. I read the person specs for the gastro post and realised that I met the entire essential and all of the desirable criteria. I thought if I briefly stated that then the past experience would count. I was very wrong and have paid for it. I also thought 150 words was an impossible limit to answer the questions with any degree of fullness and was therefore overly brief. I wanted to write essays. As Mr Smith’s answers show me, in this I was wrong. Again.
I did not give enough thought to my answers thinking that some of it was self explanatory. One could say that was arrogant just for that. For example, with respect to my being an Associate Lecturer in a question that was about teaching. I should have said what this entails. Reading through the posts it has become more than obvious to me that my answers weren’t self explanatory.
As to be accused of arrogance, all I can say is that I am far from it. I go out of my way to avoid arrogance at work and still try and project a degree of self confidence so my patients can have confidence in me. It does sting to be called arrogant and I can just see why it could have been read that way when viewed with hostile eyes. I am not sure I deserved the vehemence, for example, RJS aimed at me.
The whole communication failure side of things was aimed at the gastro aspect to the question. I have not had a gastro communication failures because I have not had enough time in pure gastro and I was trying to imply I would like more. I overthought my answer and failed to make myself clear. That is clear. With respect to day to day communication failures in general medicine, which let’s face it is what I have to do day to day as a non specialised physician. I have had plenty and could list a load. Next time I will.
Mistakes wise, of course I have made them. I read 2 options in the question and took one that enabled me to put in what I thought had some learning points, communications skills and time management points but tried not to look like an arse. Oops. Next time I will dig out an error that is a dramatic near miss. I will very much model it after Mr Jones’ answer – which was pure gold. In fact I intend to be fully inspired by Mr Jones.
As to discord within the MDT, really I have had none that I could think of. What came to my mind was MDT meetings with that question. I genuinely work in harmony in the MDT, I go to the pub with them, I listen to their woes and we share curry. They are not “team members” to me most of the time, they are mates. If the question had a real world question like “describe how you got a patient with a surgical belly from the MAU to the SAU despite stiff resistance” then I would have had a shit load of stuff to say. It is very simple; when the physio tells me that the patient cannot walk unaided I believe him/her, when SALT says the swallow is safe, I believe her/him, when the OT says such and such needs doing I believe him/her etc. I then just adjust my practice/patient care to suit. I should have said as much. Maybe I should have invented something contentious about nurse endoscopy clinics and lack follow up and how I enabled patient centred follow up. Too late for that.
I can genuinely say that my answers were honest, as I am sure that Mr Jones’ were. I am not implying anywhere that his were not. I was too straightforward and I have learnt my lesson now. What I want to say is that those questions (not my answers) were in no way a good way of working out my suitability to be a gastro reg. Of course, I would say that having fallen at the 1st hurdle. I would challenge those who got through, now they are over the joy of being granted an interview, to reflect on the questions and ask themselves whether those questions really reflect your suitability to be what ever it is you want to be. If you really think so, fair enough. I don’t.
Again, I can only thank you for your feedback (even RJS)– which is a shit load more than MTAS has provided.
But trust me when I say that my clinical practice will remain completely unchanged by this entire crappy experience. I will continue to do my level best for my patients and remain as honest with them as I have always been, I will continue to (over)communicate with my colleagues, I will strive to advance my career - should it be there to advance.
That was an excellent posting Dr Smith, and I agree you sound as though you'd be an excellent gastro reg who was unfortunate not to have played the game right.
The one-strike-and-you're-out issue is the most disgusting part of this fiasco, and if nothing else comes of the protests against MMC, I hope this element is changed, as I'm sure it's illegal.
I think it's a tragedy that you didn't have any input or feedback from your own seniors on your application (I didn't either, my department are worse than useless, but I became an obsessive reader of DNUK threads on the issue and picked out some good advice from members there). Also an ironic turn of events that you've received more feedback here than from anywhere else. Thank heavens for Dr Crippen and his loyal followers. Dr Crippen is evidence of the fact that a bit of determination and honesty is productive (unlike the BMA and Royal College efforts to date)
Last but not least - you might want to choose less of a near-miss than I did for your probity question. I wrote it late one evening, and cacked myself once I'd submitted, over the possibility of getting struck off. I thought hard before sending my responses to Dr Crippen for putting them in the public domain, and I'm still worried the GMC are going to come a-knocking on my door because I operated without supervision!
As I've said before, this MMC disaster isn't going to work in the long term. I'm almost certain there'll be opportunities for excellent clinicians who just hppened to miss out because of bad luck.
All the best, mate
Dr Smith and Mr Jones thankyou for posting and giving us non-medical people an idea of what is going on. Good luck to both of you.
Mr Jones, just out of interest, would you be able to give an idea of how long you think you spent working on your application?
What worries me is that various commentators, me included, have looked at your responses and decided that yes, we would pick Mr Jones for interview based on the responses given. I'm not sure what that says about my ability to think like MTAS. But I would like to think that it took some knowledge of medicine to know a good medic. Certainly in my line of work, if the selection criteria were such that any Tom Dick or Harriet could agree on who to appoint I'd be concerned.
This isnt meant to discredit either of you - all credit to Mr Jones for getting it right, and commiserations Dr Smith for clearly putting in the thought and not thinking like MTAS
Hi aliby,
Regarding timing, I wrote my application in the space of 48 hours, each question taking me 20-60 mins to write depending on how difficult it was to get the necessary info into 150 words.
But during the week before, I printed out all the guidelines from MMC and the Royal Colleges, and I trawled DNUK looking for pointers as to what was needed. I read the whole lot several times to make sure I wasn't missing anything.
The two points which kept coming up again and again were to answer the question using specific examples, and to make sure you specified how you met the person specification.
So I confess I did a lot of homework, call me a square or whatever! And I'm not supporting the MTAS application because I thought it was a complete pile of crap, but I do admit I put a lot of effort into playing the game because I knew I had to get it right if I stood a chance of getting a job.
On the issue of lying, it's mildly annoying that people keep accusing me of being a cheat and a liar when I am neither, but I'd point out that every single page of the MTAS guidelines and application forms reminds applicants that if they've told a lie, they'll be automatically referred to the GMC. It puts you off even considering stretching the truth a little to make yourself look good.
Could someone please explain why the decision was taken that the doctors previous employment history wasn't taken into account?
Dr Smith - presumably you get another go in the 2nd round? (and it looks to me both from comments above and from commonsense that there will be a fair number of unfilled jobs, because some candidates will get multiple offers). Are you allowed to rewrite your application?
Thanks Mr Jones. So a fair size piece of research then. Which isn't 'square' at all considering what is riding on it.
Oh, and Mr Smith - I for one don't think you are a liar. But that's because I have had a chance to read your muliple posts here and, in some small way, "get to know you". I am sure that there were candidates who wrote answers like yours which were, to a greater or lesser extent, lies - probably mostly stretchings or embroiderings of the truth. And I am certain that it is impossible for the short-listers to sort the one from the other with an acceptable degree of accuracy based only on the 150 words.
Sorry - 4.02pm s/be addressed to Mr Jones of course.
potentilla even if Dr Smith does re-apply in the second round and get an interview then according to the MMC timeline he will find out if he has a job to start at the beginning of August on 23 June - which means many candidates will have approx 4-5 weeks to find somewhere to live, new schools for their children, their partners who aren't Doctors to find new jobs etc.
Anon 4.13 - yes, I think the whole new system is silly for a number of reasons (see various posts above) - I just wondered if Dr Smith would even have a chance this year to use the feedback he has got.
Dr. Crippen,
You asked to be notified if the source document for the selection manual disappeared from the Nott-Trent site. And hey presto - it's gone in a cloud of smoke. I'm sure we'd all be very grateful if you'd make it available, either on your site or via email.
Thank you!
Sitting here across the pond, I scratch my head wondering why any outside agency has to interpose itself to do this to the training programs.
And why the training programs put up with it. After all, they have to put up with a bad trainee.
Here the decisions are made at the level of the training program, and the Match exists only to make the process orderly and less of a free-for-all. They've tweaked the system some to allow for things like getting a married couple in the same location.
And even with that, the Match comes under some criticism and even litigation (this being America).
But maybe I'm thick, but it really puzzles me what they (whoever "they" is) to get in the middle of the selection process. What was the "problem" they are trying to fix?
Hi,
Is there any chance you could link to the st selection manual as it has been taken down?
Or email me it?
Many thanks for all your work.
Strikes me that whatever happens, we are going to have a lot of junior docs, with mortgages and partners, who are going to become nomads come August. Most junior docs have families with spare bedrooms. We know they work silly hours, my little ewe lamb has a shift that finishes at 2am. Would it be possible for willing families to sign up to an accommodation register run perhaps by the BMA? You can't sell a house overnight, and your partner can't find a job overnight either.
All the horrid men in tribly hats, you seem to have attracted to this post don't seem to realise that most of these dedicated young people are paying 50% tax on the top slice of their income. 40% income tax, 9% student loan, and ironically 1% NI for the NHS.
I suppose that the gov't is not going to learn any lessons from this diabolical mess. Does anyone know which management consultancy came up with this crazy scheme?
Strikes me that whatever happens, we are going to have a lot of junior docs, with mortgages and partners, who are going to become nomads come August. Most junior docs have families with spare bedrooms. We know they work silly hours, my little ewe lamb has a shift that finishes at 2am. Would it be possible for willing families to sign up to an accommodation register run perhaps by the BMA? You can't sell a house overnight, and your partner can't find a job overnight either.
