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EDITOR'S CHOICE: Fiona Godlee Jam tomorrow BMJ 2006; 333: 0-f [Full text]

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Uneasy bedfellows

Piero Baglioni   (2 December 2006)

Re. Uneasy bedfellows

Fiona Godlee   (4 December 2006)

Will NHS attitude towards spending change.

Yogendran Visahan   (6 December 2006)

Raging against MTAS

Morris J Brown, Nick Boon, Nick Brooks, John Camm, Edwin Chilvers, Paul Corris, Paul Durrington, Paul Emery, George Griffin, George Hamilton, Alistair Hall, Tony Heagerty, Humphrey Hodgson, Richard Hughes, Kay-Tee Khaw, John Lazarus, David Luesley et al.   (7 March 2007)

Re: Raging against MTAS

stephen o'rahilly   (9 March 2007)

"Half a league, half a league, half a league onward," MMC and the valley of Death.

Andrew Burd   (9 March 2007)

Re: Raging against MTAS

Ashley B Grossman   (9 March 2007)

Re: Raging against MTAS

Philip Home   (9 March 2007)

Re: Raging against MTAS

J.S. Hill Gaston   (9 March 2007)

Re: Raging against MTAS

Maya M   (9 March 2007)

Re: Raging against MTAS

Stephen H Leveson   (9 March 2007)

Re: Re: Raging against MTAS

Kerry Jordan   (9 March 2007)

Re: Raging against MTAS

Andrew Clegg   (9 March 2007)

Raging against MTAs

Rosemary A. Eames   (9 March 2007)

MMC- MTAS is only one of the problems

Christopher JM Whitty, David Mabey   (9 March 2007)

Re: Raging against MTAS

Chris M Laing   (9 March 2007)

Re: Re: Raging against MTAS

Sarah Finer   (10 March 2007)

Re: Raging against MTAS

Piyush Durani   (10 March 2007)

Re: Raging against MTAS

Manohar Vasepalli   (10 March 2007)

Raging against MTAS

Neeraj Bhala   (10 March 2007)

Raging against MTAS

Angela Vincent   (10 March 2007)

Re: Raging against MTAS

Akbar de' Medici. MRCS PhD   (10 March 2007)

Will half measures address the core issue?

thomas o obinwa   (11 March 2007)

Raging against MTAS

Nina M Newton Butler   (11 March 2007)

Re: Raging against MTAS

Calathur G Nanda Kumar   (11 March 2007)

Re: Raging against MTAS

Theodore G Nanidis MRCS   (11 March 2007)

Couldn't Agree More....!

Dr. Atiqa Rafiq MRCPsych   (11 March 2007)

Disagree partly with Btown et al.

Neha Chote   (11 March 2007)

Shameful

Anirban Chakraborty   (11 March 2007)

MTAS - the wrong assessment

paul m stewart   (11 March 2007)

Re: MMC March on March 17th

Emma J Bywaters   (11 March 2007)

Re: Raging against MTAS

Anil Madhavan   (11 March 2007)

Re: Raging against MTAS

R Mark Gardiner   (12 March 2007)

Equality, transparency and fairness..extinct virtues?

J T George, Kavitha S Rozario   (12 March 2007)

Thank you

Mark Silvert   (12 March 2007)

Clarification

Morris J Brown   (12 March 2007)

Re: Raging against MTAS

Kenneth Kok   (12 March 2007)

Disagree partly with Brown et a;

Nina Newton Butler   (12 March 2007)

MMC and MTAS

Mohammed S Kibirige   (13 March 2007)

Re: Will half measures address the core issue?

Anil Kopuri   (13 March 2007)

Re: Raging against MTAS

Conor D Marron   (13 March 2007)

re Raging against MTAS

Mike Ebdy   (13 March 2007)

Re: Re: Raging against MTAS

Daniel Gale   (13 March 2007)

Injustice of MTAS

uma nath   (13 March 2007)

Sack those in charge of MMC

Muhammad S Sajid, West Sussex BN11 2DH   (13 March 2007)

This is exactly how overseas doctors felt about the visa ruling

Arun Natarajan   (13 March 2007)

MTAS

Peter McCollum   (13 March 2007)

Re: Raging against MTAS

Fiona J Hampton   (14 March 2007)

Re: MMC March on March 17th

Andrew Clegg   (14 March 2007)

stop this now

jonathan couch   (14 March 2007)

Flawed ST3 Interview system

Peter J Milewski   (14 March 2007)

Cannot drink from same cup

Arun T Perumpallil   (14 March 2007)

Re: This is exactly how overseas doctors felt about the visa ruling

Nikhil Bhatia   (14 March 2007)

MMC enforced interview question

NATALIE M GREEN   (14 March 2007)

Re: Raging against MTAS

Gavin J Freeman, ST4 7LN   (14 March 2007)

One month to save the NHS

Chris Maimaris   (14 March 2007)

MTAS/MMC

ben dean   (14 March 2007)

Re: Raging against MTAS

David M Lloyd   (15 March 2007)

Stand up if you are still passionate about medicine

Louise Pealing   (15 March 2007)

In support of Raging against MTAS

Charles N McCollum   (15 March 2007)

Raging against MTAS

Denis Charles Wilkins   (15 March 2007)

Re Raging against MTAS

Rumana Chowdhury   (15 March 2007)

all too predictable

m m chebbi   (16 March 2007)

New system of doctors training threatens UK clinical research

Professor J Bell, Professor Sir John Tooke, FMedSci, Chair, Council of Heads of Medical Schools   (16 March 2007)

MMC objection

Sarah Wheatly   (16 March 2007)

What can we learn from MTAS?

Robert J Howard   (16 March 2007)

An open letter to Patricia Hewitt, DOH; Prof Alan Crockard, MMC; Dr Keith Smith, MMC; Prof Martin Marshall, deputy CMO; Peter Rubin, PMTEB, Prof Carol Black (Academy of Medical Royal Colleges)

David J Nicholl   (16 March 2007)

Alternative method of selection MCQ-CCS

Srinivasan Ravi, S.Ravi   (16 March 2007)

rage rage

J. David leopold   (17 March 2007)

MTAS/MMC

TCB DEHN   (17 March 2007)

Re: New system of doctors training threatens UK clinical research

Woody Caan   (17 March 2007)

Hidden meanings of MMC and MTAS

Arun Natarajan   (18 March 2007)

This has been a long running problem.

Chris Chung   (18 March 2007)

"Howl, howl, howl, howl ..."

Nina Newton Butler   (18 March 2007)

MTAS is a symptom, not the problem

Sean Monaghan   (19 March 2007)

The Image of our Health Service

Janna V Joethy   (19 March 2007)

Raging against MITAS

stephen g wright   (20 March 2007)

Help finding a solution rather than criticising

SREEDHAR KOLLI   (21 March 2007)

Raging against MTAS

John B Cookson   (22 March 2007)

Open letter to Professor Crockard

Matt Davies   (25 March 2007)

Open Letter to the MTAS Help desk

Matthew T Piccaver   (18 April 2007)

Re: Open Letter to the MTAS Help desk

Art G O'Malley   (22 April 2007)

