Feature Specialist training

MTAS: which way now?

BMJ 2007; 334 doi: http://dx.doi.org/10.1136/bmj.39252.407350.68 (Published 21 June 2007) Cite this as: BMJ 2007;334:1300

Rebecca Coombes asks key players involved in the medical training application service (MTAS) what they would have done differently

Carol Black, chairwoman of the Academy of Medical Royal Colleges

What is your connection to MTAS?

The royal colleges, presidents of which are members of the Academy of Medical Royal Colleges, provided the person specifications against which the candidates for specialty training should be judged.

What would you go back and change about the system before it was launched?

We would require a demonstration that the application system was capable of enabling full recognition and sound balanced assessment of the qualities sought in candidates for specialist training.

What is your prescription for reforming MTAS into a workable system?

In the long term we need a computerised matching system. But it should not be used until it is adequately piloted and its performance evaluated, any bugs fixed, and the system shown to be totally secure. The shortlisting process also needs to be fixed. The scoring system did not ensure accurate discernment between candidates, and the process was excessively time consuming for consultants. Options include the use of a clinical problem solving or applied knowledge test as a long listing or short listing test—broadly similar to the process used in other countries. This ensures that all candidates reaching interview are of a high standard.

Patrick Maxwell, professor of nephrology, Imperial College London

What is your connection to MTAS?

I chaired a working group on MTAS and Modernising Medical Careers (MMC) at the Academy of Medical Sciences.

What would you go back and change about the system before it was launched?

I would not have had a “big bang” approach. Problems would have been flushed out if there had been more beta testing. From an academic perspective, I have major reservations about the assessment system, which seemed to emphasise political correctness rather than assessing excellence.

What aspects of MTAS should stay and what needs to be overhauled?

What might be useful is a central applications handling system like that used for university entries. There are obvious arguments for having an open and transparent central system. But I think it needs to give local partnerships—the deaneries, the universities, and the trusts—much more control and ownership of the process, with opportunity to publicise jobs and to have the candidates' full CVs. From an academic perspective, the credit given for a PhD or for a high level publication was minute—just one point. I don't regard that as rational. In our own system, evidence that someone had a concrete academic achievement, such as a paper in Nature, would mean that we would interview them for a job.

Martin Marshall, deputy chief medical officer for England

What is your connection to MTAS?

I have lead responsibility within the Department of Health for the MMC programme.

What would you go back and change about the system before it was launched?

I would like to have more evidence before I answer this question. Too many of the criticisms of MTAS have been based on anecdote. We now need to ensure that we take a more balanced view of what has gone well (and some aspects have gone well), what has gone badly, and what needs to be changed. That is why we await the Tooke review (the review of MMC headed by John Tooke (BMJ 2007;334:818 doi: 10.1136/bmj.39188.741053.4E)) and why the MMC team is talking to stakeholders before drawing firm conclusions. One thing I am clear about is that the development of MTAS requires committed professional leadership and engagement, and for a number of reasons this wasn't achieved as effectively as anyone would have liked.

What is your prescription for reforming MTAS into a workable system?

We mustn't dilute the principles underpinning MMC as a result of knee jerk decisions made after the crisis of the last few months. I haven't met anyone who doesn't believe that postgraduate specialist education doesn't need to be improved. There is a strong consensus that this can be achieved by setting and implementing rigorous national standards, by establishing a comprehensive curriculum for each specialty, and by assessing the competencies and achievements of trainees as they work through the curriculum. Beyond these principles, I don't think we should set “no go” areas, because active debate and compromise are the only ways to re-establish professional ownership for MMC.

Michael Rees, chairman of the BMA's medical academic staff committee

What is your connection to MTAS?

I am personally involved in many individual cases of MTAS applicants who believe they were let down by the system.

What would you go back and change about the system before it was launched?

I would not have run this ill conceived system at all. It has been a complete disaster. Why did anyone think that this method of appointing junior doctors would be workable? Carrying out an unpiloted system like this without some evidence that it would work is inexcusable. Many doctors have commented on the similarity to the US matching scheme; however, this scheme carries out interviews locally, and matching takes place afterwards so that institutions and applicants each rank their choices.

What is your prescription for reforming MTAS into a workable system?

There is no reason to believe that this system could be resurrected. Everyone has lost faith in it, and it should be abandoned. We should go back to local advertisements and appointments. MTAS has potentially undermined research in the NHS and the principle of achievement at medical school. We have tried to do two separate things at the same time—introduce an untested new career structure and do this through an untested computer system, where both are in need of overhaul.

Tom Dolphin, deputy chairman of the BMA's Junior Doctors Committee

What is your connection to MTAS?

I was one of the people warning early on about potential problems with MTAS.

What would you go back and change about the system before it was launched?

So many things! The lack of capacity in the system—so that it could have coped with the number of people using it. The issue of security also needs to be looked at closely, as the breaches this year were totally unacceptable. Also, the selection criteria used were better suited to distinguishing between foundation doctors, not senior house officers, so having different criteria at ST2 [second year of specialty training] and above ST1 from those used at ST1 might have worked better. Smaller units of application [geographical areas used in the system] would have allowed people to apply more accurately for the area they wanted to work in. I could go on all day.

What aspects of MTAS should stay and what needs to be overhauled?

The computer system of MTAS itself has failed and shouldn't be used again as it is, but there are lots of benefits in having a centralised system. One is that it allows you to have cascading offers, where the centre coordinates all the offers as they come in during the interview period and sends people their highest choice offer only, all on the same day.