All the horrid men in tribly hats, you seem to have attracted to this post don't seem to realise that most of these dedicated young people are paying 50% tax on the top slice of their income. 40% income tax, 9% student loan, and ironically 1% NI for the NHS.
I suppose that the gov't is not going to learn any lessons from this diabolical mess. Does anyone know which management consultancy came up with this crazy scheme?
Arf
You might want to have a look at this -don't expect you to read all 62 pages! I am not an expert in any way but apparently this is where it all started.
http://www.dh.gov.uk/assetRoot/0...08/
04018808.pdf
What I can't understand is why all of us let it get this far - i suppose i just assumed that eventually everything would work out ok, and perhaps a lot of other people did the same
Though the questions are not discriminating, the example answers given from the surgical applicant are clearly better than the gastro applicant. The gastro applicant did not answer the questions asked. A response of;
"With reference to an application in gastroenterology: I have, as yet, not had a failure of communication."
To a question asking for an example of a mistake is ridiculous. I refuse to believe that he has not made a mistake or a time when he feels he could have communicated better.
I realise that this is not a good way of recruiting doctors, but the answers are clearly of different standards.
Mr Jones please do satisfy my curiosity. Which " organ " exactly did you whip out ? Have you considered anaesthetics as a career?
The selction guide is mirrored on my website in the post titled Massive Medical Cull.
----------------------------
Have spoken to Celia Hall & provided her a sumnary crib sheet of the whole affair with both sets of sample answers, the guide etc. There will be something in the paper tomorrow as well, as there will on Sunday.
----------------------------
I had linked to the ferret fancier's post but did someone say that they had a copy? If so, can you please forward? My email address is on the website.
feline,
I'd rather not reveal which [organ] I whipped out unsupervised, but yes, I have considered anaesthetics as a career, but only because Anaesthetics was the only prize I won during my clinical years at med school. Fortunately my academic success either side of those years was more impressive!
"I'm sorry, but I don't accept this. Many, many people have as much devotion to their careers, and get paid a pittance for their future prospects. I also know extremely talented, highly qualified people getting paid far less than your quoted figures. [£50,000/year]"
Those figures describe a smart person who chooses to aggressively pile up positive numbers in a bank's computers. If they choose to pile up smaller numbers to pursue another lifestyle, the difference is the opportunity cost of that choice. Naturally it is a statistical measure for a large group of similar people, not a guaranteed income for a particular person. And my numbers were accurate: the opportunity cost of not piling up money when you're young is staggering.
That does not mean that doing something else is wrong, or that you have to lie awake worrying about economic metrics. My point was that costs and risks are a big factor for smart young people when they choose a career. When a government twists the cost/risk knob higher for a profession, it guarantees that the people in that profession will become stupider and/or greedier.
anonymous mysterious Mr Jones wrote... "So I confess I did a lot of homework, call me a square or whatever! And I'm not supporting the MTAS application because I thought it was a complete pile of crap, but I do admit I put a lot of effort into playing the game because I knew I had to get it right if I stood a chance of getting a job."
And there we are. It is a game to be played. Those of you who have passed an exam or two - and you medical lot will have passed twice as many as this engineer - will recognise the commonsense tedium of this.
Yes, the system is daft and destructive. In fact, it is tragically stupid. But, yes too, it is a game to be played - like all those previous games. Sad and silly but a real world event to be handled for the best. So does it choose the best doctors or does it choose the best exam-takers? I don't know. Are they the same people? I don't know that either. Bloody hope so.
Hope I die before I get sick.
Looking the DOH documents, I never continue to be amazed by the complete bullshit of competency based training.
The whole thing is based on a massively stupid and flawed assumption, that competency is a black and white entity.
Competency is a grey entity and medicine is an art.
These medical educators seem to have this bizarre notion that getting a few forms signed that state you are competent, can make up for hours of experience, it bloody well can't and we need to use this scandal to motivate a generation to rise up against this tide of incoherent rubbish.
Give me Peter Smith any day of the week.
I guess here are three main themes running through all these posts: 1) the selection method must be wrong because lots of good people didn't get interviews; 2) a lot of us have ended up without prospects.; and 3) the system favours people who can answer the questions. I'm not happy with it myself, but I think all these themes are ultimately illogical for the reasons below.
OK, suppose they had used some other method (cvs, earlier interviews, tests, more weighting on experience and references, etc)- at the end of the day there is a limited number of interview places so someone is going to miss out whatever method is used. If the perfect method had been used from your perspective, you would all have got an interview- but in doing so you would have displaced someone else who has got an interview in the current scheme, so we would have had 200 other people complaining on here instead.
The second point is that there are two rounds. If people can make four applications each, and if the selection method is even reasonably consistent, then the people who rate highly for one application will probably rate highly for one of their others too- so there will be a tendency for a lot of people to get 3-4 interviews, say, and a lot of people to get none. The person who gets 3-4 interviews can only take one job at the end of the day, so they will leave 2-3 slots for someone else. This means that there will be stacks more interview slots in round 2, so it's too early to say that things are bad.
Finally, a section method will always favour the people who are good at responding to it. A method based on CVs will favour people who right good CVs; a methods based on job experience will favour people with lots of experience; a method based on intrviews will favour people who are good at interviews; and so on. The question is what selection method correlates with selecting good doctors- I imagine that is a pretty difficult question to answer- I bet lots of us have opinions, but they are just that: opinions.
'"With reference to an application in gastroenterology: I have, as yet, not had a failure of communication."
To a question asking for an example of a mistake is ridiculous. I refuse to believe that he has not made a mistake or a time when he feels he could have communicated better.'
You're so right. When he does this next time, he'll make one up. Then everyone will be happy.
Shite.
ferret, there are some similarities between you, peter smith, dr sniper and ben dean.
but i suspect the lot of you could learn a lot from Dr jones, it's just that Mr Smith is the only one who's accepted this fact.
Crippo (or whatever yer name is)
Accusing people of lying isn't productive.
All he needs to do is reflect on a real experience where he's had a failure of communication.
Some people have such a chip on their shoulder. So there's a new system of shortlisting. Geto over it. Make the most of it instead of decrediting yourselves by insulting those who DID make the most of it.
Taking crippos comments for a moment- the question, I suppose, is designed to test whether someone has the facility for honest self-appraisal and learning- both of which are vital for becoming good safe doctors. So my top prize would go to someone who genuinely demonstrated those qualities. My next prize would go to someone who had the gumption to lie about it. I would give the bottom prize to the guy who didn't try- no imagination, no awareness of what was being expected of them, no effort- not a good omen for any career, let alone one in medecine.
Dear Dr Crippen and colleagues,
I have, this evening, created a forum that allows for polls / votes etc - including polls on "Would you strike?" and "Did you get shortlisted in the area you work?".
It is a PUBLIC forum and requires no GMC membership number to register (ie. you can be entirely anonymous) - a forum for Doctors, friends and family or, media personnel etc - anyone affected by MMC / MTAS.
I hope you will not be offended by my posting of this on your blog - this comment and forum have been created to help.
Best wishes to all,
Cosmas.
The site is listed as my Homepage below
I can think of one way to raise public awareness about doctors' plight.
If one person hands out print outs in busy big hospital entrances with heading:
Will Patient safety be compromised in August 2007.
And one can present one' point of view why that might be the case.
A cheeky PS.
Has anyone got a copy of the Assessment Criteria that was accessed and then disappeared?
I'd like to make it available on the forum.
Thank you for your time,
Cosmas
how is the government supposed to fix this problem?: too many consultants forecasted and not enough gp's. should fat cash incentives be offered to switch courses so as not to trample on doctors' sensibilities?
personally i feel that mmc should be kept but the application process should be based purely on grades.
sorry for all those gp's who have been offered 0% this time round. i wonder whether they will implement this in two phases. a bit of a laugh to quote mr fradd. at least the nurses have got the footballers offering to help out now. who will support the beleaguered british gp?
I have a copy of the assesment criteria - I think Dr Crippen also has one and is planning to post it on this site. Let me know if you want it as I can't access your site right now
http://thumbsnap.com/v/8J4WJUhH.jpg
NEARLY MIDNIGHT
To Anonymous:
“Witch Doctor – your spell needs to deal with the fact that the selectors, up-skilled or not, are all consultants and therefore, according to your logic, all very bright too”
Ah yes, The Witch Doctor is well aware of this and has taken it into account. Indeed, this very special spell will be directed solely at senior members of the medical establishment who have become “Up-Skilled Selectors.” Yes, yes, they will all have been Straight A pupils, but you see, a proportion of Straight A pupils turn out to have a special need. Without this need they may not even have been Straight A pupils at all - they may have had to settle with being AAAAB pupils or (God forbid!) ABBAA pupils, instead of AAAAA pupils. No, they need to please, to conform, and to be the best – always. This means they often have to obey. There is nothing inherently wrong with this, of course, unless they also have an overwhelming need to be seen to be pleasing, an overwhelming need to be seen to be conforming, and an overwhelming need to be seen to be the best. In these circumstances, they most certainly must obey.
And this is when a Straight A pupil takes a funny turn and becomes wobbly.