Uneasy bedfellows 2 December 2006
Piero Baglioni, Consult Physician Prince Charles Hospital Merthyr Tydfill, MidGlamorgan CF47 9DT Send response to journal: Re: Uneasy bedfellows	A former editor of the BMJ has described medical journals and pharmaceutical companies as "uneasy bedfellows" (R Smith - Medical journals and pharmaceutical companies : uneasy bedfellows - BMJ 2003 vol. 326 : 1202) and has submitted that medical journals may not be so independent after all (R Smith - Medical journals are an extension of the marketing arm of pharmaceutical companies - PLoS Medicine 2005 vol. 2 : e138). As disturbing as this opinion may be, it is widely shared on the other side of the Atlantic by a former editor of the NEJM (JP Kassirer - On the take : how medicine complicity with big business can endanger your health - Oxford Press, 2005). If people in a position to know express such concerns, something must change. Perhaps the current editor of the BMJ could start reassuring its readership by not renting its very frontcover to Big Pharma (BMJ 2 December 2006). Competing interests: None declared
Re. Uneasy bedfellows 4 December 2006
Fiona Godlee, Editor, BMJ BMA House, Tavistock Square, London WC1H 9JR Send response to journal: Re: Re. Uneasy bedfellows	Dr Baglioni may be aware that I share Richard Smith's and Jerome Kassirer's unease.[1] He may also believe me to be less than enthusiastic about the use of such "gatefold" covers on the BMJ. However, it is a reality of the market that journals depend to some extent on revenue from pharmaceutical advertising, and that prominent positioning in the journal increases the revenue per advertisement. In agreeing a few years ago that the BMJ would occasionally carry gatefold cover advertisements, Richard Smith (as the BMJ's then editor and chief executive) judged that any potential harm was less than the actual benefit to the journal in revenue terms. This fits with his more recently stated view that carrying drug adverts is one of the less pernicious aspects of the problematic relationship between journals and the industry (as compared with publishing industry funded trials and selling reprints) since readers should have no difficulty distinguishing adverts from editorial content.[2] Readers may be reassured by the fact that as editor I inherited, and with my colleagues work hard to maintain, a strict divide between editorial and commercial decisions. This means that no information is shared between the editorial team (about what we are publishing and when) and the commercial team (about which advertisements the journal will carry and when). It is the effectiveness of this "Chinese wall," and my continuing belief that on balance medical journals do more good than harm, that allow me to sleep easy in my bed despite my bedfellows. 1. Godlee F. Can we tame the monster? BMJ 2006: 333 (8 July). 2. Smith R. Medical journals are an extension of the marketing arm of pharmaceutical companies - PLoS Medicine 2005 vol. 2 : e138. Competing interests: I am the editor of the BMJ and am responsible for everything it contains including the pharmaceutical advertisements. My salary is paid from the revenues of the publishing group which come from a mixture of subscriptions, advertising, and reprint sales. My salary is not directly linked to income from any of these revenue streams.
Will NHS attitude towards spending change. 6 December 2006
Yogendran Visahan, general surgeon. Sri Lanka Send response to journal: Re: Will NHS attitude towards spending change.	During my career in the NHS, there are few things I noted. 1- Administrators are nurses who have no knowledge about management at all. 2- All chief executives are paid at least the minimum five figure salary. I have not seen them doing old fashioned hospital rounds at all. Even when a CEO is sacked he gets a very big amount money to take home and will join another Trust as CEO. 3- The CEO gets the feedback from the managers- basically who are nurses with no training in management. 4- When a management trainee is hired to advise on cost reduction, there is a big resistance by these so called managers (Ex Nurses) for change. Unless the doctors take over the management of the hospitals it will be a disaster for the NHS. Visahan Competing interests: None declared
Raging against MTAS 7 March 2007
Morris J Brown, Professor of Clinical Pharmacology University of Cambridge, CB2 2QQ, Nick Boon, Nick Brooks, John Camm, Edwin Chilvers, Paul Corris, Paul Durrington, Paul Emery, George Griffin, George Hamilton, Alistair Hall, Tony Heagerty, Humphrey Hodgson, Richard Hughes, Kay-Tee Khaw, John Lazarus, David Luesley et al. Send response to journal: Re: Raging against MTAS	The last two weeks has seen the Medical Profession in the UK torn apart by an Exocet we should have seen coming. That Exocet is called MMC and in particular its job application arm, MTAS. The howls of anguish from the juniors have been silenced only by …. well, the silence of the seniors. The Colleges have offered extreme sympathy. We, the undersigned, are roused, belatedly, to express incandescent outrage at the apparent vandalism taking place before our eyes. Although it might ease our conscience to shelter behind our Colleges and Presidents, they in turn pick the mood of their electorate, and silence shifts perception of the line to be drawn between collaboration and appeasement. In negotiations with MMC over a process which rides roughshod over the Colleges’ Royal Charters to protect education and training, the Presidents must have felt between the proverbial rock and hardplace – marginalised in opposition, complicit in submission. This is not the time for recrimination, but for a united and rockhard opposition to MTAS, offering whatever help is necessary to find a workable and worthwhile version of MMC. The speed and scale with which the Exocet has struck is truly awful. Stories from top juniors flung on scrap heaps after a decade of training, from seniors marking applications who had to look up Medical Schools to see if they existed, and interviewers too embarrassed to look candidates in the eye, and with no CV’s or references to guide – oh so elitist and incorrect when choosing a safe doctor. Stories all so bizarre and spontaneous they have to be true, and yet the process proceeds apace while proper documentation of problems is awaited… And all the while the Deans, and the myriads of helping Consultants distracted from their day-job of patient-care, are congratulated for their superhuman efforts – for their efficiency and ingenuity – some tossing coins to choose among applicants, some threatening to leave applications unread by the deadline, collecting dust while the applicant learns from the internet that he is no longer fit for purpose. Doctors intelligent? What other group in society would be such hand-maidens to their own apocalypse. The fault? Teething problems blamed on computer glitches and thousands of non-UK European doctors swamping the UK applicants with their numbers; and on wide-scale plagiarism and on answers available for sale to the ridiculous questions designed by civil servants to root out any doctor looking in vain for a box to register a first class degree. Consolation? Yes, it could have been worse if the Highly Skilled Migrants had not been sacrificed during the selection process; with any luck, we have been told with a straight face, many of them have still been given posts and will therefore leave large gaps in the second round if the Appeal Court comes to the rescue. Do you want to laugh or cry? A few seniors, signing this letter, want to shed tears of contrition and anger. We wish this nightmare to stop now. The juniors can’t stop it. Our leaders’ hands are more tied than ours by diplomatic niceties. We still wish them luck because only they are likely in the long run to succeed in bringing about the improvements required. Meanwhile there is an onus on us, and us has to mean very urgently the vast, silent majority of UK Consultants. Two things must happen. We need to register unmistakably that Consultants can be as roused and exercised by the standards of care of future patients and fate of our juniors, and therefore the NHS, as we were about our contracts, and leave our leaders and MMC in no doubt about our views. And we need possibly to stop the current interviews or, at the least, make sure that only truly excellent candidates are appointed in the first round until sense prevails and a meaningful process installed for a delayed second round. Neither will happen unless our letter strikes a chord. Our leaders have pressed the MMC and ministers hard for changes before the second round of appointments. We worry whether deckchair movement is enough. And we do not know for certain whether there will be movement, after the news story has moved on, or whether indeed any good posts will be left by then. We fear that something Titanic will hit the profession if chairs labelled MTAS are not removed or re-invented altogether. 35000 applicants – and the new UK medical schools have yet to produce a doctor! Some interview panels have already packed their bags. If isolated reports of the interview process are correct, we hope this knowledge may stiffen the resolve of others confronted with inadequate candidates or paperwork, with snowballing resignations bringing a flawed process to a halt. How can you register your views? The juniors have set up websites (www.remedyuk.org) and www.mmc360.com and this (BMJ) website will itself take comments. By the end of this week, or earlier, we will have a single- purpose website with short list of questions at http://www.cai.cam.ac.uk/people/mjb14 , which will enable us to petition the Presidents and MMC with exact numbers. And you can decide whether we petition for a temporary halt, a back-to-the-drawing-board halt, the resignation of the architects of MMC. Try to have your GMC number available so that we can prove real and unique people sign the electronic petition. Meanwhile, support the juniors’ websites, and post your responses and experiences here. We will march with the juniors on March 17th. If you join us now, we may be able to smile that day, not cry. Morris Brown, Consultant Physician and Professor of Clinical Pharmacology, University of Cambridge Nick Boon, Consultant Physician and President-Elect, British Cardiovascular Society Nick Brooks, Consultant Physician and President, British Cardiovascular Society John Camm, Consultant Physician and Professor of Clinical Cardiology, St. George's Hospital Medical School Edwin Chilvers, Consultant Physician and Professor of Respiratory Medicine, University of Cambridge Paul Corris, Consultant Physician and Professor of Thoracic Medicine, University of Newcastle Paul Durrington, Consultant Physician and Professor of Medicine, University of Manchester Paul Emery, Consultant Physician and Professor of Rheumatology, University of Leeds George Griffin, Consultant Physician and Professor of Cellular & Molecular Medicine, St. George's Hospital Medical School George Hamilton, Consultant Surgeon and Professor of Vascular Surgery, Royal Free Hospital Alistair Hall, Consultant Cardiologist and Professor of Clinical Cardiology, University of Leeds Tony Heagerty, Consultant Physician and Professor of Medicine, University of Manchester Humphrey Hodgson, Consultant Physician and Vice-Dean, Professor of Medicine, Royal Free & University College School of Medicine Richard Hughes, Consultant Physician and Professor of Neurology, Kings College London Kay-Tee Khaw, Consultant Physician and Professor of Clinical Gerontology, University of Cambridge John Lazarus, Consultant Physician and Professor of Clinical Endocrinology, University of Cardiff David Luesley, Consultant Oncologist and Professor of Gynaecological Oncology, University of Birmingham John Monson, Consultant Surgeon and Professor of Surgery, University of Hull Philip Poole-Wilson, Consultant Physician and Professor of Cardiology, NHLI, Imperial College, London Timothy Rockall, Consultant Surgeon and Professor of Surgery, University of Surrey Robert Sutton, Consultant Surgeon and Professsor of Surgery, University of Liverpool Deborah Symons, Consultant Physician and Professor of Rheumatology, University of Manchester Roy Taylor, Consultant Physician and Professsor of Medicine & Metabolism, University of Newcastle Doug Turnbull, Consultant Physician and Professor of Neurology, University of Newcastle Hugh Watkins, Consultant Physician and Professor of Cardiology, University of Oxford Robert Wilcox, Consultant Physician and Professor of Cardiovascular Medicine, University of Nottingham Nick Wright, Warden, Queen Mary College, London Competing interests: None declared
Re: Raging against MTAS 9 March 2007
stephen o'rahilly, Professor of clinical biochemistry and medicine University of cambridge CB2 2qq Send response to journal: Re: Re: Raging against MTAS	The debacle of MTAS is a disgrace to our profession.It has rendered many of our brightest and best medical graduates disillusioned and despondent. Its structure actively encourages deception and plagiarism while treating objective evidence of real achievement with contempt. If not stopped in its tracks now, its malign consequences will be with us for decades. Competing interests: The author is Chairman of the Medical Research Society
"Half a league, half a league, half a league onward," MMC and the valley of Death. 9 March 2007
Andrew Burd, Professor of Plastic and Reconstructive Surgery, Chinese University of Hong Kong Send response to journal: Re: "Half a league, half a league, half a league onward," MMC and the valley of Death.	"Forward, the Light Brigade!" Was there a man dismay'd? Not tho' the soldier knew Someone had blunder'd: Their's not to make reply, Their's not to reason why, Their's but to do and die: Into the valley of Death Rode the six hundred. Those of us overseas can only watch with astonished incredulity the (self)-destruction of the medical profession in the UK. The deafening silence of the leaders of the profession in the United Kingdom reverberates around the world and resonates of Apocalyptic apathy that characterizes such historic tragedies. Reviled or revered Margaret Thatcher won her war and destroyed a union that had held the country to ransom? What possible legacy is being sought by those who lead a noble nation into an immoral war and set out to destroy a national heritage, the NHS and a key profession that serves it. Now a gallant few are rising up to take on this monumental beaurocracy that attempts to seal the death of dreams and aspirations of so many of our young colleagues. Many years hence those who have lived through these times will gather round firesides with future generations and tell tales of these times. I do so hope these will be tales of victory and not defeat. Send out the challenge, raise the alarm. Call forth the timid souls to join you in this charge. Ride not for power, glory, might but ride for sanity and reason, ride for the future. Ride for the right. The right to practice medicine. The right to serve humanity. The right to practice ethics prescribed not by politicians but by professionals. The right to determine the destiny of who we are, who we train and who we serve. This is not the right of the noble savage. This is the right of the sons and daughters of Hippocrates to honor their oath. Ride out. Ride on and God speed. Competing interests: None declared
Re: Raging against MTAS 9 March 2007
Ashley B Grossman, Professor of Neuroendocrinology St. Bartholomew's Hospital, London EC1A 7BE Send response to journal: Re: Re: Raging against MTAS	While unfortunately abroad and so unable to co-sign the letter from Morris Brown and colleagues, I wish to add my wholehearted support for their effort to stop this ludicrous process in its tracks. I have never come across a process so flawed in concept aand incompetent in execution as the MMC, and cannot but be dismayed at the way such a procedure was imposed upon the profession and accepted by our leaders with so little discussion. I feel we have let down our junior colleagues very badly, and unless this undergoes wholesale reconsideration I fear that clinical training and patient care will suffer badly. As a profession, we must stand united to maintain the morale of all our trainees, which has never been so low. Competing interests: None declared
Re: Raging against MTAS 9 March 2007
Philip Home, Professor of Diabetes Medicine Newcastle University, NE2 4HH Send response to journal: Re: Re: Raging against MTAS	Morris Brown and colleagues are surely right to rage against the very predictable damage and chaos being caused by the MTAS system. But this was obviously predictable from the nature of the system developed. The corollary is that those developing it were either grossly incompetent or had as an agenda something that they thought worthwhile pursuing despite the damage caused. This is symptomatic of many of the facets of implementation of the MMC process. It is as though it were designed to meet the needs of the NHS (and perhaps politics) rather than the needs of the patients the NHS serves; but meanwhile the damage being done to the morale and attitudes of present and future medical staff is enormous. The Service will pay a large price for that. It is time those responsible for all this were relieved of their responsibilities, and a review is undertaken to ensure the process selects not only the best future doctors, but also engages them in enthusiasm for what it is seeking to achieve. Competing interests: None declared
Re: Raging against MTAS 9 March 2007
J.S. Hill Gaston, Professor of Rheuamtology University of Cambridge CB2 4PH Send response to journal: Re: Re: Raging against MTAS	I entirely agree with the sentiments expressed by my colleagues. I think that we must press for nothing less than the total abandoning of the MTAS process which is clearly not fit for purpose - and sadly was known to be so before implemented. In my conversations with those trying manfully to make the MTAS work, their lack of confidence in the system and inability to defend its inanities were comspicuous and revealing. My own policy of scoring applications, which was to mark vertically and adjust scores for innovative prose-writing sections in the light of solid academic achievement was never going to work unless it was adopted by all scorers. Back to the drawing board please, and quickly! Hill Gaston Competing interests: None declared
Re: Raging against MTAS 9 March 2007
Maya M, SpR Colman Hospital, NR2 2PJ Send response to journal: Re: Re: Raging against MTAS	My husband and myself are HSMP holders. I am fortunate to be a Specialist Registrar and am not having to go through the MTAS process. My husband however is and has been shorlisted for 2 interviews. I believe this is because he is a candidate of 'high calibre' as stated in his reference. However we are now truly worried that his HSMP status will have a negative impact at the interview process in view of the fact that many British graduates have not been shortlisted in round 1. Like everyone else involved in this process, we would like to have a fair chance at obtaining a training post if we are the best candidate for the job. Competing interests: None declared
Re: Raging against MTAS 9 March 2007
Stephen H Leveson, Professor of Surgery Hull York Medical School York Hospital YO1 8HE Send response to journal: Re: Re: Raging against MTAS	The whole MTAS process is flawed. The results are catastrophic in the short and long terms. There is now a cohort of young gifted doctors who are disillusioned whose careers are potentially blighted. We as a profession have never baulked at competition for appointment but the lack of useful information in the MTAS process makes this into a lottery.Good applicants are likely to not be appointed or worse to be appointed into post in which they have no interest. This is another step along the road of deprofessionalisation. Positive action must be taken by our representative organisations to reverse this process and to construct a system which is fair to trainees and will give them the chance of pursuing their chosen career paths. Competing interests: None declared
Re: Re: Raging against MTAS 9 March 2007
Kerry Jordan, Consultant Ophthalmologist West Suffolk Hospital Bury St Edmunds IP33 2QZ Send response to journal: Re: Re: Re: Raging against MTAS	What do you expect from a government department such as the DoH? Look at their successes PFI - or let's put our children and their children in hock for perpetuity "Connecting for health" "NpFit" or whatever it's called this week - up to £20 billion expenditure on an unwanted system that wasn't needed and won't work even if the contractors had been able to deliver it. ISTCs - your money and mine paying for procedures, often where there is spare NHS capacity, to itinerant S Africans and Swedes (who do not have all the governance/appraisal / hassle that we do) whose organisations are paid whether or not the work is done, and who destabilise their NHS neighbours. Billions of pounds (yes billions ) spent on useless management consultants. Since 1997 the Blair government has spent £70 billion on these parasites. (Definition of a management consultant - someone who takes your watch and tells you the time) Primary Care Trusts who, for reasons that are unfathomable to some of us, control secondary care which they know diddly squat about. Patient "choice", "choose & book" - unloved, unnecessary and not working. And then the ghastly nightmare of MMC...........mutilating medical careers. The exclamation "Doh" is commonly ascribed to Homer Simpson to express frustration with stupidity but it originated in a certain government department.... Competing interests: None declared
