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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
A small but important correction
- Andrew Clegg (22 April 2007)
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MTAS where are we now
- John B Cookson (28 April 2007)
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Learned Helplessness: Doctor's in the MTAS experiment?
- Asif M Bachlani (4 May 2007)
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Learned Helplessness
- Oliver R Dearlove (6 May 2007)
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Re: Learned Helplessness
- Tony Delamothe, Tavistock Sq, London WC1H 9JR (7 May 2007)
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Andrew Clegg, SpR Geriatrics Yorkshire Deanery, LS2 9JT
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In her snapshot of the ongoing MTAS/MMC debacle (1) Colleen Shannon includes a flow diagram to illustrate the new MMC system as compared to the old training ladder. What appears to have been a minor oversight on her behalf gives the opportunity to expand on one of the most concerning aspects of the MMC ladder for current and future trainees. In Colleen Shannon's article, the 'new system' has a Consultant post as the aim of specialist training after the Certificate of Completion of Training (CCT) is gained. This is in comparison to the explanation of the MMC career framework provided on the MMC website (2) where 'Senior Medical Appointment' is resident. The small print provided states 'These may cover, for example, GP principals, other employed GPs, consultants, or other specialist roles. These will be determined by the service.' This seeming small, deliberately underplayed information has huge implications. Poor workforce planning and underestimation of the extent of extra work undertaken by the Consultant body when negotiating the Consultant contract have meant that the Government is now entirely unable to financially support the Consultant led NHS that it promised in the New Labour NHS plan. This problem, coupled with the constraints of the European Working Time Directive (EWTD) combined with the demands of Clinical Governance have led to the 'Senior Medical Appointment' role being ghosted into the Consultant post at the pinnacle of MMC. This gives the Government considerable power over CCT holders who will be forced to accept 'Specialist' posts in a Subconsultant grade with re-negotiated terms and conditions to suit a Government wounded by their own financial incompetence who will ensure that they have us over the proverbial barrel. Equally concerning is the final line of the small print that accompanies the MMC ladder. 'These (roles) will be determined by the service.' This deliberately obfuscated sentance needs further clarification. Essentially CCT holders will be employed on terms that suit the Government and in 'Specialist' (Subconsultant) roles that are set out by the service requirement of the individual trust to meet the excellence demanded by Clinical Governance and the 24 hour shift patterns that accompany the EWTD. Another kick in the teeth for trainees undergoing the misery of the current situation in medical training. We have been kept entirely in the dark by the circumstances surrounding the machinations of MMC and MTAS and that is why we are in the present mess. Perhaps there is still time for a little light to shine through, and this cloak-and-dagger sleight of hand that the Government has played can be attended to. (1) C Shannon. MTAS: Where are we now?. BMJ 21 April 2007. 334, 824-825 (2) Modernising Medical Careers Website. www.mmc.nhs.uk Competing interests: None declared |
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John B Cookson, Director Medical Education Unit Hull York Medical School YO10 5DD
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An issue that seems to have been relatively overlooked in this discussion is the changed status of the selection process. The old system of CVs and interviews was equivalent to a series of low stakes examinations. If you didn't get the post you were after there would be another in the BMJ next week. If you failed in a number of interviews for the kind of post you wanted, you revised your ambitions. The new system of a single annual event is a high stakes process; equivalent to a finals examination with any prospect of a resit a year away. All the questions that have been raised against it therefore are those that would be asked of an examination process; is it valid (does it test what we want it to?) and reliable (reproducible)? One of the best ways to improve the functioning of examinations is to lengthen them. It needs to be asked if any 'one off' process of selection for the number of posts involved can ever be valid, reliable and also practicable? Competing interests: None declared |
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Asif M Bachlani, SHO in Psychiatry Melbury Lodge, Queens Road, Winchester, Hampshire SO22 5DG
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During a recent balaint group attended at my local posting we were talking about the recent malaise, poor motivation and malaise that was being felt by most of the junior doctors. This was all related to the MTAS fiasco which apart from most of us facing unemployment in august has recently led to personal details being available to all online. As the discussion progressed it became apparent that most of us felt so much despair and dejection about our chances of success in the upcoming interviews. It is a common belief that no matter what we did to improve our chances that success in this MTAS system was outside our control. That any current efforts put in made no difference and thus we should all give up. This as I'm coming up to taking my MRCPsych part II exams made me think about Martin Selegman's Dogs and "Learned Helplessness". This is as you recall is the situtation where the dogs were placed in harnesses and given electric shocks. The dog who received shocks but his lever didn't stop the shocks learned to be helpless, and suffered chronic symptoms of clinical depression. The follow up experiment gave the dogs a warning via a light 10 seconds before giving a shock with the task of jumping over a low barrier to escape such shocks. The group of dogs who had "learned helplessness" from the previous experiment, they just lay down and whined, and even though they could have escaped the shocks, they didn't try. To put this in context to us junior doctors in 2007 many of us love being doctors and enjoying our profession immensely. We have lost any motivation or drive to jumping this barrier ("getting a training post in the MTAS system"). The old mandate of being a good doctor where we show good competence in managing our patients as well as been trusted and respected by our consultants just seem to lead us to electric shocks. As no matter what we seem to do on a regular basis won't improve our chances in this MTAS system. The Holy Grail of passing exams ("the light warning") giving us the chance to jump over this hurdle seems almost irrelevant as this no-longer seems to guarantee any of us a job. Being a paranoid person one could think that this was deliberately done by those in government to cause "learned helpless" in us junior doctor so that with our daily pressures we accept anything and everything the government offers no matter how unreasonable or unacceptable the situation is! References: Petersen, C., Maier, S.F., Seligman, M.E.P. (1995). Learned Helplessness: A Theory for the Age of Personal Control. New York: Oxford University Press. Competing interests: None declared |
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Oliver R Dearlove, Consultant Anaesthetist Royal Manchester Children's Hospital M27 4HA
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Certainly the Editor of the BMJ is showing this phenomenon of learned helplessness. The reporting of the MTAS fiasco in this journal has been pretty abysmal and I link this to the fact that there are no knighthoods in doing so. Doctors should access Doctors net for up to date information as it unroles. You can for example find there the U-tube URL of Phil the Heckler heckling P Hewitt on question time. Here in the BMJ we are treated to a digest of how well the government is doing in all this. Oliver Dearlove Competing interests: None declared |
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Tony Delamothe, editor in chief, bmj.com BMA House, Tavistock Sq, London WC1H 9JR
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Because of the compexity of the issues involved, and the speed at which events unfold, most of our coverage of MTAS appears on bmj.com. In the second column on the home page, there is a dice logo and an invitation to "Read story as it unfolds." Following the link http://blogs.bmj.com/category/comment/mtas/ takes readers to 27 entries. From time to time we update readers of the print journal with developments. There's another analytic piece planned for a fortnight's time. Competing interests: None declared |
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