Now, when I fly around on my broomstick, I never ever come across a consultant who feels MMC/MTAS as it stands is “A Good Thing.” The words used are variable –“bullshit, crap, bollocks” are some of the milder expressions I often hear. Similar to the terms that some of the younger doctors are using on this web-site. Not terms a witch doctor would use, of course.
So, where then, have all the Up-Skilled Selectors come from and importantly, why are they there? What do they believe? Do they believe in anything very much? Do they have the interests of patients and junior doctors at heart? Do they have a special need? Have they wobbled?
Dear Dr Crippen,
I am having difficulty finding the blog 'massive medical cull' to try and get the selection criteria for MTAS. Can you provide a link?
They've taken it down. Can you link to your saved version?
please can you link to the saved version when morning properly comes. I am about going demented trying to find info.
Guys, however flattering the comparison, especially in view of his literary skills, I am not Dr Crippen. I am sure he will put the guide up later but in the meantime it is on my website here.
Dear less confused,
Sorry, I was going to answer earlier but Haloscan (or my PC) was playing up.
No, junior doctors can't re-apply next year. One of the nastier things about this new system is that if you don't get a position this year, you will never be able to obtain one. All or nothing. For those who have been practising for 5+ years (plus time for PhD/MD and undergraduate degree), this is very exceptionally arbitrary. The rationale is that this year's ST2s will be next year's ST3s and there will be no room for extras.
The NHS is a monopoly employer. Entities such as BUPA do not offer training (cuts too much into profits) and only want to employ fully trained consultants (they are faster as they're more experienced).
This may explain why doctors are so desperate. This is not just a new method of shortlisting, it is a way of binning 20% of existing juniors' careers. Given the way medical school numbers are expanding, I'm not entirely sure that current doctors will be the only ones affected.
P.S. Potentilla, promise it wasn't me being a snob, Antipodean MedAdmin Doc and I are different people.
Speaking of snobbery, I think I spotted an aside about doctors being able to fill out forms better than social workers. IMHO the reverse is true. Perhaps I've just worked with very good ones, but their interpersonal skills and ability to deal with the most heartbreaking and unresolvable of situations far outweigh mine.
antipodean dr "No, junior doctors can't re-apply next year."
Actually I think you are wrong there, doctors can apply next year as I'm sure I have read somewhere there will be natural fall-out from the scheme i.e. people deciding it's not for them etc however what the people in charge have said (what to call them!) is it will be a lot more difficult to find a job as there won't be as many positions open as this year because as you say this years ST1s will be next years ST2.
Maybe someone can clarify this?
Mr Jones, your answers were excellent because they contained both style and substance. Your clinical experience and achievements were genuine and this was visible through the medical education jargon.
You've worked hard and deserve that interview.
Shame about those with more substance then style.
Sorry, antipodean dr (and I don't know that Antipodean MedAdminDoc was necessarily being snobbish either, maybe he/she just misspoke).
BTW, BUPA don't employ consultants; consultants are employed by NHS hospitals and are self-employed for their private work. Therefore I also don't think that BUPA would be allowed to employ doctors in training grades (because they couldn't ensure training). Not many doctors have such established private practices that they can "afford" (professionally more than financially) to give up the title of consultant.
There is discussion ongoing at the moment between the DoH & deaneries about the private sector being forced to provide training as most of the elective work is migrating to ISTC's. However, the training programme is being decided by the commercial teams at the DoH, not anyone with medical education or clinical backgrounds & is being done as a paperchase & with lots of foot-dragging.
Potentilla - misspeaking, yes, a good word. Especially for me, as I was born with feet in mouth up to knees. No offense meant on my part either.
Anonymous, the concept of 'natural fall-out' is an attractive one. However, does anyone have any idea of what rate this might be at? Since the system is untested, unpiloted with no international precedents, I would doubt it. Given the horror stories coming out, I would hazard that most junior docs obtaining an ST post would cling on to it for dear life.
Private sector training? Lawyers, accountants, engineers etc all receive this. I suppose it opens up the larger issue of privatising the NHS.
commercial teams at the DoH. Nah, the concepts of "commercial" and "DoH" do not belong in the same sentence. I don't know what word you want, but it's not "commerical". (The bloke in charge of MMC is a doctor).
I am an SHO working in Australia. I've been here about a year and never intended to stay any longer. I have spent the last few hours reading through all your responses. My heart goes out to all of you. Sitting comfortably on the other side of the world, I had no idea how difficult these past few months have been. I am so so sorry to hear of all your stories. Its disgusting and I don't want to serve the filthy NHS anymore.
My boyfriend (also a doctor) and I worked together in London and came out to Australia together. He is an Oxford graduate and by far a much better clinician than myself. This is what I do not understand. We wrote our MTAS applications together and helped each other. I got three interviews, he got none. Our applications were linked, so we applied to the same deaneries, but different specialties.
Here is my personal predicament. None of my close friends have secured any interviews. I know I should be grateful, but I feel guilty about those left behind and all I have done is cry since the MTAS outcome. Please don't be offended by what may appear an ungrateful comment but I feel a huge burden of being confined to a rigid seven year contract and a deanery I have little knowledge about.
My boyfriend is very career driven and has given up all faith in making it home. If I succeed in the interviews I have to chose between leaving behind in Australia the man I have loved for 14 months or turning down an ST1 post in my chosen speciality never able to break into the ST run-through again.
I want to desperately go home but how can I leave my heart behind. If I stay in Oz and things with my man don't work out, I'll be stranded here with no prospects of getting home.
My best wishes to all of you, reading your responses I have laughed, cried, felt outraged but most of all comforted that I am not alone.
With optimism - thanks.
potentilla, look up the Commercial Directorate. It is staffed by short-term contractors who know very little of the health service or by failed managers.
MMC
Making Medics Cry
Please please please register and vote for the following post on webcameron. We need to make it one of the top three blog posts that he responds to.
http://www.webcameron.org.uk/blo...octor-
workforce
The answers that the unfortunate Dr. Smith submitted were naive and not those required of the Nuspeak Selection Lottery. WIth 75% of the marks being allotted to the application form and only 25% to the selection centre process it was critical that the form was filled out correctly.
We ultimately require a UKMLE with national rankings, but this will take time to implement. It is of course interesting to note that despite claims of vast increases in doctor numbers since 1997, change in medical contracts and working practices mean that though there 7000 more consultants there are in fact about 280 less consultant equivalents and in August there will be a shortfall of over 8000 JHD equivalents. A triumph of workforce planning. Only a socialist centralised system could achieve thise yes, New Labour really works.
So, Dr Smith is not good enought to be a gastroenterologist - he must be 'crap-mediocre' according to the RJS scale [see above].
While the medical profession is busy shooting itself in the foot, I anticipate a burgeoning role for nurse endoscopists.
comment posted at 3:30pm by A&E C/N.
So it appears opinions are divided over whether Dr Smith or Dr Jones more deserved an interview.
I'm not sure why.
Perhaps underneath they have similar qualifications and experience, but one did his homework, the other did not, and regrets it.
How on earth are these guys being judged so harshly for anything other than the facts we see before us? Especially when they both appear to be nice guys who've firstly trusted Dr Crippen and the general public with their info, and secondly been here to comment and encourage each other?
Yes you were right. The precious document has disappeared. could you please post it on your blog?
If people believe that answering vague questions is a better selection tool than a CV then I suggest they go and speak to people who select in other companies and people who select from other professionals. They are appalled by the MTAS affair.
The CV is an infinitely better tool than this politically correct joke.
There will always be some monkeys out there keen justify the indefensible, however if you lose subjectivity then you are left with nothing more than a lottery.
Those wishing to ensure a selection process based on education and experience have a simple remedy. Start a campaign to encourage applicants to complete the forms with a standard set of answers, all identical, even down to the punctuation.
You know when people say things like 'which would you prefer, an academically sound doctor with no social skills, or a sweet and understanding doctor who doesn't know their arse from their elbow?'
I'd like my doctor to be both intelligent and have social skills.
The MTAS app may not be ideal, but there are a lot of sour grapes going on. Take for example the question about extracurricular activities. There are points available for having 2 verifiable activities, and for pointing out how they're relevant to your work. Same goes for the research question - points for the theory of it, points for having done it (and having proof of this.)
The MTAS app looks for both qualities, and anyone denying this should be stating their conflict of interest.
Schooner - to do that, every applicant would have to have done the same research projects, published papers, presented at national meetings, have other qualifications and certificates, and proof of all of these things.
My guess is that not all applicants have the same achievements, and therefore will not be able to write such impressive stuff as the better candidates.
Lolita, it seems that the ratio of medical places to applicants was far more favourable than for surgical places to applicants, and the ratios for the more senior positions was worst of all. Also applicants interested in less popular specialities were more likely to get an interview. It may be that your beloved has been outfaced by the quantity of his fellow-applicants rather than their quality.
I don't suppose it helps to say that I would give my eye teeth to be able to migrate to Australia or New Zealand, does it? Or that what looked like the most terrifying precipices in my life, turned out - once I was forced off them usually backwards and wailing - to be the perfect place to fly from. A hang-gliding metaphor there. Sorry.
My heart goes out to you all, especially Dr Smith who has shown himself to be a thoughtful and reflective physician after all.
The only advice I can give anyone in this wretched mess is to imagine yourselves looking back from a perspective of five or ten or twenty years, and take the choice now that you believe you will regret the least.
Astrea.