Re: Raging against MTAS 9 March 2007
Andrew Clegg, SpR Geriatrics Yorkshire Deanery Send response to journal: Re: Re: Raging against MTAS	My sincere thanks go out to the authors of this outstanding response. I was genuinely moved when I read through both the letter and the list of esteemed signatories. It is incomprehensible as to how we as a profession have been so impotent at preventing the entirely predictable soul- destroying shambles into which we have all now catastrophically descended. The cloak-and-dagger manoeverings of the present government and its MMC collaborators are repugnant. As a direct result of their own financial ineptitude, a promise to deliver a 'Consultant led NHS' has been replaced by an MMC ladder with an original 'Consultant' post at the pinnacle being mysteriously replaced with the uninterpretable 'Senior Medical Appointment'. A disingenuous MMC plan coupled with the policy of expanding medical school intake to provide more trained doctors has been exposed as a calculated method to manufacture unemployment, thus giving the government political control over clinicians, at the same time providing the tool to drive down wages whilst creating service-providing clinicians with minimal potential for career development. At long last we as a profession are beginning to realise that we must come together to prevent the attempts by the government and its political pawns to 'divide and conquer'. We cannot let them succeed. We will not let them succeed. Andrew Clegg 1. M Brown et al. 'Raging against MTAS'. BMJ Rapid Response. March 7 2007. Competing interests: None declared
Raging against MTAs 9 March 2007
Rosemary A. Eames, Consultant Histopathologist Queen Elizabeth Hospital King's Lynn NHS Trust PE30 4ET Send response to journal: Re: Raging against MTAs	I agree with every word. Competing interests: None declared
MMC- MTAS is only one of the problems 9 March 2007
Christopher JM Whitty, Professor of International Health Hospital for Tropical Diseases, University College London Hospitals, London WC1E 6AU, David Mabey Send response to journal: Re: MMC- MTAS is only one of the problems	We agree entirely with the sentiments of Prof Morris and colleagues. MTAS is an acute emergency which shames us all and needs to be fixed. Unfortunately it is only one part of the MMC approach which will have effects that all currently practicing senior clinicians know will be disastrous, but have done too little, too late, to stop. MMC removes almost all the flexibility for able doctors to decide for themselves what is best for their own training, or to do anything even remotely out of the ordinary in a medical career. It will lead to many junior doctors doing things, probably badly, which they do not want to do, and are not qualified for, in places they would not choose to work. Under the old system, which has evolved gradually over many decades, they were able to make their own decisions so as to do things that suited both their talents, their career aspirations and their lives. MMC is bad also for the short and long term prospects of service delivery; small specialities such as infectious diseases and tropical medicine, will be staffed almost entirely by junior staff who have no particular interest in them, whilst elsewhere in the service junior doctors who would have brought enormous enthusiasm to bear on a subject they want to train in will be unable to do this. This cannot be in the interests of the NHS. The rethink of MMC must not stop at the shambles that is MTAS. David Mabey, Consultant Physician UCLH and Professor of Communicable Diseases Christopher Whitty, Consultant Physician UCLH and Professor of International Health Competing interests: None declared
Re: Raging against MTAS 9 March 2007
Chris M Laing, SpR Intensive Care and Nephrology Guy's and St Thomas's Foundation Trust Send response to journal: Re: Re: Raging against MTAS	I applaud Morris Brown et als belated call for action regarding MMC/MTAS. Though certainly less influential I am quite sure that those, such as myself, currently in the SpR grade would fully support any action on behalf of our less fortunate junior colleagues. I am afraid however that I do not think that we would be so willing to let our senior representatives in the Royal Colleges, the Postgraduate Deans and the British Medical Association off the hook. They are the only persons who have been party to these reforms and should be held accountable. Similarly senior figures within PMETB, many of them medical, should stand and defend their reforms and the MTAS design. If they, as is rumoured, opposed many of the reforms then they certainly did not make this clear at the recent briefings and conferences then it is their responsibility to explain exactly what happened and who in the DoH is responsible. They are there to represent us and defend standards on behalf of patients. Perhaps they would be willing to speak on behalf of these reforms via this website? I would recommend that the Presidents of the Royal Colleges and the BMA contact their memberships for a vote of no confidence in the system and, if such a motion is carried, they advise their members to withdraw from the process, offering PMETB an oportunity to redesign the entire system and bring it back entirely under the control of the Royal Colleges. The easiest interim arrangement would be to return to the old system pending a more intelligent redesign. Plenty of us at the coal face have got good ideas regarding postgraduate medical education. Perhaps someone would like to ask us what we we think? Competing interests: None declared
Re: Re: Raging against MTAS 10 March 2007
Sarah Finer, Specialist Registrar and Academic Clinical Fellow in Diabetes and Endocrinology North-East Thames Send response to journal: Re: Re: Re: Raging against MTAS	Modernising Medical Careers is undermining the foundations of our profession. The development of a doctor's career should be an individual and self-motivated process. Doctors, like patients, do not fit into boxes joined together by arrows and pathways. The last 2 years have seen students graduate from problem-based learning courses, into foundation programmes with excessive control over working hours and methods. During this time, morale has plummeted and the sense of one's own responsibilities as a junior doctor has been lost. By no means a criticism of individual trainees, this radical change in training is threatening the very essence of professionalism and quality of patient care. In the 'old' system, my own career has been able to develop with great enjoyment and time to focus on skills important to me. I have had opportunity to develop my clinical and research interests, within a supportive and inspiring environment. The importance of these individual and humanistic factors should not be underestimated. The injustices of the first round of MTAS job applications has only served to undermine trainees further. These same juniors have expressed their anger and upset through organisations such as Remedy UK. Without the drive from these campaigners, the Royal Colleges and BMA might not have noticed the trail of destruction left by MTAS. The inspirational lead from Consultants, through letter-writing, boycotting interviews and campaigning, is a credit to the 'old' system of training. We must fight to hold onto these qualities, and continue to question the process of training and selection of doctors through MMC. Competing interests: None declared
Re: Raging against MTAS 10 March 2007
Piyush Durani, Plastic Surgery SpR Nottingham Send response to journal: Re: Re: Raging against MTAS	I agree completely with Professor Morris's statement. The new selection system has been untested, with no validation or reliability evidence provided for discriminating amongst high achieving surgical trainees. The shortlisting scoring system was poor, with significant weight given to the answers for 'woolly' questions and signifcantly less weight given to academic achievement and clinical experience. No evidence has been provided for the validity of this. Why are we supporting the dumbing down of first, medical education, and now postgraduate medical training - this seems to be another method of deprofessionalising doctors, turning them into robotic service providers that will jump through the hoops for NHS managers, and prematurely terminating the careers of potential future innovators and thinkers that have, in the past, helped to push forward the boundaries of medicine and surgery. Competing interests: None declared
Re: Raging against MTAS 10 March 2007
Manohar Vasepalli, Unemployed E12 6SG Send response to journal: Re: Re: Raging against MTAS	Very nice to read the raging response posted by esteemed senior colleagues. Now they understand that career aspirations of juniors with good potential can be adversely affected by incompetent government policies. Imagine having an incompetent government with no policies, extremely scarce training places and substandard training in majority of hospitals.....that is seen in India. So, some of the doctors came to UK from there for training and economic reasons. Then the same incomepetent government that started this MMC debacle, over night changed rules that govern the IMG training here. Other than the words of sympathy from BMA and royal colleges nothing happened. ONe junior doctor from pakistan killed himself. Not even a mention of it in the main stream media except in 'independent'. I bet none of the consultants who are raging now batted an eye lid or are even aware of it or care about it. Now they are all raging. Juniors with no interviews are talking about going to Australia or some other country. When they go there, I hope they remember that they are IMGs in that country. I hope they also remember that they are there not because of choice but because of needs. I hope the australian or new zealand government wont change the rules one day and suddenly kick them out when they are in the middle of their training. I completely understand why every one is angry but please do not blame us for this problem. Also please think twice before saying that we are swamping all the hospitals. Until 3 years ago this useless NHS would not be able to function with out us. Competing interests: None declared
Raging against MTAS 10 March 2007
Neeraj Bhala, Specialist Registrar in Gastroenterology & General Medicine University Hospital of Coventry & Warwickshire, CV2 2DX Send response to journal: Re: Raging against MTAS	I agree with many of the sentiments and comments posted throughout the medical and general press regarding the debacle that is the Medical Training Application Service (MTAS). The independent review being carried out by the Academy of Medical Royal Colleges is undoubtedly needed. As well as sapping staff morale in an already beleaguered and stretched National Health Service, it raises questions as to how such a farce could be allowed to happen, and who is accountable? This is one of the largest post-war recruitment exercises carried out, but it is evident that the selection system is not fit for purpose. If private institutions recruited in this sloppy and haphazard manner, heads would roll. Notwithstanding the junior doctors themselves, the tax-paying public (and patients) will be horrified to hear that some of the ‘brightest and most able of their generation’ have not even been shortlisted for interview. Moreover, the initial application is marked predominantly on the basis of prose to bland non-discriminatory questions rather than their actual achievements. Would a patient rather be treated by a doctor who had done something or someone who could write beautifully about their thoughts? As the adage goes, surely “actions speak louder than words”. I applaud the efforts of the Medical Royal Colleges in stepping belatedly into the breach in this fiasco. In order to regain trust, it is imperative that junior doctors are interviewed on the basis of merit rather than the widely derided application forms used. Communication is paramount including feedback and a right of appeal for those non- shortlisted. In addition, I strongly feel that one of the key lessons to be learnt is the need for regulation of medical training to be handed back to the Royal Colleges. The future health of the public and profession hinges on it. Competing interests: None declared
Raging against MTAS 10 March 2007
Angela Vincent, Professor of Neuroimmunology University of Oxford Send response to journal: Re: Raging against MTAS	Do any other professions or industries select their junior trainees on the basis of an anonymised box-filling exercise with inadequate representation of individual achievements? All consultants and clinical academics should join the march on March 17th. Competing interests: None declared
Re: Raging against MTAS 10 March 2007
Akbar de' Medici. MRCS PhD, SHO Plastic Surgery Royal Free and Mount Vernon Send response to journal: Re: Re: Raging against MTAS	I am a junior doctor and wish to pursue a career in plastic surgery. I was fortunate to have secured an interview for ST2 plastics in the region of my choice. I have however completed a higher degree, obtained the required postgraduate exams, done all major courses, plus have several publications, presentations and patents. Despite this I would be happy to support any action which halts this absurd lottery. I want to be in a profession in which my colleagues have also got to the same point on merit. Many close friends, who I know deserve a chance, have no interviews, how can this possibly be fair. Especially as we have not been told what will available in round two or precisely how it will be conducted. We need to start from scratch, we now have a situation where even if you have an interview you don't know how it will be conducted, if it will count, or if it will be fair. I was at an ST2 interview in which no plastic surgeon was present, no interest was taken in my thesis, logbook, current job, career aspirations, publications, book, or medical patents I have devised. For those with interviews, if we don't make a stand now our profession will be ruined, we must support changes to ensure the credibility of our future training. If left unchecked this system will creep up to consultant level until the entire system is automated and government controlled allowing us to be manipulated for the rest of our careers. (I apologise for not being able to adequately express my feelings about this debate in under 150 words) Competing interests: None declared
Will half measures address the core issue? 11 March 2007
thomas o obinwa, SHO Leicestershire LPT, LE5 OTD Send response to journal: Re: Will half measures address the core issue?	Prof Brown' letter probably is the best yet at highlighting what doctors all around the UK are thinking about the MTAS recruitment process. But the outcome of any half-baked attempt to salvage something from a massively flawed system is always going to leave a good number of doctors feeling cheated - and rightly so - not to talk of the long-term impact on patient care and the NHS. The "standards" for interview are going to change midway thru the first round - because CV's will now be used and long lists revisited. And some deaneries are suggesting a higher threshold for 1st round interviewees to increase the number of round 2 places. So it has gone from unfairly selecting candidates to now being unfair to those selected too?! And the 2nd round will have its short listing done differently from the first. The only consistency here is the lack of it at every turn. I predict that there will be a slant in round 2 towards not selecting those already rejected in round 1 to give an impression that most doctors were short listed and so appear to have given all a chance. It now seems as if being selected in the 1st round is going to be a disadvantage. We now have the most unstandardised selection process in history of recruiting doctors and I think the grave concern remains that the proposed reviews, changes to 1st round selection method and new selecting process for the second round are nothing but band aids on hemorrhaging situation. It looks like the only "fair to all" process might be to repeat the whole thing from beginning. I know that if I went through the current process and came out the other end jobless to say I would be disgruntled is a gross understatment. Competing interests: None declared
Raging against MTAS 11 March 2007
Nina M Newton Butler, SHO University College Hospital NHS Foundation Trust London Send response to journal: Re: Raging against MTAS	Either MTAS is reliable and valid, or it is not. I have a PhD that involved considerable work on issues of reliability and validity and as it stands the system can be neither. It is not logical to continue with EITHER round of interviews in an unreliable system. Those who have interview(s) and who derided the application in advance of short-listing, are guilty of self-interest if they say otherwise. To be fair to ALL candidates it is imperative that this process is scrapped and an alternative formulated from first principles - ideally one that does not set geography against specialty. Competing interests: None declared
Re: Raging against MTAS 11 March 2007
Calathur G Nanda Kumar, Consultant Anaesthetist Huddersfield Royal Infirmary HD3 3EA Send response to journal: Re: Re: Raging against MTAS	Prof Morris et al have eloquently exposed the flaws in the MTAS selection system and by now this is obvious to all of us. However, I would like to ensure that I am not misinterpreting their statements and am therefore seeking enlightenment from the authors. 'The fault? Teething problems blamed on computer glitches and thousands of non-UK European doctors swamping the UK applicants with their numbers;' Presumably, they are referring to European doctors from outside the UK and not the thousands of International Medical Graduates who have been affected by the change in immigration rules. One must remember that IMGs did not walk in based on political lottery, but after taking the requisite exams and spending a fortune. They did not receive any charity as is perceived in some quarters! 'and on wide-scale plagiarism and on answers available for sale to the ridiculous questions designed by civil servants to root out any doctor looking in vain for a box to register a first class degree.' I agree with this since this has affected all fair minded doctors, both IMGs and EU. 'Consolation? Yes, it could have been worse if the Highly Skilled Migrants had not been sacrificed during the selection process; with any luck, we have been told with a straight face, many of them have still been given posts and will therefore leave large gaps in the second round if the Appeal Court comes to the rescue.' This is where I am unclear whether they are referring to the DOH view point or is this the collective view of the authors? The court appeal (or the threat of it) has prompted the DOH to agree to treat the HSMP holders on par with everyone else, so this appears to be the authors' opinion. If we are all agreed that merit should be the only criterion of selection and if that is what we all are fighting for, then the visa should not enter into the equation and there should be a role for anonymity (yes, the questions asked in MTAS were not fit for purpose). Surely the knowledgeable seniors can distinguish a qualified doctor from a CV without knowing the name or nationality! I am extremely glad to see that the fight is to ensure that the best are selected and it is sad to see so many brilliant young doctors not selected. However, we will be failing in our duty if we try to sift the best IMGs from the best UK/EU doctors. This again is failing in our duty to the profession. So I hope that I have indeed misinterpreted Prof. Morris Brown and others and that they do have the best interests of the profession at heart without any fear or favour and that they themselves don’t see the need to distinguish between HSMP and EU nationality when it comes to choosing the best! My best wishes for a speedy and fair solution to this fiasco! Competing interests: A non UK, non European Medical Graduate (and proud of it!) who is now a British Citizen and a Senior Consultant Anaesthetist in the NHS
Re: Raging against MTAS 11 March 2007
Theodore G Nanidis MRCS, SHO in plastic surgery Royal Free Hospital, London Send response to journal: Re: Re: Raging against MTAS	'Better late than never'. A sincere, thank you, to the authors for their effort and the glimmer of hope that their letter will hopefully provide to junior doctors across the country. The lives of many increadibly bright, talented and hard working doctors are being ruined. We are an asset, not a burden. A plea to all: 'help us restore the balance, stand by us, let's stop this madness'! Competing interests: None declared
