Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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some noise
- benjamin dean (15 December 2007)
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Required Reading for would be medical students
- Michael A Apple (16 December 2007)
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The bottom line!
- vasudevan c jaidev (16 December 2007)
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The future of trainee doctors
- Robert A Price (18 December 2007)
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MTAS fiasco: the lack of validity of the process above ST1 level
- Paul J. Whelan, Maja Meerten and Prof. Dinesh Bhugra (18 December 2007)
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The Abandoned Tribe
- Peter G Davies (21 December 2007)
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Better late than never, but the later the worse.
- GH Hall (7 January 2008)
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benjamin dean, sho oxford
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As professor Marshall states, the rewards from medicine can be great, obviously this depends to some degree on how keen one is too satisfy one's masters. Professor Marshall repeats the tired argument about competition that has been used by many proponents of MMC as a kind of smokescreen; by this I mean that competition is nothing new to doctors, what is new is the fact that the rushed MMC reforms are forcing a large bulge of trainees to compete for a very small number of training places, and if unsuccessful they risk being brutally frozen out for good. This problem was eminently foreseeable but ignored by the railroaders of MMC. It was also compounded by handing out hundreds of run through posts last years based on a deeply flawed process, rather than going for the sensible option of waiting for a reliable selection process before handing out large numbers of run through posts. I do not buy Professor Marshall's continued attempts to defend the MTAS process "though emerging evidence suggests that the recruitment process was more discriminating than many critics have claimed"; some deaneries managed to select good candidates largely because they ignored the nonsensical straight jacket of MTAS' rigid interview protocols. The worry about the sub consultant grade that many of us have is that it will worsen the two tier nature of care that patients receive from the NHS. Given current financial pressures and the expense involved in training doctors properly; there will be a pressure to cut back the number of properly trained doctors, which will have a negative effect on standards of patient care. Personally I have never found it acceptable to have one group of doctors who are not supported or trained to the same extent as the other; it is unfair on both the doctors and on their patients. There has been a very real debate about many of these issues in the medical profession for a while; it is just that those in positions of political power have frequently chosen to hide from these doses of reality. The profession is trying to respond from its grass roots, and as the Tooke review pointed out there is a grave problem as regards the leadership of the profession; surely this problem must lie fairly close to Sir Liam's office in the Department of Health? Either way it would be sensible for those that lead to listen to the 'noise', to quote Professor Marshall from his recent interview with the Health Committee when asked whether the same numbers of the profession wanted MTAS continued or scrapped: "Not on volume, not on noise, certainly not, the people who wanted it stopped were making a much louder noise" The noise of the majority was ignored last summer, and in my opinion it is precisely this kind of error that would be avoided if the medical profession was lead properly in a way that best represented its members and their patients. All junior doctors should be trained, or does Professor Marshall really think that a two tier system of the trained and untrained is fair on patients? Competing interests: None declared |
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Michael A Apple, GP Garston Medical Centre Watford WD25 9GP
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Professor Marshall appears still to believe that MMC and it's baleful progeny MTAS is a triumph much as the person falling from a tall building passes the 10th floor and can still say "So far, so good". He concludes his article with the advice that "Medical schools and professional bodies need to rise to this challenge". Indeed they do. They can start by warning applicants to medical school that after 10 years or so of training their future prospects will be decided by a process that excludes any hint of their abilities and achievements in favour of how good they are at plagiarising politically correct attitudinal statements off the internet. After such sifting of talent as this may provide, they should then be prepared to count themselves lucky to have a job anywhere within the NHS and that's that for the next 30 years. Oh by the way, we still expect you to display the utmost professionalism or we'll erase you from any future work via our surveillance systems. It would be interesting to see what evidence Professor Marshall has for asserting that "other professions must look on with envy" at these "benefits". More likely with incredulity. The analogy with other professions and careers is fundamentally wrong. It is clearly the case that not every lawyer, accountant, copywriter etc can secure a job with a top firm. But what they can do is find their level within the hundreds of other firms and opportunities in the market. Training for medicine in the UK is effectively training for a monopoly employer and Professor Marshall's article as well as the pronouncements of others justifying MMC and MTAS show the dirigiste and dismissive attitudes which that monopoly engenders in those who are thus wielding total power. And so I hope medical schools will follow Professor Marshall's advice and that similar reading be sent to anyone contemplating medicine as a career. This choice, they should understand, will offer success to a few and to the rest despair and disillusion within a system that will squeeze every bit of dedication out of you and then discard you on a fashionable whim and with barely muttered regret. For the sake of those thousands of able, idealistic people who do still see medicine as a worthy, rewarding and, yes, dificult career choice, Professor Marshall and others must think again. They have to find a way that brings on the best without quite so obviously dumping the rest. Competing interests: None declared |
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vasudevan c jaidev, consultant scarborough hospital yo12 6ql
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"Postgraduate medical education is now firmly on the agenda of ministers, policy makers and National Health Service Managers" Says it all doesn't it? Competing interests: None declared |
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Robert A Price, SpR4 anaesthetics Southmead Hospital, Bristol BS10 5NB