A couple of things I don't undertsand:
- are the 8 thousand unemployed actually offered no job, or just a job they don't want?
-were the number of posts in each speciality known by the applicants in advance?
thanks for helping out an ignoramus!
Hi Clyde,
All the jobs were advertised on the website, so you could work out the numbers available. As for the number of docs with no job- that's impossible to tell because there are two rounds. My guess is that the 8k figure is just scaremongering- I can't believe the NHS could cope with 8k fewer medics all at once in august. Looks to me as is the numbers of people without interviews is probably misleading- given that the 'better' applicants who score highly on their app form might get up to 4 interviews each, they have displaced lower scoring applicants from the shortlists and interviews, but they can only acept one job out of the four, so the remaining three will still be free. Before we all start panicking we ought to ask and be told the shortlisting ratios for this round. If they have stcuk with the old yardstick of 2 applicants shortlisted for every job, and if most applicants have 3-4 interviews, then only half the posts will be filled this round anyway (straightforward maths), so most of those who didn't get shortlisted this round probably will in the next.
Anon, my comments were tongue in cheek. I really should know better
Anon, my comments were tongue in cheek. I really should know better
Thanks anon, that clears it up for me a little. My concern for you doctors is that if you all go to Australia you may still find it hard to get your chosen speciality. Canada, USA, Australia are mostly short of rural GP's. If you do go overseas you should coordinate yourselves to go to different areas so you don't face even more stress. The modern british medical graduate, loosed upon the world like a great albatross...
http://thumbsnap.com/v/aajiK2oh.jpg
MIDNIGHT, AFTER THE ECLIPSE.
To Schooner:
“Start a campaign to encourage applicants to complete the forms with a standard set of answers, all identical, even down to punctuation.
The Witch Doctor spent some time reading the applications form. It runs to 9 pages and has a little ditty on top of each page in bold capital letters:
“ANY CANDIDATE FALSIFYING EVIDENCE ON THIS APPLICATION FORM OR IN SUPPORTING EVIDENCE WILL BE AUTOMATICALLY REFERRED TO THE GMC.”
“ANY CANDIDATE FALSIFYING EVIDENCE ON THIS APPLICATION FORM OR IN SUPPORTING EVIDENCE WILL BE AUTOMATICALLY REFERRED TO THE GMC.”
“ANY CANDIDATE FALSIFYING EVIDENCE ………….. get it? Nine times.
By the time you have completed the form you will have read this NINE Times. In fact - probably more because the online version had more pages.
99999999999999999 Yes - NINE TIMES 9x1 = 9 times nine 4+5=9 1+ 1+1+1+1+1+1+1+1 = 9 2x2x2=8+1 =9 23.7899 -14.7899 = 9 99999999999999999
WRONG! 10 TIMES - A BOX HAS TO BE TICKED AS WELL.
So Schooner, it is a great tongue in cheek idea – don't apologise - but they can’t do this at the moment. Until this little ditty is removed it would be too dangerous for them.
However, there are some questions that could be asked of the Up-Skilled Selector-in-Chief.
Will it be a humane, non-human automatic device that “automatically” refers all liars to the GMC?
Maybe.
Probably not.
Where is the Jury that has the capability to deem whether the evidence on each and every application is falsified or not? What tool will they use? Will this tool be evidence based, standardised and fair?
Will the Jury consist of 12 Up-Skilled Selectors? If so, will they all be a bit wobbly?
What will the Supreme Judge in the GMC do with the allegedly falsifying unemployed candidate?
What will the Supreme Judge in the GMC do with the wobbling Jury / wobbling Up-Skilled Selectors if they have got it wrong?
What will the unemployed candidate do if the wobbling Jury / wobbling Up-Skilled Selectors have attempted to make him/her permanently unemployable? Will he/she sue??
These young doctors are already being trusted with the lives of patients - morning, noon, night, and all night.
Trust is intangible.
Trust is difficult to measure.
The Witch Doctor boiled up the cauldron, threw in a fistful of hemlock, and stirred like mad!
Bah!
anon, you are chatting breeze, to pretend that people who have not been selected by MTAS are simply sour grapers is disingenuous and insulting.
Either you are one of the people who had the advantage of a marking scheme, or you do not know enough about short listing to realise that giving 80% of marks for vague questions with rigid marking schemes is plain idiotic.
Do you know of any other industry or business that selects from highly trained and highly educated people in such a manner? I think you do not.
"You know when people say things like 'which would you prefer, an academically sound doctor with no social skills, or a sweet and understanding doctor who doesn't know their arse from their elbow?'
I'd like my doctor to be both intelligent and have social skills.
The MTAS app may not be ideal, but there are a lot of sour grapes going on. Take for example the question about extracurricular activities. There are points available for having 2 verifiable activities, and for pointing out how they're relevant to your work. Same goes for the research question - points for the theory of it, points for having done it (and having proof of this.)
The MTAS app looks for both qualities, and anyone denying this should be stating their conflict of interest."
pardon me but this is pure apologetic twaddle.
The questions are not a good selection tool.
"I guess here are three main themes running through all these posts: 1) the selection method must be wrong because lots of good people didn't get interviews; 2) a lot of us have ended up without prospects.; and 3) the system favours people who can answer the questions. I'm not happy with it myself, but I think all these themes are ultimately illogical for the reasons below.
OK, suppose they had used some other method (cvs, earlier interviews, tests, more weighting on experience and references, etc)- at the end of the day there is a limited number of interview places so someone is going to miss out whatever method is used. If the perfect method had been used from your perspective, you would all have got an interview- but in doing so you would have displaced someone else who has got an interview in the current scheme, so we would have had 200 other people complaining on here instead.
The second point is that there are two rounds. If people can make four applications each, and if the selection method is even reasonably consistent, then the people who rate highly for one application will probably rate highly for one of their others too- so there will be a tendency for a lot of people to get 3-4 interviews, say, and a lot of people to get none. The person who gets 3-4 interviews can only take one job at the end of the day, so they will leave 2-3 slots for someone else. This means that there will be stacks more interview slots in round 2, so it's too early to say that things are bad.
Finally, a section method will always favour the people who are good at responding to it. A method based on CVs will favour people who right good CVs; a methods based on job experience will favour people with lots of experience; a method based on intrviews will favour people who are good at interviews; and so on. The question is what selection method correlates with selecting good doctors- I imagine that is a pretty difficult question to answer- I bet lots of us have opinions, but they are just that: opinions."
twaddle again I'm afraid. Are you trying to pretend that replacing CVs with vague questions is progess and a better tool for selection?
If so then it's more breeze I'm afraid.
By your logic why not have selection based on how many sheets of bog roll one uses to wipe ones arse?
That's just an opinion of course. Twaddle.
Look out in the world and see how other businesses and companies select top professionals, they look at their cvs and this includes knowing where they were trained, eductaed and have worked. They do not base selection mainly on other vagueries. I'm sure looking at the bogroll usage would be equally valid in your eyes, as would a lottery, but at the end of the day it's just opinion, thus any old bullshit can be justified can it?
Clyde - you forgot to mention tucked away NZ ! My thoughts exactly though. Placement for training posts will always be given to home grown candidates. Good luck to you all.
To The Ferret - I don't think that Anons post, which you have quoted above is Twaddle at all. This is what happens in the real world. Yes, businesses select candidates for interview from a CV OR an application form - depending on the company. The business can only form an opinion on whether to interview a candidate based on how well their CV is written. Having spent many hours writing my own CV it is a skill. Employers look for evidence that you can demonstrate the skills and experience they are looking for - what did you achieve and what skills did you use?
I am going to run the risk of being unpopular here by saying that, from a total outsider to the medical world, the questions put up here from the application form seemed reasonable to me and they weren't, in my opinion, vague. Personally, I think that any job application needs to be accompanied by a summary of the candiate's formal job experience in addition to answering formal questions. The questions are looking for evidence of HOW the candidate has used their Education and Training and how this has shaped their clinical practise.
Writing a 'good' application is a skill, as is coming across well at interview - it takes practise - this is what is missing from this process - candidates should have been professionally supported with their applications to enable a level playing field.
"a section method will always favour the people who are good at responding to it." - this is VERY true.
I reviewed the Deanery Document Recruitment Guidelines for Selectors. Academic qualification Ph.D MD FRCS, FRCR Glittering Prizes counted for 15% of the form's value.
The key element was that the scenarios , the touchy feelie stuff question such as describe a bad day at work or how have you dealt with anger at work counted on an equivalent level.
The eseence of the form to my mind was that in the competitive disciplines they are seekking first amongst equals and that the clinical vigilance scenarios are seeking to assess global communication skills, insight, judgment, ability to reflect on practice the capacity to learn from error and that the candidate recognises their own failibilities. The problem that arises is that this method of slection has not been validated in medical context, but as for tyhe most competitive specialties we slecting the creme de la creme it probably menas not a jot. The hard choices will be forced on those who have to choose a different discipline, but it has ever been thus.
It is possibel to Donwload the Recruitment Guide on DNUK and anyone who doesn't is a fool unto themselves.
Someone has also posted a whole load of what look like pretty reliable interview topics on the MMC forum and these correlate with the Recruitment Guide.
The more I study the process the more I realise that many candidates did not study the person specification adequately nor did they read the foundation year curriculum to understand what was required in this process. When everyone has papers, prizes, postgraduate qualifications the become irrelevant one has to market oneself and it is in the copy writing. The information was all there for everyone to see, but not everyone used their eyes or common sense, not a virtue of the academically gifted who tend to be blase about their gifts.
sorry, very unconvincing indeed.