Couldn't Agree More....! 11 March 2007
Dr. Atiqa Rafiq MRCPsych, SHO Psychiatry Rep. of Ireland Send response to journal: Re: Couldn't Agree More....!	I have been shortlisted for Three ST4 interviews in Psychiatry and appeared in the first one a week ago. I wholeheartedly support Dr. Brown's petition based on my own discontent upon some terrible flaws within the system which will undoubtedly undermine commitment and achievements of many trainees even when they have been shortlisted. I and my referees have spent precious time and effort in compiling the documentation which are not a routine part of our training needs in Ireland, subsequently being informed on the day that what was made such a big deal of on MTAS website, was never even required for my level. No one had access to my references as I learned prior to the interview. I was now to send the signed references by post who simply will not print on papers. (Only the background and not the text added by referees is getting printed). There is a serious lack of communication in terms of simple things such as end time of interview sessions alongside the starting time and booking five people in a two hours session of interviews, resulting in candidates having to wait for four five hours and then missing their trains and flights back home. Interviewees are being assessed based on six written questions without scope of probing and interactive discussion that allows seniors to assess the substance in the candidate. The system undermines seniors' expertise and professional judgment in the selection process. And if that wasn't all, the ST1 and ST2 candidates are called by NUMBERS and not names. I can't imagine myself being the only one disturbed by this. What a ridiculous managerial exercise...! Vandalism is correctly the name for it. I will not be slightly displeased if the whole process is suspended and interviews are carried out by people acting on their own behalf, taking responsibility for the selection that they make. And doctors, as in any other profession, are free to make choices of applying to specialties and subspecialties for the right reasons. Competing interests: None declared
Disagree partly with Btown et al. 11 March 2007
Neha Chote, SpR UK Send response to journal: Re: Disagree partly with Btown et al.	I agree partly with Brown et al regarding the way the selection process has been messed up. But to feel happy about HSMP doctors being made scapegoats was completely unwarranted and uncalled for. As always, looks like the author is trying to find soft targets to blame for the debacle. It is utterly disgraceful that a senior Consultant had to say such things and make the already bad situation worse. Competing interests: None declared
Shameful 11 March 2007
Anirban Chakraborty, SHO CF64 2XX Cardiff Send response to journal: Re: Shameful	It is nice to see respected and senior consultants voicing their displeasure at the fiasco called MTAS/MMC. I suspect most of it is due to the hue and cry created after many bright local candidates were left without a job interview after the first round. I would like to present the case of IMGs struggling in this country, who are NOT new to facing this problem of joblessness in UK for the first time because of the existing double standards undeniably prevailing at various levels in NHS for at least the last few years. Its acceptable and understood that the local graduates, who complete their medical studies with the burden of thousands of pounds of loans should not be left jobless after their training and its absolutely shameful and disgraceful that a developed country like UK has uncertain future for its bright junior doctors ( some of them are even going to be forced to take up other profession!!!). But this should not mean that the IMGs are sacrificed to accomodate the local graduates, which I am afraid is one of the likely outcomes after this MMC/MTAS fiasco. There should be some appreciation and recognition of the role IMGs play and has been playing in NHS. Before unceremoniously being booted out of this country we should at least discuss with them/their representatives like BAPIO to come up with a reasonable solution to gradually phase them out of this country to accomodate the local graduates rather than shutting the door on them abruptly. Leaving UK is a huge decision to most of the IMGs, who came here with enormous amount of loans for training/membership etc and there should be reasonable time given to them to sort out things like mortgages, children's education, next jobs etc before they are forced to return home. Imagine if the current UK doctors working in Oz/NZ were booted out of Oz/NZ to accomodate the local doctors in the middle of their training. Those with HSMP are 'highly skilled' migrants who agreed to make UK their permanent home. If they are not considered at par with local grads or at least the EU grads for the interviews, it is clearly violation of the understanding when they were given their immigration status by DoH. In summary: 1. I appreciate that local grads should not be left jobless at all but this should not be an opportunity by the brains behind this system to unceremoniously boot the IMGs out of this country. 2. There should be a better system where all the competent local grads should get a job and the trained IMGs should also be in the system until they are definitely no longer needed by NHS (which I doubt will ever happen). 3. 2007 is definitely not the year by which this can be attained because NHS has spent too much money to employ managers. Cant junior doctors do the job managers do as part of compulsory audit projects etc? Remember, if we have more junior doctors, then all of them can have more time to look after patients and also to do academic projects like these audits. 4. More jobs are needed for junior doctors/nurses in hospitals to provide the standard of care that can be expected by a citizen of a developed country (which I am afraid people of UK are not getting because of the financial constraints of NHS). Only God knows where we are heading with NHS/MMC but I hope this outrage against MMC/MTAS helps putting forward the case of junior doctors in NHS and I sincerely hope IMGs are not made the scapegoats of this system. No abrupt decision should be made on eligibility of IMGs before consulting them because they expect some kind of honesty and fairness from a country like UK. Selection should be fair, just and based on merit until NHS comes up with reasonable recruitment method and more jobs to accomodate everybody if they dont want an even worse NHS service to its patients. Competing interests: None declared
MTAS - the wrong assessment 11 March 2007
paul m stewart, Professor of Medicine University of Birmingham B15 2TT Send response to journal: Re: MTAS - the wrong assessment	I share the outrage of the MTAS debacle. It is totally unacceptable to adopt a process that bears no relationship to the underlying quality or ability of the newly qualified doctor. Medical undergraduates have competed at the highest level academically throughout their School and college careers; to see an alien process such as MTAS determine their destiny is insulting. More broadly this is just one issue in the evolving MMC structures that causes concern. Our profession cannot be seen as simply a "numbers game" - we must ensure an ongoing quality structure and assesment to train excellent doctors. Competing interests: None declared
Re: MMC March on March 17th 11 March 2007
Emma J Bywaters, SpR Emergency Medicine Southampton General Hospital SO16 6YD Send response to journal: Re: Re: MMC March on March 17th	I was immensely heartened to read the initial letter and the subsequent support from senior colleagues for beleaguered juniors caught up in this nightmare. I would like to appeal to everyone reading this who cares about the future of the Profession to join the march in London (or Glasgow) on Saturday 17th. The only way to make this government backtrack on their MMC plans is to keep up the political pressure, and thousands of people marching to express their strength of feeling (and the resultant press coverage) is one excellent way of exerting such pressure. Check the BMA website during the week for details of exactly where and when to turn up, and how to get your placard. It did sadden me to see a couple of responses which seemed to be ignorant of the hard work that the JDC and the wider BMA has been doing since MMC was conceived. We certainly have not been silent, and have fought (despite attempts to exclude us from the process) to steer the MMC team away from the worst excesses of their plans, and have won concessions, for example linked applications. We had anticipated and raised with the MMC team many of the problems which have come to pass and made strong representations that the introduction of the new system ought to be delayed until it was actually ready. These calls were ignored. Your union is still acting; the JDC met yesterday and as you would expect spent most of the day discussing where we go from here. Again, see the website for more information. Hope to see you on the March next weekend. Competing interests: I am a member of the BMA's junior doctors committee
Re: Raging against MTAS 11 March 2007
Anil Madhavan, SpR Radiology St.Thomas' Hospital, London Send response to journal: Re: Re: Raging against MTAS	The amount of support junior doctors are recieving from their seniors are moving and humbling. I have met only one consultant so far who is not sympathetic to juniors on this issue. However that raises the question, why are the consultants not following the example of the brave surgeons from West Midlands and boycott the interviews? That is the only way we can make sure that the falwed first round does not go ahead. Competing interests: None declared
Re: Raging against MTAS 12 March 2007
R Mark Gardiner, Professor of Paediatrics University College London Wc1E 6JJ Send response to journal: Re: Re: Raging against MTAS	I agree wholeheartedly with the sentiments expressed by Professor Morris and his colleagues and support any action which will restore sanity and fairness to the MMC process. Competing interests: None declared
Equality, transparency and fairness..extinct virtues? 12 March 2007
J T George, Specialist Registrar in Diabetes, Endocrinology and General (Internal) Medicine York Hospital, York, YO31 8HE, Kavitha S Rozario Send response to journal: Re: Equality, transparency and fairness..extinct virtues?	It is heartening to see senior professionals highlighting the shortcomings of current specialty selection process. We agree with the authors that, amongst many other factors, large number of applications from non-UK doctors is contributing to the current crisis. However, we disagree with the authors in their suggestion that a 'sacrifice' of highly skilled non-UK doctors forms part of the solution. The introduction of European Working Time Directive (EWTD) and the expansion of the number of doctors employed by the NHS resulted in many non-UK doctors migrating to the UK. As many as 30% of NHS medical workforce have trained outside Britain1 and some hospitals have had overseas trained doctors contributing to more than 50% of their junior workforce2. A recent survey has shown that over three quarters of them were attracted by prospects of post-graduate training, mainly from British Commonwealth3. When non-UK doctors were recruited by the NHS, with extensive worldwide campaign, 4, 5 prospects of equal opportunities were offered5. Non-UK doctors employed in training positions therefore assumed natural progression to more senior positions based on merit and experience. If non-UK doctors were qualified to be employed by the NHS in the first place, why should they be barred from competing for more senior positions once they have obtained further qualifications and competencies? Is career disruption for a bright young Indian doctor who has worked and trained in the NHS less of a concern than the same for his British counterpart? Many non-UK doctors have, despite many challenges posed by the system, risen through the ranks to serve the NHS as specialist registrars, general practitioners and consultants. We need to aim for a system that is fair, equitable and transparent where all current trainees in the NHS can compete based on their qualifications, competencies and reference. Falling victim to divisive 'divide and rule' politics is perhaps the biggest mistake the medical fraternity can now make. References 1. Goldacre MJ, Davidson JM, Lambert TW. Country of training and ethnic origin of UK doctors: database and survey studies. BMJ 2004; September 11;329(7466):597. 2. Biggs J. Under half of senior house officers in Anglia in 1997 were United Kingdom graduates. BMJ 1998; February 7;316(7129):473. 3. George JT, Rozario KS, Anthony J, Jude EB, McKay GA. Non-European Union doctors in the National Health Service: why, when and how do they come to the United Kingdom of Great Britain and Northern Ireland?. Hum Resour Health 2007; Feb 27;5:6. 4. Department of Health. Special envoy to show the world the best of the NHS. Available at: www.dh.gov.uk/PublicationsAndStatistics (Accessed 03/11, 2007) 5. Department of Health. Opportunities for doctors in England and Wales. Available at:www.dh.gov.uk/PublicationsAndStatistics (Accessed 03/11, 2007)] Competing interests: None declared
Thank you 12 March 2007
Mark Silvert, SHO Psychiatry Royal Free, NW3 Send response to journal: Re: Thank you	I would like to thank the authors of this letter. It has been widely circulated, and at last there is some feeling that not ALL of our senior Consultants have abandoned us. We have learnt from you, trained under you and evolved to undertake research, audit, win prizes, and obtain flawless appraisals and decide for ourselves through working with our mentors what we would like to choose for our lives with medicine. MTAS takes away our rights to live where we want, practice an area of medicine that we are passionate about and reduces all our hard work over many years to roughly 10 percent of a management consultancy type application form online. Morale has never been so low, and many tears have been shed from ourselves and families, over complete lunacy. This process must be stopped. "Grant me the strength, time and opportunity always to correct what I have aquired, always to extendits domain; for knowledge is immense and the spirit of man can extend indefintely to enrich itself daily with new requirements." Maimonides - One of the first great Physicians. He must have known MMC was coming!!! Competing interests: None declared
Clarification 12 March 2007
Morris J Brown, Professor of Clinical Pharmacology University of Cambridge, CB2 2QQ Send response to journal: Re: Clarification	We would like to assure Drs Chote, Chakraborty and Kumar that we are of course completely with the Highly Skilled Migrants. We assumed the sentences beginning ‘Consolation....’ would be read with the same horrified irony with which they were written. Competing interests: None declared
Re: Raging against MTAS 12 March 2007
Kenneth Kok, LAS plastic surgery Selly Oak Hospital, Birmingham B29 6JD Send response to journal: Re: Re: Raging against MTAS	I agree whole heartedly with Prof Morris's letter. MTAS and MMC have destroyed the morale of junior doctors in the UK. It is sad that we have allowed this juggernaut called MMC to progress as far as it has, but I am (as are many other junior doctors I am sure) touched and relieved that at least some of our senior colleagues and leaders are putting up a fight. I have been training under the old system and in order to obtain a NTN in plastic surgery I have jumped through numerous hoops such as obtaining a higher research degree, publishing manuscripts, presenting at meetings and obtaining valuable registrar experience. The tides then suddenly changed and I found myself trying to compose creative answers to questions that assessed the 'soft' competencies required of a doctor. Some of these questions might have been appropriate during the actual interview, but to use them as the basis to selection for higher training is just ludicrous! For the record, I have not been short-listed for any interviews. I fear for the future of the NHS and the patients it serves. It is not too late however and we must act on a united front if we are to see change. Personally, I would like to see the whole MMC scrapped and the system returned to its previous incarnation. There is no denying that the old system had its fair share of faults, but MMC is not fit for purpose and by no means a fair replacement. Competing interests: None declared
Disagree partly with Brown et a; 12 March 2007
Nina Newton Butler, SHO University College London Hospitals NHS Foundation Trust Send response to journal: Re: Disagree partly with Brown et a;	I am saddened to read Neha Chote’s comment about HSMP in Professor Brown et al’s magnificent letter. Irony is defined as, "expression of one’s meaning by simulated adoption of another’s point of view or laudatory tone for purpose of ridicule" (Concise Oxford Dictionary). Reading the letter as a piece of prose, even out-with its context, suggests that far from making scapegoats of HSMP the contributors are firmly on their side. I would wager Neha Chote an ST3 post on it being so! Competing interests: None declared
MMC and MTAS 13 March 2007
Mohammed S Kibirige, Consultant paediatrician TS4 3BW Send response to journal: Re: MMC and MTAS	It has taken us a while to appreciate how the NHS has been undermined by bad planning or lack of it and now trying to destroy the workforce that keeps it running. The team that embarked on this project did not think through the consequences of their delibration nor did they ask themselves why doctors have always been available for their patients. We have always been committed to the profession and our patients, Many of those who tick boxes for a job may not necessarily be committed but feel that so called modernisation is the best way forward. In this case modernisation seems to be causing more harm. I agree with many colleagues on the issues that have already been discussed and that we should ensure that the message to the responsible individuals is clear- Abandon the scheme until all aspects have been thought through. Competing interests: None declared
Re: Will half measures address the core issue? 13 March 2007
Anil Kopuri, SHO, Neonatology Birmingham Womens Hospital, Birmingham B15 2TG Send response to journal: Re: Re: Will half measures address the core issue?	While it took Prof Brown et al's superbly eloquent letter to outline the miseries of a MTAS/MMC candidate to highlight the systematic failures and short comings of a hugely expensive exercise, I agree with Dr Obinwa's view that midway changes to the system is not the solution to a hugely unpopular and impractical process. Moving goalposts half way through is both unjustified and unwarranted for the thousands of candidates who have indeed applied after having looked at the number of posts offered in the first round and have been preparing for their interviews accordingly. And there are those candidates who have already been interviewed. The only respectable and ethically correct way should be to scrap the whole system and start afresh. It would be kinder to all the parties, the candidates, the interviewers and the deaneries/trusts(who by the way would be able to save a few million pounds by not going through a ridiculous exercise, saving money by not employing locums and paying the travel expenses in thousands). While piloting ST programmes has been on stream for quite a while, I fail to understand why a slow gradual introduction of the system was not adopted over a few years. Although a belated realisation, time is still on our side. I sincerely hope the whole of MMC/MTAS would be looked into in detail, and would not just amount to a 2 week cover up. While I have immense respect for the Academy of Royal Colleges to come out with a plan to save the face of MMC/MTAS, I feel the investigators should atleast be given resaonable time to go through the process, identify problems, suggest solutions and rectify the system. We still have a few months before all junior doctors would be jobless and it is prudent to use this time to introduce a fair, correct and robust version to make any further appointments. Competing interests: Am a junior doctor applying for MMC myself
Re: Raging against MTAS 13 March 2007
