MMC resignations...

It's not just the students going through the process who are unhappy with the system - so are the people who set it up and were contributing to running it.
Resignations seem to be propping up left, right and centre. To be fair, those resigning are the ones who were probably doing their best to improve a system. Just a shame it didn't work out.
The latest is from one of the student representatives - his letters are a good read and summary of the situation:

letter of resignation, as sent to Professor Crockard 18/03/07.

Dear Alan,

I am sorry to inform you at what must be an impossibly busy time that I wish to resign from my position as medical student advisor.
When I took the position I had many reservations with the MMC systems but believed that I would be able to help students get the best deal from these changes. Seven months on, I retain these reservations and regret that I have not been able to have the impact I had imagined.Now as then (when I presented you with a petition signed by 1300 students), I believe:

• The nature of the new application system effectively randomises medical students to jobs across the country
• The importance of academic achievement has been downgraded
• The importance of other achievements at medical school has been nullified by the nebulous nature of questions and the lack of a CV
• Two years is not long enough to decide on one’s specialty, to gain a broad enough range of experience, to become a good enough doctor: pressure is on to decide early, but the random nature of the application leaves no scope for strategising or planning ahead
• Morale at medical schools is low; they are not the aspirational, centres of excellence they should be, rather ‘centres of competence’
• This anxiety has filtered down to those students considering applying for a place at medical school

Through contact with a wide range of students over the last seven months, I know that these views are widely held. Just two nights ago, I talked to a Bristol student representing a group of 40 who echoed my above sentiments. I have, however, come to realise that continuing to transmit such views to the MMC team can have no effect as it is focused on the successful implementation of a system rather than the guiding principles and details of that system.
In my limited experience, the role of student advisor is not used, as MMC aspires, to ‘encourage dialogue with the stakeholders’. Instead the role seems to be a token attempt to suggest the involvement of students in MMC strategy; a publicity vehicle to lend validity to a system that has not, in fact, considered student opinion and insight at all.When I was asked recently to find some students / SHOs who were happy with the new system to help build some positive press, I knew this role was not for me. I am not interested in spin or image, in making something seem other than it is. I am interested – perhaps naively - in getting the popular voice heard and acted upon and in standing by my own personal, political and professional principles. I now realise that in order to do this effectively, I need to be working within a different framework.
I would like to thank you for giving me the opportunity to fill the role and personally wish you all the very best for the future. I can honestly say that I have enjoyed meeting you and having the chance to work with you and the team as a whole.

Yours Sincerely,
Alex


letter as sent to the CMO 31/03/07:

Dear Professor Sir Liam Donaldson,

I recently resigned as medical student advisor to MMC.
Despite claims from the health minister that the new Foundation Programme has ‘widely been acknowledged as a success’ there are, and always have been, huge misgivings about it at student, junior doctor and all other levels. I hoped that access to the MMC team would give me an opportunity to make these views heard. I was wrong. Although you continually tell us that you are ‘working with the profession’ you are not, at any level, listening to it. This is why I resigned: please find enclosed my letter of resignation to Professor Alan Crockard.

From a grassroots level upwards, your recruitment of those from the profession has been tokenistic at best. My role was little more than a publicity stunt. You want to be seen to be involving us but care little for the reality of what we actually have to say.Even at the highest levels you have been seen to charge professionals with responsibility but withhold authority.It is not my job to outline the infinite professional, personal and philosophical problems that blight your new systems – the 12,000 junior doctors who recently marched through London could do this more eloquently than I could ever hope to – but it is my job to expose the growing chasm between yourself and the profession.
Your agenda does not meet with the approval of the profession. You must acknowledge this. It is not acceptable for you to enlist members of the profession from all levels and to then ignore them. It is not acceptable to use your implementation team – MMC – as a vehicle for spin, as a way to convince the profession that things are other than they are. It is not acceptable for you to hide behind the responsibility you have dispensed to MMC and at the same time maintain your authority so you can push through your own agenda.
And yet, this is what you are doing. No matter what the profession says, no matter how vociferously it protests, no matter what damage is done to families up and down the country, this is what you will continue to do. How kind of Lord Hunt – at a time when faith in your systems is at its nadir - to illustrate the DoH’s utter contempt for the profession, by saying “I would like to reconfirm our commitment to MMC which aims to recruit and train the best doctors to provide the best possible patient care.”
This is your project. Everyone else – from MMC to MTAS, from the royal colleges to PMETB, from the advisors to the spin doctors – are merely your implementation tools. Ultimate authority rests with you. It is now time for you to take responsibility. If you continue to force through these reforms, I want you to know that it is obvious - even from a medical student level - that you are a million miles away from being the ‘bridge between the profession and the government’ that you claim: you could not be acting more undemocratically if you tried.
If you find this image unappealing, your options are clear: take heed of the groundswell against you and your agenda and cede your authority back to the profession. If this is also unpalatable to you, then you must resign.