The weighting towards thes questions was ridiculous, 80% of marks to them and 20% or so to actual concrete achievements.
Even if the playing field was level, which it most definitely was not, then the forms are poorly designed and a poor selection too.
If you read the actual evidence behind MTAS, there is bugger all evidence for the application forms.
There is evidence that length selection centres are good, hardly surprising that a rigorous day long assessment is good at disciriminating between candidates.
Evidence that the application forms are a good tool is worryingly lacking even in these quoted studies!
I have no doubt that some deaneries have excellent local selection processes, however the MTAS form is crap and there is no evidence for it.
The CV is eminently better and should not have been replaced by something that is so untested and flawed.
As for the number of jobs my sources in the Deaneries and the DOH suggest that there were approx 31500 applicant for appros 16100ST jobs ( bu there were the 600 non-existen jobs in one Deanery du to computer error )and 5600 approx FTSA jobs . The Academic Fellowships were grossly underubs scribed only 2 applicants for 10 posts In Manchester this is apparently true nationwide. So the bright sparks should think ACF for ROund 2.
The other fly in the ointment in August is the 56 hour week kicks in and we may be short about 8-9000 junior doctors on on-call rotas nationwide. From next years there is a potential funding crisis for F1 trainees with no guarantee of posts for all!!!!!
this method of slection has not been validated in medical context AFAIK, it has not been validated in any context, in the sense of being supported by scientific studies that show that it is the best way to identify the best candidates for short-list.
For instance, if the "probity" question is supposed to test probity, I suspect it of having a high rate of false positives and false negatives.
ferret, you mention "the actual evidence behind MTAS" and "quoted studies" - where is this info available please?
The various people who are saying that there is variability in the ability to write a good CV, and that you still have to market yourself, are right; but it's a matter of degree. A CV has more veriafiable facts on it, and also the open-ended nature of the format makes it easier for the assessor to read between the lines, both in terms of detecting the bull-shit and in terms of giving the benefit of the doubt to those who have had less training in CV presentation.
It's good to see that the debate is becoming a little more balanced and scientific here. I think we need to separate two isues.
One- is there realy going to be a big shortage of jobs at the very end of the process (bearing in mind that this is just the first round, so people without interviews are still likely to get interviews in the next round)?
Two- what would be a better selection method? The questions on the form, to my mind, were quite probing, and called for quite a lot of thought and analysis. I wonder how many of the people who din't get interviews first time left their application to the last minute.
The problem with the CV approach is that it makes it difficult to define a standard evaluation method that can be used with a degree of consistency, given that the source material varies so much from applicant to applicant.
There is f*ck all evidence behind the application forms:
http://www.bmj.com/cgi/content/f...ll/330/7493/
711
the evidence that came out of this study was that long assessment centres were good at selection.
There is no mention of the competency based application forms being correlated with job performance, this ommission is glaring.
The study has several rather gaping flaws too.
Here's the evidence for competency based stataments, i use evidence very lightly:
http://www.blackwell-synergy.com...1468-
2389.00132
The whole thing has come from evidence that never existed.
I have yet to see a shred of evidence that these application forms are a good tool.
It's a shocking bit of chinese whisper.
@Anon 1.57pm
One - yes, probably; because of a combination of the NHS's current financial travails and the number of medical school places being increased a few years back. The new system is being introduced at exactly the time that it will (because it is inflexible) do the most damage to the careers of individuals).
Two - "probing"; now there's a weasel HR word. Does it mean "designed to elicit the most relevant information" or "requiring some time and thought to draft a high-scoring answer"?
a standard evaluation method that can be used with a degree of consistency This ONLY matters if it ALSO has the best (or at least a pretty good) chance of identifying the right candidates. IMHO many so-called evidence-based recruitment processes are actually designed to avoid specific legal challenge. Which is a perfectly reasonable hard-headed business aim, but is NOT the same as identifying the best candidates. Or even having a very good chance of identifying pretty good candidates.
I'm a bit confused by what The Feret is trying to say, I've just had a quick look at the BMJ site, the document states:
"The selection process and assessment centre described here is based on a validated competency model comprising the three stages of initial application forms, referees' reports, and an assessment centre."
So in this model, it appears that there was an initial application form, complemented by referees' reports, and the assessment centre.
Those of us outside medicine have to take our chances with whatever method of selection a prospective employer has chosen, I don't see why Doctors are any different????
one problem with "taking your chances" is in this instance 250000 quid of public money has been invested in these guys, from a commercial point of you not employing them is a huge waste of money.
This is regardless of all the other ramifications
Dear Paul - absoutely agree - but if there are more 'bums' than 'seats' what's the answer???
Some large employers invest heavily in the training of individuals who then leave or are pushed/made redundant, so in some respects there are similarities.
Re cost of training-
One could argue that we should just train fewer docs, and then recruit from abroad if we find we have too few.
Also, the fact that we've wasted 250k training someone isn't an argument for continuing to waste money on them if there isn't work for them to do.
Anyway, I dispute that the 250k is a pure training cost- we're worked to death while we're trained so the taxpayer gets something for the 250k.
We shouldn't get too despondent- I'm prqactising my answers for round 2.
I think it was the withc doctor above who mentioned that lying on the MTAS form means referral to the GMC for a ticking off.
The questions in the form asked for certifiable data, presented in a reflective manner.
The form may be less than perfect (nobody is denying this, ferret, so keep your fur on!) but I maintain that there is no way on earth a useless candidate could score well on it (unless they lied, and were subsequently referred to the GMC).
Likewise, the only way a genuinely good candidate could fail to be shortlisted is by failing to do their homework and answer the questions.
"Writing a 'good' application is a skill, as is coming across well at interview - it takes practise - this is what is missing from this process..."
The unpretty truth is that the start of any selection process is a killing field. One looks for obvious shortcomings and weeds out the unready, the untidy, the underprepared and, sadly, the unlucky. That's mostly what the "bits of paper" are for. Inevitably some good candidates get dropped. It's a shame but there we are. But there is another thing we want tot. One wants one's application paper/questionnaire to be able to point out the weak ones so that they can be discarded but the skill is to have the same application point out the good people.
This incidentally is a very hard thing to do and IMO these questions are poorly devised to do these two different but desirable things. The fact remains however that the best people in any field tend to adapt to what is required of them - even if it is filling out stupid questionnaires.
"...want too" Note to self: preview before publish.
Anthea, the question-marks are over the "initial application form", which puts a very heavy emphasis on answering (briefly) questions to which "model" answers are relatively easy to fudge, thereby (a) not selecting out good liars (b) not identifying otherwise good candidates who are bad at drafting model answers and (c) not cutting down the numbers usefully for short-listing anyhow. (Which is to say that the short-list will have lots of excellent truthful candidates, and lots of others).
Those of us outside medicine have a very much wider choice of potential employers than junior doctors, who basically have one in this country. Furthermore, as taxpayers we should have a specific interest in whether the selection methods chosen by the monopoly employer, the government, are likely to give us best value for money by identifying the best candidates.
lying on the MTAS form means referral to the GMC for a ticking off IF you get found out. Most people will not exactly lie, they will embroider and spin and (inevitably in 150 words) summarise. And only the terminally incompetent will actually get found out enough at interview to get referred to the GMC. How on earth could you actually "certify" all that "and then I reassured the team and patted the anaesthetist on the head" stuff?
Has everyone caught up in this farce seen the document "Recruitment to Specialist Training - A Resource Guide to Selectors"? I found it on the web yesterday. It tells you all you want to know about your interview and about the correct answers to the computer generated questions.
Thinking about those questions on your computerised application form, they are the culmination of decades of effort by politically correct educationalists. They have been quietly beavering away for years to undermine what they perceived as medical power and arrogance whilst you were all flogging your guts out working on the wards, taking all the gut wrenching responsibility, coping with the emotional burdens, working in appalling crumbling buildings with appalling crumbling patients and in your spare time, studying.
Take a look at the people who run the MMC (MMC website -Meet the Team). And look at their backgrounds. Look how many are not in medicine at all. Make no mistake, these people are in positions of major power in that empire. They carry the baton for generations of those who mistake medical ability and authority for arrogance. They want you to stop being the most important person in the multidisciplinary team. It reminds me of the 11 plus. Those who had been coached in how to answer the questions had a better chance of a Grammar School place. Next time you must be sure that everyone has seen the Resource Guide. They cannot change the criteria. Basically they are selecting those who appear to be the most humble, reflective, kind communicators who are so analytical as to avoid medical errors. Study the Clinical Governance agenda.
I am really upset about this injustice. It is keeping me awake at night. I know what a brilliant group you are, and selfishly, how important you are to my personal health care. What is so important about you in society is your mix of intelligence and altruism and how you put up with the worst working conditions of any professional group to care for people. I have written to my MP.
Anthea, you need to read the articles fully and understand them:
The last few weeks has seen MTAS (medical training application service) start off with more than a few glitches. In fact the system has been called a ‘shambles’ on the broadsheet front pages (1). The potential human cost of such system failure appears to be massive, so it begs the question: is there any evidence that backs up the MTAS process?