Conor D Marron, Spr in General Surgery BT18 0NG Send response to journal: Re: Re: Raging against MTAS	Professor Brown and colleagues, and indeed all those posting on this thread should be congratulated in the fact that they are taking an interest in postgraduate medical and surgical education. Apathy has been our profession's biggest downfall for some time. I fully agree that the methods by which MTAS has been introduced have been flawed, difficult and disadvantageous. However, we must be careful to distinguish MTAS and its failures, from MMC itself. MMC is the new training process and MTAS is the tool by which people are selected to it. I think that we would find it incredibly difficult to prove to the public that MMC is a waste of time and money and should be abandoned - after all a competency based system of training that trains doctors to the level of a CCT focusing on competencies acheived rather than time served, and perhaps in a shorter timeframe, would obviously be of benefit to the NHS. Certainly in Surgery the timeline for MMC from ST1 to ST8, with 2 years of Foundation beforehand, is not at all different to that proposed by Calman - combined with additional reassurances of competency this could be better? or at least this will be the spin! Lets pick the battles we can win. So, if we say that MMC goes ahead (actually it already has with foundation 2 trainees completing these programmes in August this year throughout the country), then we need to decide how to select to these jobs. I cannot help but feel that the problems of MTAS and this procedure are significantly due to the fact that it has aimed for a 'big bang' effect of 'now or never'. ASiT and other trainee bodies have tried to promote that the JACSTG proposals to allow a phased transition over 2-3 years should be adopted, however this has been resisted by deaneries and MMC. This would have allowed the playing field to be leveled somewhat, but instead we are left with a system that is trying to discriminate the best doctors from respective year groups but over between a 3-10 year experience difference. This is the situation if we consider in practical terms the 3rd year SHO (or 4th year SHO) just finished BST aompeting with a pre-NTN trainee who has finished BST, has completed a PhD, and has worked a year as a LAT - this could lead to someone with 8 years of post registration experience competing for entry to the same level as someone with 4 years post-registration experience. How can this playing field ever be level? For those calling for the MTAS system to be abandoned and an immediate return to the old selection methods, what would happen is that the people who have been around longest (thereby having more publications, higher degrees, presentations, courses etc) would fare better with sequentially increasing shortlisting criteria to get to the competition levels required for interview. Is this fair on the exceptional quality but more junior trainees? IS it fair to tell someone that they will not be interviewed and have a training job purely because they are only 4 years into the system and not 9? OUR MAIN PROBLEM IS TRYING TO SELECT PEOPLE, WHO HAVE SO MANY LEVELS OF EXPERIENCE, AT THE ONE TIME. Whatever the decision is in the end, not everyone will be happy. Surely then to increase the numbers of trainees is the answer - infact they already have increased numbers of 'trainees' who are at a higher level of training with MMC. The problem here is that there are a limited number of trainers and an ever decreasing number of training opportunities due to ISTCs, 'bankrupt PCTs' etc. Combined with evolving CCT holder unemployment, it would appear that both the opportunities to train vastly more people and the prospects for these people at the end of the training period are still problematic. It can be argued that there is capacity to employ more consultants - but ultimately I fear we are seeing the introduction of a sub-consultant grade that will be equivalent to the Associate Specialists - to vastly increase numbers of trainees now would expidite that even further. The latest announcements from the Royal College of Surgeons and the DoH and on the MTAS website tell us that application forms will be reviewed for those people not shortlisted and who may then be offered an interview - how will this work in those deaneries where interviews have already taken place? Will the same interview questions be used? Will the exact same panel members be used? How will this work? In those deaneries that have not yet interviewed how much longer will the panels be required to interview for if more people are invited for interview? Will these people be released by their trusts to carry out the interviews? I fear that these announcements may only be paying lip service to something that is not possible or even likely to happen. We must remember that it is up to those consultants interviewing to ensure that the candidates that they appoint are of the very highest quality and that it is still in our power as a profession to select people of the highest calibre. Do I personally think that we should abandon the current system? the answer is NO, as I do not see a viable and realistic alternative to what is there - I do not think that simply returning to the old methods is viable or fair on those more junior candidates. I think that the reasonable thing is to interview and appoint only those suitable and recycle vacant posts for future rounds (however many it might take!) - only if there is no doubt at all should people be appointed. We must not forget that many very high quality, prepared, and good candidates have been shortlisted, and interviewed, and we must not denigrate our colleagues. ASiT and other trainee bodies have tried very hard to put our points across to the relevant bodies involved in MTAS and indeed at the JCHST meetings, combined with BOTA, we have given the COPMeD representative a very hard time and we have been successful in negotiating some amendments - but even crucial errors that we pointed out prior to the the new year were not addressed - and we were chastised as having 'misunderstood' - plainly we had not! Like Professor Brown's Exocet missile, I fear that the biggest travesty is that the medical profession are now at each other's throats and we have clear division of loyalties - for alongside everyone disgruntled there is someone who feels that the right thing is being done. Public and Private abuse is not acceptable, and we must unite as a profession in order to find a viable and realistic way forward that will select the best doctors in order that the medical care delivered to our patients can be of the highest possible standard in the future. Regards, Conor PS - There are oft quoted mistakes relating to IMGs and the situation in Australia etc. I have spent a year early in my career working in Australia, and have many friends and family working there. I have also helped with the inception of the Royal Australasian College of Surgeons Trainees Association (RACSTA) and so have insight to the Australian System. Australia are happy to employ doctors from the UK or elsewhere to work in 'Areas of Need' ie those areas where they cannot get their own graduates to work. This is on the basis of a one year 'Temporary Residence' Visa, which may be extended annually for up to 4 years - but no longer. It is virtually impossible to get a surgical training rotation in Australia (I have tried and the loopholes are varied and many!) as a non-Australian Resident. Indeed surgery has the same problems there as we do here with people taking too long to progress from SHO level to SpR level. Therefore the Australians are due to introduce a new system from January 2008 called Integrated Surgical Training - a seamless progression of trianing in surgery without the standard hurdle between SHO and SpR which will be competency assessed - sound familiar? So actually the situation in Australia for trainees from the UK is the same as it is here in the UK for IMGs now. I am not getting into whether this is right or wrong - purely stating a fact. The Australians have however opened the doors to people who are fully trained already or who are prepared to work as family doctors in bush areas. This might be a slight confusing issue. Competing interests: President of The Association of Surgeons in Training
re Raging against MTAS 13 March 2007
Mike Ebdy, GP Principal Tarleton Health Centre, PR4 6RQ Send response to journal: Re: re Raging against MTAS	Please remember the words of Hippocrates:- "My colleagues will be my brothers." Who would let their brothers be treated in such a way as this without protesting? Competing interests: None declared
Re: Re: Raging against MTAS 13 March 2007
Daniel Gale, SpR in Nephrology Hammersmith Hospital, London, W12 0HS Send response to journal: Re: Re: Re: Raging against MTAS	Juniors have no freedom to boycott this horrific process as they will be committing individual career suicide. We are reliant on the appointing consultants, if they share the views so prevalent amongst their colleagues, to halt this process by refusing to appoint. Each Trust will be able to fill vacancies by recruiting in the normal way prior to August. Alan Crockard could do the most good at this point by stating publicly that the 'lottery-conveyor belt' (MTAS-MMC) is a catastrophe for doctors and, in the long term for patients as well. Doctors cannot expect the government, the press or the public to intercede to keep Medicine a profession - it is our responsibility and scrapping MMC is absolutely essential for this. Competing interests: None declared
Injustice of MTAS 13 March 2007
uma nath, consultant neurologist sr4 7tp Send response to journal: Re: Injustice of MTAS	I am grateful to Morris Brown et all for raging against MTAS iniquities. MTAS is an unnecessary and beaurocratic sledgehammer to crack a nut which does not exist. Doctors are and always were capable of exercising sound judgement in selection of their own future colleagues. MTAS structure is heavy on administration and light on commonsense. Competing interests: None declared
Sack those in charge of MMC 13 March 2007
Muhammad S Sajid, Surgical Research Fellow Worthing Hospital, West Sussex BN11 2DH Send response to journal: Re: Sack those in charge of MMC	I agree completely with all my medical and surgical friends about disappointing outcome of this MMC and MTAS. The new selection system has been untested, with no validation or reliability evidence provided for discriminating amongst high achieving surgical trainees. The shortlisting scoring system was poor, with significant weight given to the answers for 'woolly' questions and signifcantly less weight given to academic achievement and clinical experience. No evidence has been provided for the validity of this. Why are we supporting the dumbing down of first, medical education, and now postgraduate medical training - this seems to be another method of deprofessionalising doctors, turning them into robotic service providers that will jump through the hoops for NHS managers, and prematurely terminating the careers of potential future innovators and thinkers that have, in the past, helped to push forward the boundaries of medicine and surgery. I call for the immediate resignation of this impotent MMC/MTAS system in charge and bodies involved in the implementation. Competing interests: None declared
This is exactly how overseas doctors felt about the visa ruling 13 March 2007
Arun Natarajan, SpR Northern Deanery Send response to journal: Re: This is exactly how overseas doctors felt about the visa ruling	This is precisely the kind of outrage that thousands of non-EU overseas doctors experienced, when the visa rules were unleashed. They cried their hearts out, but few listened. There was little coverage by the media. Did the British medical elite voice protest then? Look how they are crying foul now - when their own, are the victims of unfairness and jeopardy. How does a taste of your own medicine feel, gentlemen? Having said the above, I must add that I fully support the tirade against this insanity called MTAS. Competing interests: None declared
MTAS 13 March 2007
Peter McCollum, Professor of Vascular Surgery University of Hull, Hull & East Yorks Hospitals. HU3 2JZ Send response to journal: Re: MTAS	I was away examining in Aberdeen and so unable to sign the original letter, the contents of which I heartily endorse. To use scientific jargon, the shortlisting process was severly lacking in specificity and sensitivity and the interview process conclusions were not justifiable. We do however need an alternative viable, reliable, reproducible, fair and valid solution (to use the educationalist jargon!). The fact that the MTAS process does not offer any of these elements is a disgrace to all concerned, including those of us who parcipitated, and an affront to the trainees. The difficulty is to put in place a mechanism which can at short notice replace this process without reproducing the unacceptable aspects of it. Was the old Senior House Officer scheme really "the lost tribe” or rather a “lost opportunity”?! We could learn a lot from other systems such as that run in Australia or do we not like learning from our younger cousins? Competing interests: None declared
Re: Raging against MTAS 14 March 2007
Fiona J Hampton, Consultant Paediatrician Middlesbrough, TS4 3BW Send response to journal: Re: Re: Raging against MTAS	I would like to add my wholehearted support to this letter. I would also like to apologise to junior colleagues for being amongst the silent majority for so long, recognising some of the likely problems but not knowing what to do to try to stop the disaster sooner. I am grateful to some senior colleagues for starting this valiant attempt to avert meltdown, and can only hope for a successful outcome. The massive support on these pages must hold out at least some prospect for the development of alternative processes. Competing interests: None declared
Re: MMC March on March 17th 14 March 2007
Andrew Clegg, SpR Geriatrics Yorkshire Deanery Send response to journal: Re: Re: MMC March on March 17th	I would fully support the sentiments of Emma Bywaters (1) regarding the work of the BMA, JDC, Royal Colleges and senior clinicians in the MMC debacle. Without their collective dilligence the face of the current MMC picture and makeup of bodies such as the JCHMT would have been (as was the Government's ideal solution) of an entirely political bent. Clinical input into training and career development would have all but vanished and we would be trained to deliver healthcare on entirely political grounds and to provide a service to meet the wants of the Trust. It is entirely toward the disdainful arrogance of the Government and its political arm of MMC & MTAS that we should be focusing our anger. Only they truly know (whilst we accurately speculate) the true intentions of the MMC plan. Any clinician who has been privy to, complicit with, and submissive to these intentions should be ashamed. Regards Andrew Clegg 1. E Bywaters. MMC March on March 17th. BMJ Rapid Response. 11th March 2007 Competing interests: None declared
stop this now 14 March 2007
jonathan couch, f2 sevenoaks hospital, TN13 3PG Send response to journal: Re: stop this now	a pleasure to have some consultant support for a change MMC/MTAS has set the medical profession on a slide that will leave it skilless and useless to the people it has undertaken to care for this can and should be stopped i for one don't want the general public to know more about medicine than their doctor's - not that i don't believe in an informed public, just that our training should equip us to do our job, which in the proposed format, i seriously doubt it will. Competing interests: None declared
Flawed ST3 Interview system 14 March 2007
Peter J Milewski, Consultant General and Colorectal Surgeon Pembrokeshire and Derwen NHS Trust, SA61 2PZ Send response to journal: Re: Flawed ST3 Interview system	This is my impression of the new-style ST3 interviews I was asked to help with, as a local consultant, recently. Of course the importance of the ST3 process is that this is our last chance to ensure that the right people join what is essentially the back straight of the race to consultancy. I’ve got to say I feel there is merit in certain aspects of the new process. These are the attempts to increase objectivity by using certain standardized questions and probes, also by using a scoring system and three pairs of interviewers in different rooms. Also, from my point of view, it was nice to feel that I might have a small input into Wales-wide appointments, particularly any that might end up in my institution, rather than have complete unknowns foisted upon me. However, in introducing that system and getting rid of certain aspects of the old system, MTAS have thrown out the baby with the bathwater. That is, the ability to probe in much more depth specific aspects of each individual candidate’s abilities and record. What is more, there does not appear to be anybody we can blame for what I feel is one of the most crass errors I have ever had the doubtful privilege of observing in medical training in the NHS. We had some heartsearching about whether to proceed, especially as an email from the College had appeared advising us not to interview without seeing the CV’s. Eventually we proceeded on the basis that we had the opportunity, I understood, of drawing a bar across the scores, below which we would refuse to appoint. Thus, we should be able to appoint only the obviously meritorious. I hope this proves to be correct. The feedback I gave at the end of the day was as follows: 1) The new system in its present form is a JOKE 2) We had no opportunity to go over in detail the candidates’ portfolios and CV’s, despite the fact that they had been told to bring them !! (in fact three candidates pointed this out, and we had to sympathize). 3) The scoring system allows you to sift out the few at the top and bottom of the scale, but is practically non-discriminatory for the half or more who score within a rather wide mid-range. Personally I felt that, if there is a maximum score of (say) 48, then one could not distinguish between the merits of candidates scoring between about 24 and 36, and that it would be most unfair to make any appointments based on relative scores within that range. Yet there is nothing else to go on! 4) We had no opportunity to go over the references. The Chairperson told us she had been over them and found no problems. Of course they were new-style references which I suspect do not have the subtle value which old-style ones do. In my experience, there were often valid inferences to be drawn from the old- style ones, either from what was not said, or from the way things were expressed. Or alternatively, one might draw an inference from the fact that a reference had not been sent, or at least make a check-up phone call. 5) Finally, we had no opportunity to make informal enquiries which can often be most revealing. What all this means, to my mind, is that we consultants are now reduced to mere scoring machines, and the final decisions about appointments are out of our hands. Frankly, I very much doubt if a review can correct all these defects in the short timescale available and think that serious consideration should be given to a mass consultant refusal to take part in the second round, and an insistence that, for the time being, there should a reversion to old-style appointments. If there is a mass refusal, whoever is in charge at MTAS (and that seems difficult to identify) would have to agree. Competing interests: None declared
Cannot drink from same cup 14 March 2007
Arun T Perumpallil, Associate GP Trainer Essex Send response to journal: Re: Cannot drink from same cup	From the letter of Brown et al and the responses which followed, it is very clear that MMC/MTAS and the recent recruitment of junior doctors is grossly inappropriately planned and executed. One response in particular is from Marron where he states that our main problem is trying to select from candidates with varying levels of experience is absolutely true. One other major draw back is trying to select to different specialities on same policies. In General Practice a system similar to current MTAS has been implemented although not centrally for the last 3-4 years and has been hailed as success by most. The major difference with General Practice and other specialties is that all candidates mostly have either very limited or almost nil experience in General Practice and hence looking for core competencies through various selection methods were appropriate. Similarly research experiences were not considered to be a major competency for a General Practitioner and traditionally candidates were not boasting about their number of publications or Phd. To transcribe such a recruitment process to a specialty like surgery or even many medical specialities were inappropriate and as proved unworkable. I sincerely hope the combined efforts of all the Royal Colleges will bring out a solution to this recruitment problem, but it would make more sense if each specialty devised its own method of recruitment according to the needs of the speciality. It has to be agreed that when there are more candidates than the number of posts available there will not be a recruitment process which is fair to all. Is it the full page advertisements that appeared in overseas dailies 3-4 years back requesting Doctors to fly to UK, to be blamed for the crisis? Competing interests: None declared
Re: This is exactly how overseas doctors felt about the visa ruling 14 March 2007
