Fiona Patterson replies to Parashkev Nachev

“Although there is over a century's literature on selection methodologies, rarely has any process provoked such fierce debate as MTAS. Many facts surrounding specialty selection, and our role within it, are not well understood. This is illustrated by Dr Nachev's personal view (BMJ 2007;335:615 doi: 10.1136/bmj.39342.515961.59), which contains two fundamental factual inaccuracies. The problems surrounding selection methodology are multi-faceted and multi-dimensional, well beyond disregarding CVs, relying on ‘white space' questions and poor IT delivery.”

For the distress caused, I share the anger of the profession. The inquiry led by Sir John Tooke details the facts about our role in the process (www.mmcinquiry.org.uk). Here, I highlight critical issues to encourage close scrutiny of facts surrounding principles, methodology, and context underlying MTAS, so that there is learning for the future.

Clearly, in the past, selection practices in medicine have been effective. Although few would deny there is scope for improvement, the CV and interview process has generally worked well. So why change? MTAS was devised alongside the MMC (Modernising Medical Careers) programme introduced by the Department of Health, where the fundamental principles underpinning gateways to progression were changed overnight. Consequently this changed the rules governing selection. Traditionally, medicine has relied on robust indicators of attainment on the CV, such …