This study (2) analysed a new system used to select GP registrars, which incorporated application forms using competency based statements, structured interviews and a lengthy selection day at an assessment centre. Saliently the use of the application forms is all but ignored in the results and discussion. The focus is upon the finding that those candidates who did well at the very long assessment centre selection, which involved several 20-40 minute stations, did better in their jobs three months down the line. This is not a particularly dramatic result; as most people would assume that the more rigorous the assessment centre, the better it would be at weeding out the weaker candidates. There is no mention of a correlation between the application form scores and job performance, this is surprisingly omitted.
“Furthermore, as the comparison and matched group were demographically not equivalent to the initial intervention sample (354 applicants), caution is needed in generalisability of the results”
Quoting directly from the study (2), the authors are admitting that great caution should be taken in generalising from these results, possibly advice that MTAS should not have ignored. There is another similar study (3) that has been published since this, which found that a lengthy rigorous assessment centre process was useful in selecting paediatric doctors for higher training. From what I have gleaned, the evidence shows that lengthy and rigorous assessment centre selections are good at selecting candidates; hardly rocket science is it?
MTAS has used an application form which gives a rather large amount of weight to competency based questions, and a rather minimal amount of weight to concrete provable achievements like royal college exams, prizes, publications and courses. Is there any evidence base on which the MTAS form has been sculpted? This study (4) is about the only evidence around concerning the use of competency based statements. It demonstrated that applicants who added competency based statements to their résumés got higher scores from Human Resources departments. The relevance of this to MTAS seems pretty contentious, to say the least.
MTAS does not seem to have much evidence behind its application forms. The recurring theme from the research seems to be that thorough selection days at assessment centres are very useful in getting the best candidates for the jobs. The process of allocating such a high percentage of short listing marks for competency based questions does not seem to have ever been validated or proven, and this makes the current bunch of juniors look increasingly like experimental subjects. What is wrong with the Curriculum Vitae and good old references? After all, these formats have stood the test of time and are still used as a selection tool to this day by numerous big companies and businesses around the globe. A good reference is the highest commendation one can be given, the referee is putting his reputation on the line for you, and this cannot be summed up into numbers and highly structured scores. It is also insane to pretend that it makes no difference which university one attended or which jobs one has had, this is political correctness gone raving mad.
If one assumes that the MTAS process is incorruptible, then we are still left with a new selection tool that has no evidence behind its use. However if one entertains the possibility of a corrupt MTAS process, then we have an even bigger disaster on our hands. There have been rumours that some candidates have had access to confidential information, thus giving them an unfair advantage in this selection process. So either way, the CV is looking like a utopian tool in comparison with MTAS.
The potential human cost of a deeply flawed selection process is massive. Whatever the tool used, the unemployment of junior doctors was going to be a big problem; but with a flawed selection tool, some of the very best junior doctors may be amongst those signing on. How on earth did the MTAS application form come into existence in its current form? As it appears that scientific evidence had very little do with it.
.If everything that is subjective continues to be brutally destroyed in this manner, it will soon become apparent that not much remains. If things cannot be translated into numbers, it does not mean they are meaningless, far from it. We are humans after all, and by trying to rigidly standardize everything under the sun, we are forgetting this important fact. The subjective human touch is often impossible quantify, but this doesn’t make it worthless; it makes it priceless and we might not be in the pickle we are in today if certain people had remembered this.
1. The Daily Telegraph front page 01/03/2007 http://www.telegraph.co.uk/news/...03/02/
nhs02.xml
2. A new selection system to recruit general practice registrars: preliminary findings from a validation study. Patterson et al. BMJ 2005;330:711-714.
3. Randall, R, Davies, H, Patterson, F, Farrell, K (2006). Selecting doctors for postgraduate training in paediatrics using a competency based assessment centre.. Arch. Dis. Child. 91: 444-448.
4. Jim Bright and Sonia Hutton. The impact of competency statements on resumees for short-listing decisions. International journal of selection and assessment. Volume 8 Issue 2 Page 41 - June 2000.
Basically the studies have found no correlation between application forms scores and job performance, and this is the most positive study for MTAS!
There is no evidence behind competency based questions in application forms!
ps anthea a couple of extra points:
even the authors say their stidy shouldn't be used to generalise from due to demographic problems!
They had a day to carry out assessment of candidates, as well as interviews.
There is nowehere near this amount of time for ST selection centres, thus it's another problem with comparing the two.
Also the only evidence found that the assessment centres were good at finding the best candidates, the application forms were not linked up with the good candidates, meaning that MTAS has zero evidence behind it.
Tinkerbell asked...."Has everyone caught up in this farce seen the document "Recruitment to Specialist Training - A Resource Guide to Selectors"?
I have. Hopeless tosh and twaddle. And produced by some outfit called Work Psychology Partnership. They have a website here. An interesting website and a first for me. I was unable to find a single sentence meaning any damn thing at all. Oh except for the one under Our People which effectively said that they have no people and hire in any old dogsbody as and when the need arises.
Please kindly also sign this Online Downing Street Petition about General Medical Council (GMC) Racism :
http://petitions.pm.gov.uk/GMCRacism
If we don't get the message across to the GMC now , then Eastern European Doctors are going to be doomed as well - in addition to those many thousands of African and Asian Doctors who have already suffered such rabid discrimination by the GMC.
mongoose, this is who two of them are
As far as I could see, the "selectors" stuff was mostly a bog-standard Powerpoint presentation about avoiding unconscious interview bias, of the sort that any interview training course would give - did it really have "the selection criteria"?? admittedly I was under the influence of Taxol yesterday when I read it.
I feel sorry for our young doctors who have been let down by the Royal Colleges who have given in to the politicians and are being run by MMC mob. I have been interviewing for registrars, senior registrars and SpRs for 20 years and now I am told to go on an interviewing course and a diversity course. Well enough is enough - roll on retirement. If I was a young doctor I would emigrate.
potentilla wrote... "this is who two of them are"
"Organisational Psychology" Yikes! Thanks, potentilla.
And, no, I didn't find anything in the doc that one could not get better elsewhere.
http://thumbsnap.com/v/dGFHJDT8.jpg
Two small experiments by the same group of researchers. This does not constitute an evidence base for selection within the medical domain. They say so themselves.
There is no therefore no validation of the method. It has been rolled out prematurely as an experiment at great expense and consternation.
So, there you have it - you are an experiment. You are the further investigation. You are the wider sample. The first experiment was an interesting preamble. No more. No less. The first experiment involved small numbers and the outcome was measured after only three months! The second experiment was even smaller.
You are the real big experiment!!! You are all taking part in a psychological research study. You will eventually be published in the scientific literature. Be honoured!!
I hope the nature of this exciting experiment was explained to each and every one of you. I hope each and every one of you gave your written consent before participating.
The first preamble experiment obtained ethical approval from Sheffield University.
The second smaller experiment obtained ethical approval from The City University Psychology Department, London.
Who gave ethical approval for this third “real” experiment? Does each and every Up-Skilled Selector know this is an experiment? Did they all check that there was ethical approval before becoming Selectors? I hope so.
Or did the wobbling Up-Skilled Selectors just obey?
You need to be aware of all of this.
The Witch Doctor hopes you will not wobble too.
http://thumbsnap.com/v/dGFHJDT8.jpg
Well, well, well, the ferret has beaten me to it - and very excellently, I must say. The ferret is clearly an AAAAA pupil but not of the wobbling variety. But since I only come out at the witching hour, let me say my piece too.
Consider these two documents:
The Witch Doctor has emphasised some bits in bold italics.
DOCUMENT A
A new selection system to recruit general practice registrars: preliminary findings from a validation study. Fiona Patterson, Eamonn Ferguson, Tim Norfolk, Pat Lane, BMJ 2005;330:711-714 (26 March), doi:10.1136/bmj.330.7493.711
DOCUMENT B
“Recruitment to Specialist Training: a resource guide for selectors”
1. The Witch Doctor has noticed that in Document B, Professor Fiona Patterson is recorded as a workshop facilitator.
2. The only reference firmly quoted in Document B to back it up, is a reference to Document A ie a reference to work of same Professor Fiona Patterson, first author. Professor Patterson is Director, Organisational Psychology Programme, Department of Psychology, City University, London. Professor Patterson was also a co-founder of The Work Psychology Partnership established in 2002, the consultancy involved in writing the evanescent training manual "Recruitment to Specialist Training." This is the consultancy charged with nationwide up-skilling of the selectors.
3. Some quotations from Document A
“Assessment centres are one of the most reliable and valid selection methods but have not been applied in the medical domain”
“Discussion
A competency based selection system for recruiting general practice registrars on the basis of an application form, referee's report, and an assessment centre improved the reliability and validity of selection compared with traditional methods. The significant positive correlations between the competencies assessed through application, reference, and the assessment centre showed good evidence of reliability.
The validity of the assessment centre was shown by a significant positive association between performance at the centre and job performance three months into practice, and by recruited trainees being rated more highly by trainers than a matched group in another region. The reliability and validity (predictive and case comparison) findings are encouraging but preliminary, given the small sample size. Furthermore, as the comparison and matched group were demographically not equivalent to the initial intervention sample (354 applicants), caution is needed in generalisability of the results. Our findings do, however, indicate that these evidence based methods are worthy of further investigation.