Nikhil Bhatia, SHO medicine St Mary's Hospital Isle of wight , PO30 5TG Send response to journal: Re: Re: This is exactly how overseas doctors felt about the visa ruling	Being an IMG myself I don't think it is fair to compare the plight of all junior doctors at present with that of IMGs only after the visa rule changed. I understand that the government would change rules to protect the interest of its citizens, however that being said some sort of grace period for IMGs needed to be given or they should have been accomodated and further intake of IMG's stopped earlier on before introduction of visa rules. I am not surprised that british media did not give adequate coverage to the IMGs but then it has also ignored the MTAS mess till now. I think in anycase we need to unite together and get a fair deal for all . The fact however is IMGs will be made scapegoats and each may have to think about themselves if they do not get into the system. I know of few consultants in my hospital and also on other forums who have sympathised with the IMGs but there is not much they can do as it is a government policy and they cannot go against there own graduates who are entitiled to further training.However a lot of IMGs got shortlisted in round 1 . This may not be the case in round 2. I myself have not been short listed but will apply in round 2 since for now atleast we are able to apply and at the same time I am looking for opportunities abroad. Competing interests: None declared
MMC enforced interview question 14 March 2007
NATALIE M GREEN, SHO, ANAESTHESIA UNIVERSITY HOSPITAL AINTREE, L9 7AL Send response to journal: Re: MMC enforced interview question	Today I had my interview for an ST2 post in Anaesthesia in Mersey UoA. In my 15 minute interview, I was asked 3 MMC-enforced questions, no more, no less. My portfolio was not opened, and my CV not looked at. 1) How has your last year in Anaesthesia lived up to expectations? (fair question) 2) Why do you want to work in this region? (Again, fair and salient question) 3) Tell me the positives of MTAS (Medical Training Application System)... ...I was not allowed to talk about MMC (Modernising Medical Careers), which I can see has some reasonable advantages, but was confined to talking about MTAS. I was not allowed to give an opinion, or to present its faults, only to recommend it. You can imagine how many of us struggled with this. How this interview allowed anyone to differentiate between who is safe and competent to deliver an anaesthetic and continue their training is totally beyond me. These questions were stipulated by MMC and supplied with their own marking scheme. It appears doctors are being appointed on their ability to tow the party line. I am appalled. How can we let this happen? Competing interests: None declared
Re: Raging against MTAS 14 March 2007
Gavin J Freeman, FY2 Cardiothoracic Surgery University Hospital of North Staffordshire, ST4 7LN Send response to journal: Re: Re: Raging against MTAS	As an Foundation Year 2 (FY2) doctor, watching what is happening is very disheartening. I got shortlisted in 4 deaneries for ST1 Core Medical Training. My initial joy soon passed once I read about the furore surrounding the MTAS process. Some of my (mainly surgical) colleagues were not so fortunate (in part due to the fact that job numbers have been reduced in surgery) and this further added to my feelings of guilt. Then there is all the FY2 "bashing" on Doctors.Net to contend with. I have full sympathy for those who did not get shortlisted and I appreciate the multiple failings of MTAS. The plagarism and creative writing accustions, the technical problems, the shortlisting process and all the other rumours regarding how people had access to marking schemes and so forth all undermine the process further. The lack of transparency further adds to this problem. Everything on my application had documented evidence to support it. MTAS is just the latest in a catalogue of disasters in our training. They should have introduced it in stages, with only the FY2's applying initially, whilst maintaining a percentage of jobs for the SHO's to compete for amonst themselves. This would hopefully negate some of the hostility aimed at us. MMC as a whole is the problem, with dumbing down of our training, limited hours of work, increased competition on the wards for obtaining procedural skills, and the erosion of the house officer/FY1 and in some cases FY2 as more and more nurses and nurse practitioners take on roles associated with doctors in the past. FY1's don't do nights in my Trust anymore with nurse practitioners taking on the role of first responder. Incidently these get regular training on practical skills and get paid more money for the role. We have little work-life balance now as promised, with uncertainty of whether or not we'll have a job or even where it'll be. Thankfully, I haven't bought a house or have any ties to a particular area. Many doctors do though. I have worked extremely hard to get my interviews. I don't feel guilty anymore. I have been extremely vocal within my Trust about the erosion of our training and Senior Colleagues agree with me off the record but seem unwilling to voice their concerns. Thank God some seniors have finally spoken up, I only fear that it is too little too late. There hasn't been much senior public support for us until now. I hope that whilst the troops are mobilising to take on MTAS that MMC is not forgotten and that we take this on too. If the whole application system gets scrapped and I have to go through it all again, I am confident that I have worked hard enough to get shortlisted again. Competing interests: None declared
One month to save the NHS 14 March 2007
Chris Maimaris, Consultant in Emergency Medicine CB2 2QQ Send response to journal: Re: One month to save the NHS	I'm a consultant in Emergency Medicine at Addenbrooke's hospital, Cambridge for 16 years and for 13 years held senior positions in regional and national training committees. On Monday 11th March I resigned all these positions in protest against MTAS, the new recruitment system. I have received tremendous support for my stance from many colleagues both junior doctors and consultants. I remain convinced MTAS must be suspended immediately. MTAS is not fit for purpose. I have asked the 10 Downing Str web site to create the following petition under the title ONE MONTH TO SAVE THE NHS: ‘We the undersigned petition the Prime Minister to Suspend the MTAS immediately and work with all the medical profession to modernise medical careers’ I’m awaiting approval of the petition and would kindly ask you to promote it. I chose my title because by 23th of April the results of the first round of MTAS will be announced and if it is not suspended by then, the NHS would be damaged irrevocably. This is what I wrote for the petition: ‘There is strong feeling amongst junior doctors against MTAS the new recruitment system. MTAS has not been tested, is seriously flawed, it will affect medical training detrimentally and is extremely unpopular amongst medical staff of all grades. MTAS will not stand up to public or legal scrutiny because of all the problems it has faced from its inception until now. Our junior doctors will loose faith and not trust the recruitment process and this will destabilise medical workforce in the NHS. It took 4- 5 years for GPs to develop a similar but much simpler recruitment system. Hospital specialist training is a lot more complex and one-size fits all will not work. The aim of the petition is to suspend MTAS in its current form and return to the old system of recruiting training doctors for another year. This will give us more time to work out how to implement the MMC-modernising medical careers and we would learn from the mistakes made so far. We will regain the confidence and trust of our junior doctors’ Competing interests: None declared
MTAS/MMC 14 March 2007
ben dean, sho oxford Send response to journal: Re: MTAS/MMC	The government and the department of health have blood on their hands concerning MMC and its application side arm MTAS. The EWTD has undoubtedly created problems for medical training, but there is precious little evidence behind the solutions that our leaders have come up with. The gimmick of 'competency based' learning and assessments have become the Holy Grail, while anything old fashioned and established has been thrown out with the bath water. The 'competency' based approach is a form of educational fundamentalism. Anyone who disagrees is smeared and simply told they are wrong, in a way that insinuates that old methods are encouraging 'incompetence'. The 'competency' based approach is also fundamentally flawed as it relies on the premise that 'competency' is a black and white, binary like entity; when it clearly is not, as anyone who has practised medicine will tell you. It is not always progress to attack the subjective and replace it with the 'objective'. Many things cannot be summed up into boxes and numbers, and you gain nothing by forcing slightly abstract subjective judgments into this fundamentalist objective straight jacket. The politically correct 'competency based' camp also has precious little evidence for policy of destroying everything except their own ugly child. How experience and time on the job can be replaced by shiny forms with numbered boxes is beyond me. It is also bizarre that those behind this 'competency based' approach want to try and nail down specific objective competencies for one and all, as if there is a magical point when a doctor passes the line of 'foundation 1 competence' and subsequently 'foundation 2 competence'; these lines are purely subjective and in trying to remove the human element of judgement, the whole process becomes a farce. We are human after all and in failing to acknowledge that medicine is a very human science, these educational fundamentalists are making a grave mistake. MMC is the spawn of the same flawed thinking, and if anyone doubts that there are greater powers at work: "I can confirm that the Department does also hold correspondence in relation to consultations between Government Ministers and interested parties, including expert advice in the development of policy in this area. However, the Department considers that this information is exempt from disclosure under section 35 of the Freedom of Information Act for reasons set out below. "Section 35 covers the formulation of government policy. While the Department appreciates that there is a general public interest in the availability of information about public sector activity, this must be weighed against the public interest in officials being able to provide frank advice to Ministers in an environment that is as free as possible from public controversy on issues about which opinions may be strongly held. In this case, we have determined that the balance of public interest favours withholding the information."(1) This is quoted from a DOH email reply to a freedom of information request. The response to the appeal is awaited. The point is that MMC is not about 'better training' and 'better patient care'; it is a politically motivated assualt on decent medical training that will only result in harm for doctors and patients alike. 1. DOH Email February 2007 Competing interests: None declared
Re: Raging against MTAS 15 March 2007
David M Lloyd, Consultant HPB Surgeon University Hospitals Leicester, LE1 5WW Send response to journal: Re: Re: Raging against MTAS	I am also outraged by the way the changes have been implemented. My excellent SHO's have been interviewed by non-clinicians without the souind knowledge of surgical training. The whole process is a farce and unprofessional. Many of the applicants have done a thesis (MD or PhD) yet this counts for very little in the assessment. In fact it accounts for similar points to someone saying that they had a good experience one day helping a patient! These are dedicated hard working competent surgical trainees who should not be swept away and rejected from medicine. All trainees with a thesis (and thereby 3 - 5 years post-grad training) should be given the opportunity to face interview and compete against their peers for a career in medicine/surgery. I want this MMC process abolished immediately. Competing interests: None declared
Stand up if you are still passionate about medicine 15 March 2007
Louise Pealing, SHO medicine Barts and Royal London medical rotation King George Hospital, IG3 8YB Send response to journal: Re: Stand up if you are still passionate about medicine	I am so heartened to see the wealth of opinion and passion on this website. I have never felt so demoralised in my place of work and with my career choice than the last 6 months and it is good to be reminded of the level of passion, motivationa and sheer intelligence and empathy of my profession. Thank you to the consultants who are finally speaking up and yes it is right that it will take the consultants with minimal conflict of interests possibly with both boots not firmly entrenched in the BMJ (British Medical Jamboree - but thank you for the website!) nor the Royal Colleges, to make the difference as we the juniors are fairly powerless in this whole debacle. I agree that those of us fortunate to have interviews or even the new academic training posts at reg level are not to sit back we are all in this together and just as vulnerable. It seems that the Establishment is well and truly hell-bent on destroying our profession, values, work-life balance, autonomy and possibly our numbers now too, even though all of us junior doctors are constant victims of cross-cover and missing out on leave. Who would become a doctor in the NHS? I am sad to say that should I ever have a family...if I am ever in the same region as my partner, then I would certainly discourage any new fresh eager mind. I do hope the Government are not fool enough to think we are "captive" to their whims. Yes I have spent many years training and yes it is my second degree but that does not mean I want to look forward to a future without autonomy, further training or hope of proper advancement, shift hours with no renumeration, service provision alone. I will simply sling my hook somewhere else and I would encourage my juniors to not be despondent about their prospects as they are highly employable within the educational, private or corporate sectors. The patients will suffer, and it won't be the "professional" patients who are all part of the patient select committee but instead the vulnerbale, the frail, the poor, those who already suffer. Those that we set out to help in the first place and those that the Government sweep aside when polling opinions or handing out peerages. I hope we all have the stomach for this fight and may I be so bold to suggest that we seriously think about strike action as this seems to work so well with our fellow public service providers. Those that say we would compromise patient care need to read all the other comments on this site and spend a day in an NHS hospital. I think if we don't take action we are ultimately not upholding best practise. We could provide the same cover as we do at weekends or bank holidaysfor 24 hours . We and the patients and the practise of medicine as it still stands will be the victims if we continue to dilly-dally and pray it all goes away and somebody else will sort it all out for us. Competing interests: None declared
In support of Raging against MTAS 15 March 2007
Charles N McCollum, Consultant Surgeon, Professor of Surgery The University Hospital of South Manchester, M23 9LT Send response to journal: Re: In support of Raging against MTAS	When I wrote to The Times with over 100 academic colleagues referring to the "pick a doctor by computer 'fiasco'" on 4th March 2006, we clearly warned that the MMC had absolutely no idea how to appoint doctors. Their subsequent initiative to appointing specialist trainees, using the MTAS, underlines this extraordinary level of incompetence. We should completely abandon this system before the end of this week. No more interviews should be conducted until the selection process can be seen to fairly reflect the qualities of our applicants. At the very least, this needs applicants to submit an application in which they are given an opportunity to highlight their strengths and weaknesses. This application should clearly be based on a Curriculum Vitae recording all previous qualifications, work experience, interests and whatever else the applicant thought should be brought to the attention of the selection committee. Competing interests: None declared
Raging against MTAS 15 March 2007
Denis Charles Wilkins, Consultant Surgeon Nuffield Hospital, Plymouth Send response to journal: Re: Raging against MTAS	We must learn from this debacle. The government is intent on marginalising the medical profession and has been doing so since the Griffiths report. MMC is just another opportunity, which we have naively allowed to take us further down this road by corrupting quite a reasonable idea to clean up medical training and regulate the SHO grade better. Who needs central applications? Only an organisation intent on central control, I suggest. Why, Oh why, did we let PMETB slip by us with scarcely more than a murmur? I am with the juniors on this and we should press for a complete halt to the system and reversion to deanery based appointments based on application and appointment. Applicants can then be allocated to ST1,2 or 3 as the deanery sees fit and as was conducted successfully during Calmanisation. If trainees wish to climb mount Everest, do research, work in a mission hospital and sail round the world before they apply then let that all be weighed in the balance. Many of our generation did just this and were all the better for it. I willingly lend my support to a full scale revision of this wretched, communistic political correctness that is MMC and PMETB. Competing interests: None declared
Re Raging against MTAS 15 March 2007
Rumana Chowdhury, SHO Neurology National Hospital for Neurology and Neurosurgery Send response to journal: Re: Re Raging against MTAS	Many thanks to Martin Brown and colleagues for taking a stand against MMC, the support or our seniors means a lot to us. These are desperate times. I wanted to add the specific point that the 2009 cut-off, that is that our SHO training, MRCP etc won't "count" from 2009. As such many of us will be stuck, unable to apply for any job relevant to the career we want to pursue, the career we have already dedicated so much time and passion to. I speak particularly for other Neurology SHOs like myself, who have no idea whether to embark on research now in fear that we will be completely stranded in a few years time, yet in reality have no other choice. The official advice of "consider changing specialty" just isn't an option for most of us. A limit of 2 years to fit into a new system which is so fundamentally flawed is simply wrong, and I hope everyone will keep pushing for this particular aspect of MMC to be overturned. Competing interests: None declared
all too predictable 16 March 2007
m m chebbi, SHO cardiff Send response to journal: Re: all too predictable	as someone from abroad, i have tried to understand how the public communities exist in the UK, and i give an example to state my summary: in the road where i live, i heard a very loud scream by a child at about 6 pm one day, and not one person got out of their houses to see what was happening. i have moved houses 4 times in 4 years, but not once have neighbours actually made an attempt to visit or find out who was living next door. the impotence, there is no better word, with which the royal colleges, bma, pmetb, etc, have submitted to MMC does not surprise me at all. perhaps it is because the best and the most intelligent people decided to continue making a difference by sticking to their clinical jobs.. and people who believe in care pathways and tick box systems as a way of ensuring quality patient care went on to design and MMC. if the people who were part of this huge enterprise did not envisage this catastrophe, i can only see 2 reasons: 1. low IQ levels 2. extreme disregard for the profession. let me explain low IQ levels: since the application is actually marked and data entered online, why are applicants not able to see their scores and how much they fell short of? providing feedback after round 2 when all the dust has settled is of NO USE to an applicant. one might want to ask me what i am doing here in this country and why? why? 1. my own ambitions to go abroad. 2. misrepresentation by GMC etc of opportunities in the UK at least until 2005. assurances of equal opportunites. a statement in the papers by the ex-health secy. alan milburn requesting non-uk doctors to come to the UK in 2001. it is my firm belief that countries like US, australia, canada etc clearly spell out options BEFORE letting in professionals. only in the UK do people talk about flexibility - so that they can do what they want in the end and twist their way around words to get around ethical issues. why are we now surprised that the government has done this on a national scale? i did not foresee anything else happening. the only silver lining is that it has not distinguised among nationalities of doctors not being shortlisted, at least in round 1. from my side, the MMC team deserve full congratulations for achieving their objective: massacre medical careers. Competing interests: None declared