Yours Sincerely,

Alex Liakos


(picked up from the lost doctor)
more news on mmc

MTAS and West Midlands deanery pulling out of the system

Picked up from howithappened.com - the formal statement:

"The ST3 Interview Panel for General Surgery in the West Midlands have unanimously come to the conclusion that the MTAS procedure for recruitment to ST3 in General Surgery, has not been implemented according to agreed guidelines.

We have therefore declined to continue with the interviews today.We have come to this conclusion after considerable debate. We feel that this is the right course of action, which has at its heart the best interests of surgical trainees, training and our patients.

A serious procedural flaw, which came to light this morning, has been the complete lack of a longlisting process prior to selecting candidates for interview. This alone is sufficient grounds for postponement or cancellation and makes the entire recruitment process open to criticism and challenge.

Our meeting at 8.00 am today was the first available reasonable opportunity for the panel members to meet, discuss the process and air their concerns and reservations. With the limited information available today on-site, the longlisting process could not be completed satisfactorily. In addition we feel that the recruitment process for ST3 in its current format is in contradiction to equal opportunities legislation and NHS best practice guidelines.

We have in addition, wider concerns about the current MTAS process as follows,

As far as we are aware, the shortlisting application form has not been validated or demonstrated to be suitable for appointments to ST3 in General surgery which in effect is a pre-consultant appointment.

The application form domains available to the shortlisters and its accompanying scoring system have not been shown to select candidates best suited to be surgeons. It fails to distinguish adequately between candidates, giving credibility to creative writing skills rather than hard evidence of competency.

The time-scale imposed nationally has ensured that the whole process has been rushed. The unrealistic deadlines and sheer number of applications caused the MTAS computer system to crash. Changes in process have been implemented in order to meet deadlines. The marking system for shortlisting has been inconsistent throughout the country with forms being marked by a varying combination of members of the medical profession and lay people. There has been a lack of cross validation between markers and different marking methods (horizontal and vertical) have been used in different deaneries. Therefore there has been no standardisation or quality control.

The staff in the West Midlands deanery have worked tirelessly without adequate resources in place to try to meet the deadlines set. This has meant working holidays and weekends repeatedly entering marks onto an unreliable MTAS Website. They have finally provided a shortlist of candidates for ST3 in General surgery on the Friday evening prior to the Monday morning interviews. In all, the deanery has received 11500 applications, well in excess of the projected 8000.

We owe it to our patients and the profession that we are able to select and appoint the best candidates to surgical training posts and felt strongly that this was impossible today.

We have agreed to return to help re-shortlist and interview once the entire process has been proved to be reliable, robust, reproducible and has been validated and agreed upon nationally.

Above all we have carefully considered the plight of the candidates outside today, waiting to be interviewed. We have stayed and spoken to all the candidates about our decision with honesty, openness and integrity. We have been at pains to assure them of our best intentions towards trainees and surgical training as a whole. We share their concerns and the concerns of the hundreds of other young doctors who haven’t been shortlisted for any job. We share their anxieties at a system, which is being described and unjust and unfair. We have been overwhelmed by their positive responses to our action and are humbled by their words of support. We have provided support for all the candidates with the offer of contact email and telephone numbers if they require any further assistance."

the joys of MTAS

There are alot of very unhappy doctors about at the moment, angry with an application process that doesn't look at academic/clinical ability to any significant degree - but concentrates on the ability to waffle one's way through a series of questions, with a limited number of words. On top of that, certain specialities have set job interviews in different regions of the country, at the same time, and refusing to shift them when interviewees inform them of the clash. 'If you're not committed enough to come to an interview, we don't want you'.
All very reassuring. hrmph.

I am not generally a reader of the telegraph, but here's their story.
a doctor dealing with the system.

the questions for the final year application form for first job (points in brackets). 150 words each. The questions themselves at first glance don't seem so bad. But attempting to answer them was a nightmare. There was also no mark sheet, so you didn't know what was wanted. And the total result was given - not a breakdown - so you can't figure out where you went right, or wrong. Slightly frustrating to say the least.

1 - Give an example of a non-academic achievement explaining both the significance to you and the relevance to foundation training. (6)

2 - List your academic achievements (4)

3 - Describe an example (not necessarily clinical) of a time when you had to deal with pressure OR overcome a setback/challenge. What did you do and what was the outcome? (6)

4 - Describe an example from your clinical experience where your behaviour enhanced the experience of the patient as the central focus of care. What did you do and what was the outcome? (6)

5 - Describe an example from your own experience (either clinical or non clinical) that has increased your understanding of the importance of team working. What was your role and contribution to the team? (6)

6 - Describe an example of how your organisation and planning skills have contributed to a significant personal achievement in the last five years. What did you learn from this which is relevant to foundation training?

6 - Describe an example of a situation where you had to demonstrate your professionalism and/or integrity. What did you do and what was the outcome?