The assessment centre method is also worth pursuing in other medical specialties and undergraduate selection, where the design is based on a thorough role analysis.10 Such analysis is essential if good reliability and validity is to be achieved and for a legally defensible system.19 The current assessment centre system for general practice registrars operates on an assessor to candidate ratio of 1:3 whereas traditional methods have a ratio of 1:1.5. This is an obvious saving in resources and time.”
"Ethical approval: Research ethics committee of Sheffield University."
There has been another study in 2006 involving the selection of doctors for post graduate training in paediatrics using a competency based centre. Professor Fiona Patterson was also involved in this study which assessed 27 doctors.
"We present data which were drawn from only one area of the UK and our findings need to be validated on a wider sample."
ie two small experiments.
http://thumbsnap.com/v/bizategs.jpg
In the witching hour stange things happen.
The above postings are the wrong way round. The second comes first.
sent this as a letter to the telegraph:
I am in the second year of my training as an SHO in Psychiatry, currently working for the St Mary’s training rotation. I am passionate about my chosen discipline, and my ambition is to continue as a career psychiatrist. I did not choose Psychiatry on the basis of simply needing a position, or because it is perceived as unpopular, and therefore easier to get into, or to back-up more general training; I wish to specialise because it is my vocation.
I competed with other doctors for a place on the rotation, via application forms and interview process. Subsequent to my appointment, I successfully completed each 6 month post, leading up to the present. As part of my training, progress has been formally assessed at intervals, by each Consultant I have worked with. I have been judged overall as above average, and I give a direct quote from an example comment: “James has been an excellent trainee. He is very highly regarded by the team and myself.”
In the normal turn of events, I would have approximately another year to go before completing my SHO training, subject to passing Parts 1 and 2 of the Membership exams for the Royal College of Psychiatry. I would then be free to apply for further, higher training as a Specialist Registrar, ultimately leading to becoming a Consultant.
In my recently completed post in Old Age Psychiatry, my Consultant and myself incorporated assessment techniques from the new system, beginning in August. This marks a change in approach to more structured, and continuous means of assessment; for example, a Consultant will directly observe a trainee doctor’s interaction with a patient, and mark them using a pro-forma, downloadable from the Royal College website. I was found to be above the expected standard for my level of training.
In my background, I achieved an Intercalated BSc, extra to my MBBS medical degree; in support of that BSc, in reflection of my previous exam performance, I was awarded financial aid in the form of two scholarships. As part of that BSc, I gained valuable experience in laboratory-based research. All the above should enhance my employability.
Prior to embarking on specialisation, I worked for a year as a Foundation Year 2 SHO, in a pilot scheme for the new system now in place nation-wide. This position allowed me opportunity to demonstrate that I had gained “core competencies” of a junior doctor, which again, should make me more, not less employable in terms of the new system.
Previously, when time came to apply for another job, one had the option of applying to many individual hospitals within many different regions. Some prospective employers would ask for your own CV, others relied on application forms, though still allowing a high degree of self-expression in selling your self. If offered interview, then this was likely with the very people who would be your seniors in the work place.
With the introduction of MMC/ MTAS, I found myself obliged to essentially reapply for the type of position I had already secured, and done well in, for the last two years. Many raised fears about the impending change and new, untrialed application system; reassurances were made that these were unfounded. Now things look different.
Applying on-line, I was faced with a series of stock, confusing, polythematic questions, as a way of ‘proving’ my suitability for (continued) training. The idea seems to be to look at the person specification for the level of training you are applying for, work out which key phrases and attitudes are expected from each question, and try to include them in your answers. Hopefully these are picked up when scored according to a tick-box protocol. The choice of places to work is now limited to a maximum of four, from broad geographical divisions of the country; once successful in interview, you will be able to list a preference for where you are ‘sent’ within the region that wants you. Subsequently it has become clearer that past experience, extra achievements, degrees, good references, etc. are very much subsidiary in this new way of assessment; answers to the questions are key.
The process was plagued with glitches of numerous kinds; the crunch came when several Regions could not meet an extended deadline by which to finalise their shortlists for interview. The impersonal computer system informed me that so far I was unsuccessful in any application, but this was still subject to delayed announcements. Days after I had worked it out for myself, I was finally put out of my misery with a confirmation of emphatic rejection. Informing my Consultant referees, one said that they found it disappointing and surprising, agreeing that it was unfair, the other expressed amazement that I had not even been short listed. There is no opportunity for feed-back, support or appeal in this eventuality, from the faceless, mechanised MTAS.
This system is an unhappy mixture of rigid, State control, and pseudo-market forces with artificially increased ‘competition’, in the sense that little provision has been made for doctors in the old system, versus newer doctors coming up through the ‘modernised’ system. Arbitrarily, the new system will be loaded in their favour in the name of ‘fairness’. Behind this seems to be an almost ‘1984’ turn of mind: a circular argument where the new system is defined as ‘improved’ (because it is the new system), so those trained in it are, de facto, more desirable employees; it may also be cheaper in the short term.
Competitiveness only makes sense on a level playing field. It is alleged that somehow, a few applicants were able to acquire copies of the ‘secret’ marking scheme for the assessment questions. Thus they had unfair advantage in being able to tailor their answers accordingly. Some have paid agencies to write their answers for them. I am aware of a colleague who had part of their application written by a more senior doctor. The unseemly rush to mark the underestimated number of applications, apparently leading to some not even being looked at, or being scored by non-medically trained individuals, builds the case for injustice.
An example of one of the application questions, (the emphasis is mine):
D1. Give a specific example of a time when you became aware that a clinical mistake had been made, either by you or someone else. How did you deal with this situation and how did your actions contribute to the outcome?
Apparently, though not clear from the question, a reply detailing your own mistake, as opposed to someone else’s, received a higher mark. As it is a question about ‘probity’, one is expected to realise that this is an opportunity to demonstrate your willingness and ability to learn from mistakes; detailing someone else’s error is more suggestive of denial of blame. A politically correct mea-culpa might give you the edge. My own answer described a situation of shared culpability: perhaps a more explicit confession of my fallibility, despite my elitist professional status, would have been more acceptable?
Naturally, one can assume that those implementing these questions will be able to quote studies, the statistics of which endorse their efficacy in accurately and objectively discerning aptitudes deemed prerequisite in a doctor. Curious then, that such consistently reliable tools should lead to a situation where one person can be rejected across the board, but other individuals receive a range of ‘yes’ or ‘no’ answers to their applications.
Following the outcome of the current round of interviews in late April, there will be a second round of applications. It has already been made clear that by this stage, most full training posts, of up to six years duration will have been filled. Some remaining posts will be a new form of stand-alone, year long placements. These will count for training, but once you are out of the main system, it will be increasingly difficult to re-enter as time passes, as ‘new’ doctors continue to progress in the hierarchy. I remember attending a seminar where a spokesperson for MTAS attempted to address this concern, by implying that posts in full training will always become available, due to the eventualities of illness or maternity leave.
As has always been the case, some posts will not be recognised for training, and are merely for service-provision. To remain employed, there may be no option but to accept such a post, but again there is now greater risk of resultant career stagnation. If made redundant second time around, I may have to offer my skills abroad, or with bitter regret, leave my medical career behind.
Public money has been lavished on my training as a doctor: in a sense there is a contract between myself and the State. I, and my family, invested much in this venture; I still have to complete repayment of my student loan. Now my primary means of fulfilling my social obligation, and satisfying my private debt, is in danger of removal by the same system that trained me. Does this breach my human rights?
The uproar that has resulted from MMC/ MTAS has so far been met with bland platitudes from the Authorities, thinly masking a pitiless indifference. The bleating protest of a profession over which this Government now has a near monopoly of power is unlikely to make much headway, I fear. What to expect, when it has consistently demonstrated shameless, craven venality in much wider arenas of control?
is a bit long! doubt thnery will publish, but it gets it off my chest
Excellent post Dr Lacey. Thoroughly enjoyed it! Not long at all. I want more......
A short note from an American who sympathizes with your problems.
Whay don't you people band together and rise up as one and STOP this nonsense?
Just march en masse and DEMAND a fix. You have to pull out all the stops. For starters, refuse to provide medical treatment to the politicians who force this godawful system upon you (and their familes).
Why do you Brits put up with this treatment? Why?
Organize a one-week strike of doctors. All of you should leave the country for a vacation on the Continent at the same time. When interviewed about it, give out the email addresses and phone numbers of those responsible.
You are going to have to take strong action to get your country's medical problems righted. What are you waiting for?
Dr Lacey - 'a bit long'........ yes, but an absorbing post, nontheless.
The MMC fiasco puts me in mind of the sort of treatment recently dished out to the senior nurses in our [overspent] Trust.
First jobs were rebranded knowing full well that there were more applicants than posts.
Then scores were settled, some nurses were 'unsuccessful' following re-interview.
Remember we are talking about servants who had been with the Trust [or previous incarnation] for over 20yrs in some cases.
A few of them did not even bother applying perhaps realising that their views would not fit in with the 'new' management agenda, i.e. balancing the books through ward closures, and reducing the nursing buget by approx £3mil according to unofficial reports.
These changes were not driven by the pursuit of excellence or some overarching strategy, no, it was it was simply crises management of the worst kind.
After this degrading exercise the cynics amongst us said 'I told you so' to the more idealistic nurses who thought their years of dedication might count for something.
And I'll bet we were not the only Trust to endure such unsettling changes.
But MMC seems to put this cack-handed episode into the shade, I must admit I didn't think that was possible.