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Martin Marshall is quite wrong when he says that all junior doctors expect to reach the top of the profession by becoming consultants or principals in general practice. Achieving this merely signifies the end of our training and the beginning of our careers, not the pinnacle of the profession. We do reasonably expect that our job prospects should be enhanced by the 10 to 15 years we have spent in training, rather than diminished. If the government wants to staff the NHS with less well trained doctors for less money, then they should just say so instead of misrepresenting us as expecting unfair advantage over other professions. Competing interests: None declared |
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Paul J. Whelan, Specialist Registrar in Psychiatry South London and Maudsley NHS Trust, North Southwark CMHT for Older Adults, London SE16 2TH, Maja Meerten and Prof. Dinesh Bhugra
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Marshall’s recent BMJ editorial about the future for trainee doctors was both timely and insightful (1). It correctly highlighted the increased competition for specialty training (ST) jobs in the fallout of Modernising Medical Careers. Marshall implies that the Medical Training Application System (MTAS) was more valid and reliable than is commonly perceived by the medical profession on the basis of “emerging evidence [which] suggests that the recruitment process was more discriminating than many critics have claimed.” Without the benefit of reading the unpublished report (2) upon which Marshall’s claim is made it is hard to truly comment. We are not sure whether the author of the report was involved in the development of MTAS. However, the results of published evidence question the validity of the MTAS short-listing process (3). Of the 101 trainees on two highly sought-after London psychiatry senior house officer rotations we surveyed during the MTAS application process, only 60% were short-listed. Subsequently, the MTAS Review Group abandoned the short-listing process as it was deemed flawed, and offered all applicants an interview in the deanery of their choice. Whilst some evidence exists that the interview component of the selection process at ST1 level has a high degree of validity and reliability (4),this may not be transferable to other levels of training (5). This is particularly pertinent to the psychiatry trainees surveyed, who had been appointed following competitive interview using a validated and standardised assessment tool prior to MTAS (4). In a follow-up survey, 36% of the sample failed to obtain a training post through MTAS (6). Quite rightly, many respondents who were unsuccessful felt deeply unhappy that they were left with no training job, especially because they were already in the middle of their training process. We applaud the recommendations of the Tooke report (7), as does a majority of the respondents to the survey who commented on the interim report. However, this is probably cold comfort for the former trainees who continue to pay the price of the MTAS fiasco, and the worry is that it will get worse before it gets better. We urge the leaders of the profession to work together to speak with a united voice for the sake of a generation of trainees which is feeling increasingly alienated. References: 1. Marshall M. The future for trainee doctors BMJ 2007;335:1222-23 2. Carr A, Patterson F. Evaluation of short listing data. Education South West (Peninsula Institute). 2007 June 14. (Unpublished report). 3. Whelan P, Jarrett P, Meerten M, Forster K, Bhugra D. MTAS fiasco: lessons for psychiatry. Psychiatr. Bull 2007;31: 425-27. 4. Rao R. The Structured Clinically Relevant Interview for Psychiatrists in Training (SCRIPT): A New Standardized Assessment Tool for Recruitment in the UK. Acad Psychiatry 2007; 31: 443-446. 5. Patterson F. Fiona Patterson replies to Parashkev Nachez. BMJ 2007;335:802. 6. Whelan P, Meerten M, Rao R, Jarrett P, Bhugra D. Stress, lies and red tape. The views, success rates and stress levels of the MTAS cohort. 2007. (Unpublished). 7. Tooke J. Aspiring to excellence. Findings and recommendations of the independent inquiry into Modernising Medical Careers. 2007. London: Aldridge Press. Competing interests: P.W. gave a talk on MTAS funded by Janssen-Cilag; M.M. was an MTAS applicant; D.B. is the Dean of the Royal College of Psychiatrists. |
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Peter G Davies, GP Principal Keighley Road Surgery, Illingworth, Halifax. HX2 9LL
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Ronald Reagan gave us the useful maxim that the most scary phrase ever was, "I'm from the government and I'm here to help." So the news that post-graduate medical training is on the agenda of ministers and N.H.S. policy wonks is deeply worrying. M.M.C. and M.T.A.S. has been a disaster for UK medicine. The Tooke Report may claw something out of the wreckage. It now looks as if we have to tell medical students coming through that a large number of them will do their studies for nothing. Medicine is a long and hard training, both emotionally and intellectually. It costs the taxpayers a significant amount per graduate, and it costs the graduates themselves too in fees and large debts payable on graduation. Apparently M.M.C. was introduced to solve the problem of the “Lost Tribe.” It seems to have achieved this by creating an Abandoned Tribe, of unemployed young doctors who cannot even get their medical careers started. To suggest that we should return to “a pyramid rather than a square” for medical careers suggests a return to the old days of time expired registrars and senior registrars that was so familiar to doctors over 40 during their training. M.M.C. seems to be taking us back to the very problems (lost juniors, capricious selections, ill defined selection criteria) that it was supposed to be an answer to. I note that Professor Marshall has just left his post as Deputy C.M.O. How much longer can the C.M.O. himself stay presiding over this appalling and inhumane mess of his own creation? Competing interests: None declared |
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GH Hall, Retired Chairman Central Manpower Committee. EX1 2HW
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When asked for comments on the contemporary world, the novelist Anthony Powell declared "Rage, contempt, and despair." The neglect of the agreed measures in "Achieving a Balance" (in medical manpower) tends to make one agree. The present disaster was predicted and avoidable. Vested interests in academe, the colleges and the Department of Health combined and conspired to suppress prophylactic measures. They cannot be trusted to behave any better now. The BMA abandoned its protective role but is the only organisation which has shown any contrition or determination to do fairly by the whole of the trainees- meaning, all of us. There is a remedy- as desperate as the desperate situation demands. There must be an immediate reduction in medical school input and immigration of medical graduates of, say 50%. The ineluctable rule of manpower planning that the numbers in each grade must be in the same proportion as the years spent in the grade must be remembered and acted on. Otherwise career long misery will increase and demoralisation ruin our beloved profession. Competing interests: None declared |
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