Anyhoo, better get on with some work.

The MDAP experience...

2 final year medical students writing about their experiences with MDAP (first job application for newly qualified doctors), what they thought was wrong with the system, and how they think it can be improved.

The foundation programme - application and training, from the Royal College of Physicians of Edinburgh.

Information and advice (or lack thereof) for the unmatched final year students.

new doctors and jobs

The medical student's (monthly newspaper) take on the multi-deanery appliation process, with a very Independant style review of the facts and figures.

Editorial in the Lancet on the drama that is newly qualified doctors and jobs. Only 8 of the 48 points in the job application for new doctors is for academic achievement. Something is not quite right there. The last sentence says quite a bit... (though I do recommend you read the whole thing).

The Lancet 2006; 367:1029
UK medical schools: undervalued and undermined
Last weekend, 400 medical students travelled from around the UK to take part in Medsin's global health conference, held at Guy's, King's and St Thomas' Medical School in London. Medsin is a network of medical students which raises awareness about global health issues. The vigour of its annual conference illustrated not only the commitment of medical students to global humanitarian concerns, but also the altruistic values and incredible motivation instilled in them by their medical schools.
Yet the achievements of these medical schools are now being undermined in a disgraceful and incompetent manner. The Department of Health, which has neither experience nor understanding of medical education, training, or careers is eroding the central responsibility of medical schools—namely, to deliver qualified and capable doctors into the NHS and to strengthen the research base of medicine.
Medical students and newly qualified doctors already feel insecure about their prospects. With headlines appearing weekly suggesting that thousands of jobs may have to be stripped out of the NHS because of budget deficits, the acute instability of the health service is bound to raise anxieties among those about to join its ranks.
This crisis has been boiling for some months. But it came to a head with a letter published in The Times on March 4 by 86 senior figures from UK medical schools. Charles McCollum, professor of surgery at the University of Manchester, and his colleagues drew attention to the way in which the Department of Health was ignoring requests by leading medical professors to review urgently its programme for Modernising Medical Careers (MMC). At the time, 660 qualified doctors had not yet been awarded an F1 place (the first of two foundation years), leaving many excellent students devastated by this apparent rejection of the skills they would bring to patient care. Astonishingly, a new untested standard of competence was proposed for those who had low scores in the new F1 application procedure. This idea has now, fortunately, been abandoned. But students will still be prioritised on the basis of a completely untested scoring system.
The F1 application process consists of 48 points, only 8 of which relate to academic achievement. The rest are self-assessments and are open to manipulation. The responsibility for granting full qualification after the F1 year rests with medical schools. It has nothing to do with postgraduate deans. Medical schools have a statutory responsibility for the primary medical qualification (medical degree), the pre-registration training year (F1), and full and final registration at the end of F1. By not discharging those responsibilities—eg, by ceding control of the fate of F1 trainees to postgraduate deans—medical schools will be in breach of their legal duties, putting themselves at risk of legal challenge from students who feel that their expectations are not being met.
Respected academic clinicians who have dedicated themselves to teaching medical students and preparing them for practice quite reasonably ask why politicians are now involving themselves in procedures for selecting and training doctors. It is the universities and Royal Colleges that have responsibility for setting and delivering professional standards of practice, not civil servants and ministers. By shifting responsibility for newly qualified doctors in this way, the government is creating a cohort of disenfranchised and demoralised young clinicians who feel hampered in pursuing career paths that best suit their talents and patient needs. This state of affairs is utterly crazy.
In response, medical students are organising a nationwide petition to oppose these ill-thought-out “reforms” (over 1000 signatures have been collected so far). Royal Colleges are being encouraged to take up the issue with ministers on the grounds that MMC has been imposed with little consultation, is damaging training, and is likely to be difficult to reverse if action is not taken soon. The Council of Heads of Medical Schools is continuing to campaign for a selection process for F1 trainees that is truly in the best interests of patients and will establish a real educational continuum as students move into clinical practice.
In 2005, the Royal College of Physicians published its final report on the future of medical professionalism, Doctors in Society. The report emphasised that “Professionalism cannot be imposed by governments or by a regulatory culture. It must emerge from and be sustained by doctors themselves”. The Department of Health's unprecedented and mistaken incursion into medical education, together with its covert attack on medical schools, are yet further examples of a thinly veiled political desire to deprofessionalise medicine.

More on MMC...

Randoms can access final years job application on the web and edit them as they please due to security issues

Petition against the MMC and its job application structure for newly qualified doctors (1114 signitures last i checked)

An unallocated final year medical student, freaking out on a blog

Some powerpoints on the foundation programme from the london deanery

MMC

i thought it was just us medical students who weren't too keen on the new system of job allocations, clearly not...
http://www.timesonline.co.uk/article/0,,2-2068825,00.html

http://www.timesonline.co.uk/article/0,,59-2068283,00.html