New system of doctors training threatens UK clinical research 16 March 2007
Professor J Bell, President, Academy of Medical Sciences 10 Carlton House Terrace SW1, Professor Sir John Tooke, FMedSci, Chair, Council of Heads of Medical Schools Send response to journal: Re: New system of doctors training threatens UK clinical research	We are committed to the development of a professional medical workforce, able to contribute to national health, wealth and knowledge creation. To achieve this we must identify and nurture a strong cadre of clinical academics for the future, building on the opportunities afforded by the recent UK funding schemes. It has therefore been particularly disappointing that the new system of application to specialist medical training (MTAS) has paid scant regard to the determinants of academic potential. Academic trainees - those doctors wishing to pursue careers which encompass research as well as patient care - have been particularly badly affected by the decision to anonymise applications and deprive the assessors of details of previous clinical and research experience. These trainees, who are amongst the brightest of their generation, are a precious commodity. Without a scientifically informed and research-orientated medical workforce throughout the country, the government's vision of the UK as a world class centre for biomedical research and healthcare, cannot be realised. We welcome the Review of the application system which must include advice from the Medical Schools. It will be imperative to ensure that the next, and subsequent rounds, assess and give weight to educational achievement and potential, if we are to develop doctors who are at the forefront of biomedical research. Competing interests: None declared
MMC objection 16 March 2007
Sarah Wheatly, consultant anaesthetist South manchester University Hospital M239LT Send response to journal: Re: MMC objection	I agree wholeheartedly with the sentiments expressed in the multiply authored letter of objection to MMC, and am very happy to add my name to any petition. I am sure the vast majority of consultants in the country feel exactly the same. Whilst not involved in recruitment and selection (thank goodness) I have seen the anguish of both trainees and consultant collegues who are, and am flabbergasted that something so appalling has been allowed to happen. What can we do now? Is it possible to scrap the whole thing and go back to the drawing board? - but this time involve those who are experienced in medical recruitment and selection - and have a little more common sense and practicality in mind than whoever decided on MMC. Competing interests: None declared
What can we learn from MTAS? 16 March 2007
Robert J Howard, Professor of Old Age Psychiatry Institute of Psychiatry, King's College London, DeCrespigny Park, Camberwell, London SE5 8AF Send response to journal: Re: What can we learn from MTAS?	I share the outrage expressed by Morris Brown and the co-authors of his petition and, like them, would like to see the incompetent architects of MTAS taken to task. It became clear very early to those of us who underwent training for the short-listing and interview processes that the system was as flawed and unfit for purpose as we had been led to believe it would be from the information that had filtered through from Royal Colleges and Deaneries during the preceding 18 months. I'm ashamed that more of us - who realised that the Emperor was in fact completely naked - didn't kick up more of a fuss and hence allowed our Colleges to roll over and accept the process. Many of us took false comfort from previous experience that changes in titles and training systems often have only minimal impact on what happens to trainees. We were horribly wrong. What I have learned from MTAS is that we should shout out loud and early when we have concerns about initiatives that affect postgraduate training - particularly if, like MTAS - they fail a simple test of face validity. So, I wish to alert colleagues to my growing concern about the arrangements for quality assurance (QA) of postgraduate medical training by PMETB. Responsibility for QA of postgraduate medical training lay with the Royal Colleges until September 2005. The Royal College of Psychiatrists had been visiting every training scheme in the UK and Ireland at least every 4 years and as part of those visits interviewed all SHOs and SpRs. I was part of a PMETB Deanery Approval visit in 2006 during which it was clear that the focus for QA had shifted to the Deanery, rather than individual training schemes. Yet, PMETB's intention was still to visit every Deanery to examine training in every speciality every 5 years. But PMETB is not resourced to sustain even this reduced (compared to the old College-based system) level of QA. Next week I am going on a PMETB Deanery Visit during which assessment of the Deanery's performance on training in Neurology, Old Age Psychiatry, Psychiatry of Learning Disability, Clinical Neurophysiology and General Practice will be assessed in 3 days and used to determine whether or not postgraduate training in all specialties in that Deanery are to be approved for 5 years. I want to do what I can to support effective QA of postgraduate education in my own specialty and am delighted that Old Age Psychiatry has been selected - but I wonder how my surgical, general medical and other unrepresented specialty colleagues will feel about having apparently slipped off the national QA radar. I mean no criticism of the staff within PMETB's Approval and Visits department who are a professional and dedicated group, but I do wonder if in a few years time we will all be asking why we allowed something as important as the QA of postgraduate training to become so (in the current jargon) "light touch". Competing interests: None declared
An open letter to Patricia Hewitt, DOH; Prof Alan Crockard, MMC; Dr Keith Smith, MMC; Prof Martin Marshall, deputy CMO; Peter Rubin, PMTEB, Prof Carol Black (Academy of Medical Royal Colleges) 16 March 2007
David J Nicholl, Consultant Neurologist & STC Chair for Neurology (West Midlands) Queen Elizabeth Hospital, Birmingham, B15 2TH Send response to journal: Re: An open letter to Patricia Hewitt, DOH; Prof Alan Crockard, MMC; Dr Keith Smith, MMC; Prof Martin Marshall, deputy CMO; Peter Rubin, PMTEB, Prof Carol Black (Academy of Medical Royal Colleges)	An open letter to Patricia Hewitt, DOH; Prof Alan Crockard, MMC; Dr Keith Smith, MMC; Prof Martin Marshall, deputy CMO; Peter Rubin, PMTEB, Prof Carol Black (Academy of Medical Royal Colleges) Date 12/3/07 Dear colleagues We the undersigned are chairpersons of respective specialist training committees within the West Midlands and Northern deanery. We are fully aware of the problems that have occurred nationally with MMC, particularly with the MTAS computer system, long-listing and short-listing as part of round 1 of the application process. We believe that the recent statements of both the Academy of Medical Royal Colleges and the Department of Health are both misguided and likely to exacerbate the problems by failing to call for immediate suspension of interviews within round 1. In essence, since the DoH have called for an urgent review but failed to suspend interviews, this will immediately mean that any unsuccessful candidate will be able to make a legal challenge under existing employment law. There will be easily enough data from the interviews that have already taken place to get a measure of both the scale and nature of the problems. Round 1 of MMC has been the first implementation of this novel system, in effect a nationwide pilot study. We would urge that there is an immediate cessation of interviews so that precious time is spent analysing the existing data and also to prepare more fully for a more comprehensive long-listing, short-listing and interview process. Finally, we would stress that all of us want to see MMC work, but it is vital that all parties have the time for a proper application process to work in order for the nation to have the best trainees it deserves. Our patients deserve nothing less. Dr David Nicholl STC Chair Neurology (City Hospital, Birmingham) Dr Matthew Rogers STC Chair Microbiology (University Hospitals Coventry & Warwickshire, Coventry) Mr Rob Spychal STC Chair General Surgery (City Hospital, Birmingham) Mr Tim Graham STC Chair Cardiothoracic Surgery (Queen Elizabeth Hospital, Birmingham) Dr David Spooner STC Chair Oncology (Queen Elizabeth Hospital, Birmingham) Dr Jeff Bateman STC Chair Gastroenterology (Princess Royal Hospital, Telford) Dr Jennifer Short STC Chair Infectious Diseases (Heartlands Hospital, Birmingham) Mr Derek Skinner STC Chair Otolaryngology (Royal Shrewsbury Hospital, Shrewsbury.) Dr Timothy Williams STC Chair for Neurology & Programme Director- Northern Deanery (Newcastle General Hospital) Dr Graham Venables, President elect, Association of British Neurologists I would further add that since circulating the letter above it has come to my attention that the figures that DoH has been using (namely 30000 applicants for 22,000 jobs) are not correct. I was informed by an unimpeachable source on 8/3/07 that the correct figures are 33,000 applicants for 18,530 posts. I am aware that the DoH denied this figure today in the Daily Telegraph (12/3/07) but I have confirmed from my source that the 33,000 applicants for 18,530 posts is correct but all panel members were sworn to utilize the inaccurate figures. I find it impossible to have faith in a system which is based on deceit when we cannot be given accurate data. Since we sent this e-mail on 12th March, I am pleased to hear Ian Gilmore, President of the Royal College of Physicians using the correct figures (15/3/07). Competing interests: None declared
Alternative method of selection MCQ-CCS 16 March 2007
Srinivasan Ravi, Consultant Surgeon Blackpool, S.Ravi Send response to journal: Re: Alternative method of selection MCQ-CCS	I really, cannot believe, how the MTAS and MMC have subscribed to this psychological claptrap of assessing individual CV's with positive and negative attributes. This indicates extreme gullibility on their part and the presumption that HONESTY is all pervasive. My personal view is that a better system may be one with MCQ's conducted nationally. The top 'x' percent as determined by the process be moved on to assessment of what I'd like to call 'CCS' - Clinical, Communication and Skills. In this way we might do more justice than asking questions on an application process and deciding by psychological nonsense, knowing the answers to be untrue. It is only a few times that we can read how 'the Registrar missed the aneurysm and the applicant got it right'. IT JUST DOES NOT MAKE SENSE.. Ravi --- Competing interests: None declared
rage rage 17 March 2007
J. David leopold, consultant Physician swansea Send response to journal: Re: rage rage	Sir. The eloquent letter from our eminent colleagues needs no embellishment. This is nothing short of the worst disaster to befall British Medicine in my lifetime. I am a Selector, interviewer, senior tutor, and have anticipated the prospect of working with excellent trainees. But MMC is not designed to further the interests of patients, still less colleagues. It is designed to destroy professional control, and its envied presumed components of patronage, and elitism. Its incarnation is reminiscent of The Cultural Revolution, or in more extreme form, Pol Pot. Only when the shibboleths have been struck down can the State rule unchallenged. It is very evident that the architects of the dysfunctional apparatus remain silently. Whoever they are, they deserve to be pilloried. I march tomorrow in humble support of the profession in this country. This process must stop immediately, posts be extended, and proper consideration be given to a wholly new system which could command the support of the profession generally. Kind regards David Leopold Competing interests: Dynastic succession.
MTAS/MMC 17 March 2007
TCB DEHN, Consultant General Surgeon Royal Berkshire Hospital, Reading RG15AN Send response to journal: Re: MTAS/MMC	Dear Sir, The debacle surrounding the MTAS interview procedure has exposed one of many chinks in the ediface of both MMC and PMETB. Our junior doctors should understand that both the above are part of a subtle campaign to TRAIN as oppose to EDUCATE. There is a wealth of difference: achieving advancement by 'competency'is a world away from the same endpoint achieved by education. Many of the 'silent consultant body' eg those in the SACs, have consistently railed against the twin assaults of MMC and PMETB but our protests have been ignored and disparaged by those in high office. The 'old' British postgraduate education system had its imperfections, but no system can be perfect. It is pertinent to note that the Irish medical profession and DoH have refused to join their colleagues in the UK by retaining the 'old' system. They are now laughing at the complete shambles that we have permitted to replace a system respected across the world. Twenty five years ago the Sectretary of State for Defence, Lord Carrington, resigned on account of the fact that the department of which he was head had a major intelligence failure allowing the Argentinian invasion of the Falkland Islands to go almost unnoticed. Those in senior medical positions in MMC who have ignored the warnings and protestations of others who have devoted much time in postgraduate education should take a leaf out of Lord Carrington's book and resign their positions for, along with the rewards of leadership, come the responsibilities of accepting failure. This act would restore some lost faith of our juniors in the integrity of their senior colleagues. Competing interests: None declared
Re: New system of doctors training threatens UK clinical research 17 March 2007
Woody Caan, Professor of public health Anglia Ruskin University, Cambridge CB1 1PT, UK. Send response to journal: Re: Re: New system of doctors training threatens UK clinical research	Bell and Tooke have raised a vital issue for the future of academic medicine in the UK (New system of doctors training threatens UK clinical research, rapid response March 16th). The turbulence and unpredictability recently introduced into postgraduate medical training could make potential researchers more risk-averse and so reduce the pool of potential clinician-scientists. The key time to interest young minds in scientific research seems to be in late adolescence, where various links between teaching hospitals and schools have been shown to stimulate involvement. [1] Interestingly, this is paralleled by the Department of Health 'skilled for health' further education pilots to promote health literacy among socially excluded groups, even if learners begin with very low past educational attainment. The most convincing evidence comes from Stanford [2], although among adolescents one can not predict which area of science (e.g. biological or physical sciences) will benefit from this early stimulation - but some do enter medicine. In terms of catching the science fever, after entering medicine, a population of "late bloomers" who begin a PhD well along their career has been characterised [3]. Unlike Bell and Tooke's trainees who already have a PhD, these late bloomers are more productive and sustained in their research [4]. However, there is a risk of relying on these late starters to fill the need for academic posts, based on our study of academic health visitors they are the most productive but also have short academic careers and are in short supply. [5] [1] Rosenbaum JT, Martin TM, Farris K et al. Cam medical schools teach high school students to be scientists? FASEB Journal 2007; Epublication PMID 17351126. [2] Winkleby MA. The Stanford medical youth science program: 18 years of a biomedical program for low-income high school students. Academic Medicine 2007; 82: 139-45. [3] Ley TJ, Rosenberg LE. The physician-scientist career pipeline in 2005: build it and they will come. JAMA 2005; 294: 1343-51. [4] Kearney RA, Lee SY, Skaken EN, Tyrrell DL. The research productivity of Canadian physicians: how timing of obtaining a PhD has an influence. Academic Medicine 2007; 82: 310-15. [5] Hillier D, Caan W, McVicar A. Research training and leadership for midwives and health visitors. Community Practitioner 2007; 80: 28-30. Competing interests: Involved in supervising doctoral research.
Hidden meanings of MMC and MTAS 18 March 2007
Arun Natarajan, SpR Northern Deanery Send response to journal: Re: Hidden meanings of MMC and MTAS	MMC Medievalising Medical Careers Make More Confusion Mega Medical Catastrophe Mangle My Career Modern Medical Castle-building Making Medical Conundrums MTAS Most Talented At Storytelling Medical Training Application Snafu Mediocrity Trounces Apparent Superiority Mental Trick Assessment System Mark The Adventurous Seeker Markedly Twisted Assessment Structure Competing interests: None declared
This has been a long running problem. 18 March 2007
Chris Chung, Registrar ML8 5DY Send response to journal: Re: This has been a long running problem.	I was mysteriously dismissed from a Geriatric SHO post which I earned fair and square three months before I was due to begin in 2004 without ever being told why in writing and the BMA never got anywhere either. Now I know why. Jobs have been bleeding away for a long time, and it is getting worse. I applaud all the Professors above. I applaud all those who are taking a stand. Competing interests: None declared
"Howl, howl, howl, howl ..." 18 March 2007
Nina Newton Butler, SHO University College London Hospitals NHS Foundation Trust Send response to journal: Re: "Howl, howl, howl, howl ..."	As flies to wanton boys, are we to th' gods, They kill us for their sport ... (King Lear, IV, i: 36-37) Notwithstanding our action to date, who is listening? Who is watching? Where was TV news coverage of several thousand doctors marching in London and Glasgow yesterday? Why has there not been a single question about this fundamental issue on the BBC's Question Time? The answer can only lie in Dr Leopold's searing analysis (17 March) of our professional demise. As long as we do nothing more than tinker, we are complicit in the process of allowing ourselves to become no more than flies to wanton boys... I very much doubt that the consequences of Friday's Review Committee will be anything other than cosmetic. Can anyone really see interview panels being reconvened, and decisions already made being reconsidered? It is already several weeks into the process - by the time action becomes reality, the majority of ST posts for 2007 will have been allocated and the Review Committee's recommendations will at best be palliative. Without unanimous action from interviewing consultants NOW it seems that this wanton system, will perpetuate in the hands of boys who know no better. With regard to our wonderful profession in genral, and MTAS in particuar, let us not look back to say that we stumbled when we had eyes to see. Competing interests: None declared
MTAS is a symptom, not the problem 19 March 2007
Sean Monaghan, Final year medical student University of Birmingham B15 2TT Send response to journal: Re: MTAS is a symptom, not the problem	As a final year medical student, I feel somewhat underqualified to contribute to a discussion involving so many of our senior colleagues, who clearly display the same level of passion and anger that the juniors caught in this rat-trap at the moment - and my peers who will have to negotiate this perilous system in a couple of years - displayed in London and Glasgow on St Patrick's Day. Obviously, much of the focus of this outcry has been the immediate situation, namely the flawed attempt at converting the Calman system into MMC in one fell swoop. This is obviously a catastrophe, and the junior doctors caught in this mess have my full sympathies and support. Much of the opinion stated in the responses to Brown et al's letter[1] seems to have been against MTAS and its rushed introduction, rather than against the process of 'Modernising Medical Careers' per se. Frankly, if the system as proposed is introduced fully, people in my position stand to benefit. I have a fairly firm idea of what I'd like to specialise in, and I will be competing mainly with my peers when applying for ST1 posts. However, I have grave concerns about the nature of our postgraduate career progression. Rather than the meandering SHO years of the old system, where we could happily take standalone posts in whatever speciality took our fancy and work for six months to gain more experience for membership examinations or to try out a speciality before deciding on a final career path, we are now being forced into deciding our future a mere 18 months after graduating from medical school. What about the people that aren't sure what they want to do? What about the people that want to spend some time working abroad, or travelling, or reading postgraduate degrees, or researching? These questions have been asked, again and again, and the lack of open, honest answers from the Deaneries (probably reflecting the lack of open, honest answers from the MMC committee and PMETB) is deeply disturbing, in my humble opinion. In his letter[2], Wilkins mentions the benefit that this flexibility had on his generation and calls for 'a complete halt to the system'. I second this wholeheartedly. Even at this early stage, I can recognise that experience is a far better learning tool than competency- based teaching. It is very heartening to see such resounding support from our professors and consultants. Please, though, don't be satisfied with your efforts so far. The entire system is flawed; our collective silent apathy has allowed this malignancy to anchor itself in the heart of our profession's future and grow unimpeded. The time for half-measures and off -the-record opposition has passed. References: [1] Brown MJ et al. Raging against MTAS. BMJ Rapid Response. 7th March 2007. [2] Wilkins CD. Raging against MTAS. BMJ Rapid Response. 15th March 2007. Competing interests: None declared