During our little drama there was to be no rescue from the powers that be, but I do not recall any RJS type gloating - don't bank on him/her joining the protest/march.
Holy smoke! I thought our Management were terrible, but this just kicks all my Local Authoritys insanity into touch.
Whoever thought up this scheme to cut the NHS budget must be several light years out of their mind. Perhaps the psychiatric profession could do us all a favour by 'sectioning' whole tranches of the NHS Management overburden. Them and the politicians who put this forward.
Regards
Bill
Dr Lacey wrote... "Naturally, one can assume that those implementing these questions will be able to quote studies, the statistics of which endorse their efficacy in accurately and objectively discerning aptitudes deemed prerequisite in a doctor..."
Not a chance of that happening, as has been unearthed by The Witch Doctor and others. There is then the further bit of difficulty.
OK let's say that having consulted the runes they have ranked this legion of doctors in some way. (Some sort of mad psuedo-competency matrix I expect.) What can we now do about matching this massive amount of data with available posts? Yes, you guessed it. Some equally crazy process has been undertaken to describe the requirements for each post. (And I have little doubt it will have been a hopelessly silly last-minute process like the application marking.)
So we have two sets of slap-dash, unsupportable data-gathering and marking plastered together and used to produce - what? A complete shambles.
Nonsense of the first order. I bet those acadedmics pulled in a tidy six or seven figure sum though. Perhaps we should be told. Was there a tender process do you think?
Well, I guess the quote from me should be read in a sarcastic tone of voice...'lies, damned lies...' and all that
"Well, I guess the quote from me should be read in a sarcastic tone of voice...'lies, damned lies...' and all that"
Didn't doubt it for a minute, Dr Jim!
I have just heard that shortlisted candidates have been turned away for interview for ST3 in surgery today at Birmingham. Apparently it's part of a protest at the shortlisting process. Great - even those of us who have been shortlisted can't guarantee we will actually be interviewed!
I hear the CMO has written a nauseating letter of praise and congrtulation to MTAS!
I hear the CMO has written a nauseating letter of praise and congrtulation to MTAS!
Dr James Lacey | 05.03.07 - 5:00 pm | #
++++++++
OooooooooooooooooooooooooooooooooooooooH
Please, please someone send me a copy of the letter!
John
The letter is on the MMC website I understand.
letter
http://www.mmc.nhs.uk/
download_f...u_19_Feb_07.jpg
Dr C, all you need to do is get your arse into the MMC forum at DNUK. There are links to everything there, and no-one will see you lurking
URGENT
Today there are a number of meetings of consultants in various specialties in the Trent Region who will be discussing following the lead of the West Midlands Surgeons and cancelling interviews.
Will keep you informed.
I happen to be GP VTS trainee that jumped ship last year and have to say the application process last year worked great - 1 application to 1 deanery for a job you wanted, so no clashing interviews, only getting applicants that wanted jobs etc etc.
What I was thinking was this - there are various feedback forms on peoples satisfaction with job selection processes, including a draft in Nottingham Trents selection booklet - why not get everyone to fill one in electronically and then turn it into an email we can send to relevant people.
If this happened over and over again this would get a point across, clog up system and generally be a way of venting displeasure, might also cause a few headaches for computer server !
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SIGN E-PETITION TO REMOVE HEWITT FROM POST AS HEALTH SECRETARY - on goverment website, just google 'e-petition', great idea, already a few thousand posts.
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I hear that some Guardian readers have responded with sneering contempt to Doctors' complaints regards the MTAS/ MMC situation. I haven't had the heart to look myself; I think I'd be too upset!
I did some literature checking myself, and this is the most relevant stuff I've found so far, and it's a pretty mixed outcome, as a lot of research findings are.
The two main points are:
1) Assessment centres beat all other forms of candidate appraisal hands down and
2) MTAS-type forms can be astonishingly good but their validity depends entirely on contextual stuff all of which our darling government spectacularly cocked up. In other words it't a good tool which has been used in a way which completely invalidates it.
+++++++++++++++++++++++++++++++++
I sling this reference in from the BMJ on the subject of Assessment Centres simply because it is so salient, but I am not going to bother quoting it because it does not discuss self-assessment of competencies: http://adc.bmj.com/cgi/reprint/91/5/444
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Now on to the meat. The following damns self-assessment with some very faint praise. It is interesting because of where it comes from. The text first:
"Application forms ... are often extended ... to collect self-assessment data on competencies. Evidence suggests that certain forms of structured self assessment have been shown to correlate with assessments made by referees and may have some value in selection (Jones & Fletcher, 2002, 2004). However, it is difficult to arrive at a validity figure for application forms alone."
And now the reference: http://
www.civilservicecommissio...port_050727.pdf
This is a report made to the government. They cannot claim they did not know.
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I decided to check out the articles Fletcher references. the one I read turned out to be the sort of academic paper I loathe, consisting of jargon embedded in poorly constructed sentences. However a couple of interesting things came out of it:
"A meta-analysis carried out by Mabe and West (1982) found predictive validity to be relatively low (r=.29), but that it could be substantially improved (r=.64) by incorporating certain measurement conditions including instructions emphasizing comparison with others, previous experience of self-evaluation, guaranteed anonymity of raters [I am not sure if "raters" are candidates or assessors - candidates, presumably - AB], and the expectation that SAs will be validated or checked against other measures."
In other words, the effectiveness of MTAS-type self-assessment depends on a lot of contextual stuff, and in particular it is biased against candidates who have not done this sort of thing before.
They also say: "Harris (1994) presented a model of rater [ie candidate?] motivation, which describes the circumstances under which raters will disclose accurate information or consciously distort it. He proposed that motivated raters are likely to use thorough and analytic processing strategies (deliberate processing), leading to the retrieval of more information from memory. Those with low motivation are likely to use a quick heuristic-based approach (non-deliberate processing), associated with simplistic decision-making and integration processes (Chaiken, 1980; Petty & Caccioppo, 1986)."
In other words, this was biased against candidates who consider it to be bullshit / creative writing and biased in favour of those who answered the paper questions as seriously as if they had been interview questions. This is nasty, because it gives the government the opportunity to claim that it is the candidates' fault for not taking it seriously.
Self-assessment in a selection situation: An evaluation of different measurement approaches / Lee Jones and Clive Fletcher / Journal of Occupational and Organizational Psychology (2002), 75, 145–161
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I am now badly in need of sleep, having waded through a dozen or so papers like this, so I'll leave you with the following:
"In an extreme case, an adverse reaction from applicants can lead to a legal challenge. Gilliland (1993) suggested that such challenges are less likely if candidates feel that the selection method has four characteristics:
(1) job relatedness,
(2) an opportunity for the candidate to demonstrate ability,
(3) sympathetic interpersonal treatment,
(4) questions that are not considered improper."
MTAS fails on all four counts, then.
Personnel selection (2001) / Ivan T. Robertson and Mike Smith / Manchester School of Management, UMIST, UK / Journal of Occupational and Organizational Psychology (2001), 74, 441–472
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I confess, my reading this evening has turned my opinions around somewhat. I'd been thinking "the form's ok, but it's wrong to use a thing like this to cut numbers and it's a shame it's been implemented so badly".
It is now clear to me that the form has been completely invalidated by the appalling implementation, which is a different kettle of bicycles entirely.
What a f**king shoddy scandal the whole thing is.
Astrea.
I have compteted 3.5 years in the NHS and the last 2.5 year as SHO in O&G. I have just start a LAS SpR post. I have MRCOG1, DFFP and attended all most all the relevant courses. And I am a British citizen.
I did not get a single interview.
However I looked at some of the applications of my fellow SHO and SpR who did manage to get interviews. One application where the doctor was shortlisted to 3 deaneries, was littered with spelling mistakes and the grammer was hopeless.
It must have been monkeys who selected people for interviews.
I doubt reviewed 1st round or the 2nd round will be any better.
God help the NHS.
Dear friends and colleagues
I am no fan of MTAS/MMC and thank my lucky stars that I am a year 2 SpR.
But it seems that with a number of excellent candidates who didn't get interviews, they did not answer the questions. When it says describe a mistake you made, it doesn't mean a mistake someone else made and you nearly missed. This is a computer and not another doctor that is looking at what you have written. It can't read between the lines and see that you are an intelligent skilled professional. But what did everyone except? It was clear from the outset that this was automated.
Did some excellent candidates assume they would get the interview they deserved?
Of course the system is flawed in muliple ways, and will hopefully implode, but for next time, like with examinations, answer the question folks.
Best Wishes
Steve
Steve, why should anyone dumb down to the level of writing anodyne pap?
They used the wrong tools for the job, Full stop.
Hi Dr Crippen,
Argh, I thought the CaRMS (Canadian Resident Matching Service) process was bad enough. First rounds, second rounds, and the Scramble.
I hope PS matched here so I can refer to him.
And Steve: Everyone knows the "right" answers to those stupid questions. Come on. Noone needs a degree in anything to make those up; they're probably free to download.
Answering them *truthfully,* though, is another thing altogether, and PS is a (rather arrogant, but what consultant doesn't have a touch of arrogance ) consultant I'd trust, apparently.
Which doc would you rather have? The guy who can play the game (i.e., download the "right" answers from the Internet) or the guy who's honest even when it costs him like that?
And why is it that in English we don't have a neutral pronoun? 
--drncc--
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