The Image of our Health Service 19 March 2007
Janna V Joethy, MSc student University College London Send response to journal: Re: The Image of our Health Service	It is good to see that some of the senior consultants have joined in with this debate and it was reassuring to see 12000 other doctors on the recent march. MTAS has recently attracted a lot of bad press. There is too much at stake to just ignore this. The British medical training and the NHS used to be held in high regard by health care workers from other countries who considered it "world class". The bad publicity in recent years of the NHS and the current MTAS fiasco is only going to make matters worse. Apart from the damaged image of the NHS and MTAS, something needs to be done to save a very disheartened group of doctors and the patients who will eventually suffer if this system is not checked. Competing interests: None declared
Raging against MITAS 20 March 2007
stephen g wright, consultant physician, hospital for tropical diseases, uclh nhs foundation trust mortimer market, london wc1e 6jb Send response to journal: Re: Raging against MITAS	The initial aim of modernising medical careers (MMC) was laudible; that every junior doctor's post should be in an established training programme with aims and objectives. What was not apparent to me at least was how this process should relate to specialist registrar (SpR) training in, for example, mainstream specialities such as medicine and surgery and how both MMC and SpR training should relate to entry into sub-specialty training. Was, for example, general acute medicine training to be completed first with some electing to remain as acute medicine specialists while others sought sub-specialty training? It appeared so for a while and then not. Rapid evolution has led to a system of selecting trainees for combined sub-specialty and general training but at a much earlier stage of their career and experience than applied in competition for national training numbers. It appears odd that selection for postgraduate medical training, as currently organised, leads to major career decisions very early after graduation with comparitively little clinical experience and exposure. Particularly when, in relation to schooling, restrictive choices at early stages of school career are viewed as a bad thing. The process newly instituted for selecting trainees uses a method that did not seem to have been carefully assessed by canvassing the views of junior doctors and those who have been recently involved in recruitment before starting it nationally for real. The method chosen actively prevents the use of previously accepted, useful criteria such as markers of academic excellence and encourages the use of dubious practices that are similarly employed by students seeking undergraduate university entry. Profesor Morris Brown and many others have decried the recently launched selection process and I would join them, demanding that the recruitment process be urgently reviewed. Change and change and change again has been visited on the health service. Our junior doctors and our patients deserve better than MITAS mark I. Competing interests: Being sufficiently old that I may need the ministrations of junior hospital doctors for some life threatening emergency and so want them to be the best there are.
Help finding a solution rather than criticising 21 March 2007
SREEDHAR KOLLI, SpR cardiff Send response to journal: Re: Help finding a solution rather than criticising	Dear Sir/madam, I understand and support the huge amount of dissatisfaction from eminent members of medical profession. My question is why didnot all this experienced brains think and act before daring to ask the government before MTAS and MMC went nationwide.The idea of MTAS and MMC didnot happen overnight .The idea of MMC was born couple of years ago and why didnot you think of your trainees and training programme . Even today ,I can challenge some of you donot bother to look into the training needs of trainees and donot bother to teach them enough nor bothered to relieve them for teaching.All these elite didnot bother to anticipate .You donot want best doctors for NHS but to oppose any change. Why were you quiet when best and deserving overseas doctors faced immigration hurdle with visa regulations .The world is closely wacthing the disintegration of medical profession in a country which was considered best in world once upon a time.NHS is the best system of holistic patient care in the world.I have seen India which provides better training to doctors with scarce infrastructure and USA with better training with advanced sophistications .But feel NHS provides best holistic patient care pampering patients but deteriorating training standards. Let us not cry over the spilled milk.Then what are the solutions.Computer based system is time tested and successful in USA for recruiting residents then why should not it work in UK. We only need to make changes in criteria for shortlistings and needs doing by experienced same speciality External deanary consultants and not Medical staffing or Managers to eliminate bias. 1.As patient care is our top most priority selection should be based on experiance and qualifications in that particular field giving them more marks than personal statement .Unless I have given my MRCS exam I never got a broader idea and confidence in understanding basic surgical facts. 2.I donot agree publications/research should be given more marks in any of ST shortlistings as it is difficult for a for trainee to acheive core competancies in short period and carry on research in a unsupportive environment. 3. Portfolio is a good thing to put pressure on trainee and the trainer.It deserves support and helps the trainee in long run. 4.Name and visa status should be blinded to shortlisting committee. 5.Finally referees should be only asked to give structured referance as in MTAS. Competing interests: None declared
Raging against MTAS 22 March 2007
John B Cookson, Director Medical Education Unit Hull York Medical School Send response to journal: Re: Raging against MTAS	I write as the Director of the Medical Education Unit of one of the new medical schools. I therefore have no direct responsibilities for postgraduate education but the students do make me aware of their thoughts about their future particularly as they approach graduation. Here is what Jessie Morgan, one of the most able, wrote in a reflective essay recently (quoted with permission). 'I have always been passionate about medicine and ever since starting medical school I have gone the extra mile to make the most out of the learning opportunities offered to me. Medicine has always been my vocation and I have never contemplated doing anything else, not since the age of nine years old when I stopped wanting to be an actress! It therefore surprised me last week, when I found myself pondering over whether medicine was really the right career for me. This doubt was sparked by the huge MTAS application for specialist training fiasco. A friend of mine who is a surgical SHO, who has given me some of the best teaching I have ever had, sent me a text saying “I’m jobless… goodbye Great-Britain.” I could not believe it. And then it became apparent that 8000 other junior doctors were in the same devastating position. I simply cannot begin to understand how the system of recruitment can have gone so drastically wrong, leaving some of the best doctors unemployed. If I had done 8 years of medicine, spent hundreds of pounds on membership exams, won prizes and got publications, worked on Christmas day for 3 years running, I would certainly think that I deserved to be treated better than being rendered unemployed. And so, as I contemplated the fate of these poor juniors across the country, I also began to contemplate my own fate. What is going to happen to me when I qualify? Am I going to be guaranteed a job? If so, for how long? What would I do if I were in this situation? Go abroad? Give up medicine? Before medical school I wanted to be a paediatrician, for no other reason than I loved young children. After a short time at medical school it became obvious to me that surgery was going to be my career pathway and that being a woman would most definitely not get in the way of that. However, I have more recently become more confused over what I want to specialise in. I am pretty sure that I would rather do hospital medicine, and if I were to go into general practice it would be for the wrong reasons ie lifestyle choice, the lack of compulsory on-call and weekend work etc. I thoroughly enjoyed the paediatric block and found the work fascinating, and am now contemplating it as a potential career pathway. As a result I have organised a self-proposed SSC in paediatric diabetes to get some extra exposure to children with a chronic disease. However, how can I be sure that paeds may be what I want to do for the rest of my life? How can I be sure that I will even have a job in a few years time? Then I started thinking about where I would be in a few years time. At what point will medical training give me any stability? For the forthcoming years and for as long as I can imagine, if I am to continue in medicine, I will be on constant rotations. These rotations may well be as long as one year, but that is still a rotation. Will I be able to settle down, have children and enjoy being with them before I get to consultant level? Thinking about all these things has in fact perturbed me. I find it sad to think that someone like myself, who was so motivated, so enthusiastic about medicine, has been contemplating whether or not it is worth continuing in the field of medicine, just because the government has installed new policies for post graduate medical education and job applications. Things that appealed to me in medicine are slowly being taken away- the options of testing and trying numerous specialities before committing to one particular one, the fact that patients on the wards trusted you because they knew you. However I have realised why this situation has upset me; without medicine I would feel empty, like part of me had ceased to exist. Medicine has become such a big part of my life and I enjoy it enormously. To be told from one day to the next that the UK could no longer provide me with a medical training post would be truly awful. So no matter how many doubts I have had over the last week, I have come to the conclusion that I would be incapable of giving up medicine, be it by choice or because I was not offered a job in the UK.' Competing interests: None declared
Open letter to Professor Crockard 25 March 2007
Matt Davies, SHO Surgery King's College Hospital, London Send response to journal: Re: Open letter to Professor Crockard	24th March 2007 Dear Professor Crockard, I write to express my grave concerns regarding the latest guidance from the MTAS review panel (Friday 23/3). An undoubtedly flawed system has now turned into a farce. I was one of the ‘lucky’ ones. After coming from a Welsh valley comprehensive school I went on to achieve an Honours degree in Physiology from King’s College, was elected President of King’s College London Students’ Union, left Guy’s, King’s and St.Thomas’ medical school with distinction, medals, prizes and published papers. I have instructor status in three life support courses and am just finishing my London teaching hospital surgical rotation. When I applied through MTAS (Medical Training Application Service) for an ST1 post in Emergency Medicine I took a week off work to fill in my application form. I spent close to forty hours producing an application that I was extremely proud of. It reflected who I was and what I had achieved. I was subsequently shortlisted in four Units of Application (the maximum). I was, of course, thrilled. I felt that I now had a very good chance of realising my ambition to become an Emergency Medicine trainee. Today, I don’t feel so good. I was going to write yesterday but I was so apoplectic with rage after reading the review panel’s recommendations that I thought it not productive. Instead, I now feel upset, concerned about my future career, wondering where I am going to spend the rest of my life, about having to leave my friends in London and, most importantly, really let down by those who I thought were there to protect us, our training and ultimately the safety of our patients. This includes you, Sir. My main concerns are as follows: ‘Independent’ review panel On Tuesday 6th March the Department of Health announced an ‘independent’ review of Modernising Medical Careers (MMC) and the Medical Training Application Service. I ask the question that how can a panel be ‘independent’ when it contains Professor Alan Crockard, who, as MMC National Director was instrumental in rolling out MTAS and Mr Keith Smith (MMC programme lead)? Their inclusion is of great concern. The role of the Royal Colleges. I note Professor Douglas’ (President of the Royal College of Physicians of Edinburgh) comments that "I am also personally very annoyed that there has been negative spin blaming the Colleges for being party to designing the MTAS process.” I am very concerned about this statement. If they were not party to the designing of the MTAS process then they should have been. And, it was their responsibility to ensure that they were party to what was going on. That they are trying to portray themselves as Knights in shining armour coming to our (their trainees) rescue after the event is absolutely outrageous. Abandonment of shortlisting Professor Ian Gilmore states that “the shortlisting process was so seriously flawed that it could not be relied on to select candidates for interview fairly.” These words really undermine my achievement of being shortlisted in four areas. I feel that I am a good candidate and deserved to be shortlisted on the basis of my achievements, qualifications and, yes, how I answered the questions on the application form. But now I am being penalised for my efforts. The hours and hours spent developing answers to those questions, it turns out, were an utter waste of time. We are now giving everyone an interview at their first choice Unit of Application despite the fact that there is huge discrepancy between qualifications, experience and achievements. What an absolute waste of time for consultants, candidates and deaneries. What other organisation would offer everyone an interview without candidates being shortlisted? Now, instead of being one of, say forty, shortlisted for twenty jobs there will be perhaps four hundred competing for those posts. Discrepancies in the interview procedure I have already attended three interviews. I have spent day’s off work traversing the country from Bristol to Leeds to Manchester. I have my final interview in London next week. Attending interviews has been of significant personal financial cost. I have spent hours preparing diligently for each one, updating my portfolio and yes, gone through the emotions of apprehension and anxiety. Yet again, for what? These interviews have been a complete waste of time and will contribute nothing as I will no longer be allowed to have a second, third and fourth choice if I am unsuccessful in London (my first). More importantly, it has been a waste of time for those consultants who have spent hours interviewing me instead of carrying out clinical commitments and caring for our patients. It also transpires that candidates will now be able to show the panel their CV and that this will form part of the assessment process. Consequently, ‘new’ candidates who were not previously shortlisted will be assessed in a different fashion to the previously assessed candidates for the same position. This is unfair. I respect the fact that the deaneries should be satisfied that ‘there should be no significant difference between interviews or a new round one should be instituted’ however, this would involve me potentially having to go back to say, Manchester, for another interview for the same job! Do you not think that we have better things to do? You may have forgotten, Sir, but interviews are an extremely stressful process and are not experiences that are taken lightly. Patient safety This new process cannot be good for patient care. The thousands more interviews required take consultants off the shop floor and leave trainees having to take even more days off leaving other colleagues or locums to cover their workload and care for their patients. Undoubtedly, these developments are yet another stressor for junior doctors and contribute to us taking our ‘mind off’ the real issue at hand - providing the best quality care to our patients. In conclusion we as junior doctors have been treated appallingly. We have been let down by the Government, the Department of Health, those at MTAS and the Royal college’s. Yet, who is going to take ultimate responsibility for what has happened? I was asked at interview recently ‘Dr Davies, define probity.’ I answered that it was all about being honest and having integrity, of taking responsibility for ones actions and holding your hands up when things go wrong. It is expected of us as juniors and is a fundamental facet of being a good doctor. I do not wish to question your probity, Sir, but someone should take responsibility for this fiasco. I await your response. With best wishes, Dr Matt Davies BSc (Hons), MBBS (Dist) Competing interests: None
Open Letter to the MTAS Help desk 18 April 2007
Matthew T Piccaver, F2 Public Health Medicine Suffolk PCT Send response to journal: Re: Open Letter to the MTAS Help desk	Dear Sir or Madam I understand this is not the fault of your good selves on the help desk, but the whole MTAS application process has been a complete balls-up from the start. I have no doubt much midnight oil has been burnt to rectifty the problems, and for that I am grateful. The whole process has resulted in so much uncertainty. Do you know if you can pay your mortgage in August, because I don't. Imagine a situation where the nation has spent millions of pounds training people to serve the public, only to present them with the prospect of penuary in a few months time. Seems like a waste of tax payer's money. If they have too many doctors stop training them, and stop importing them from developing countries that desperately need them at home. Now, many of us are fairly intelligent, reasonably well qualified people, and will undoubtedly have some form of work come August, but potentially not as a doctor. I'm trying not to whine as I'm in a fairly fortunate situation. There are plenty of people worse off than me, and this is something none of us should forget. I don't have to walk twenty miles a day for clean drinking water, or worry about where my next meal is coming from. But it doesn't stop me being worried about my future, and that of my collegues. Most of us who entered medicine want to help people. That's it! Sounds corny and cliche, but its the truth. Trouble is, we ran up a bucket load of debt in order to do this, so we need to keep on working. An unfortunate side effect of higher education in the UK. I just wanted to thank you for trying to fix things, it\'s probably not that easy. I have no doubt you have received many emails to this nature. Kind regards Matt Piccaver I suspect you've had countless letters like this, so I don't expect publication. Yours sincerely Dr Matt Piccaver F2 Trainee in Public Health Medicine Competing interests: None declared
Re: Open Letter to the MTAS Help desk 22 April 2007
Art G O'Malley, Consultant in Child and Adolescent Psychiatry and Clinical Lead Knowsley CAMHS The Wellcroft Centre Wellcroft Road Huyton Merseyside L36 7TA Send response to journal: Re: Re: Open Letter to the MTAS Help desk	The review group must be informed of the Chaos within the MTAS help desk. I submitted a Query 8 days ago to which the help desk has refused to reply. Have you all had the good sense to vote with your feet and refuse to cooperate with this fatally flawed unjust and not fit for purpose system. Do you wish to be the generation of civil servants who presided over the disintegration of patient health care built up over the last 60 years in the NHS? Competing interests: None declared