MMC/ MTAS Disaster For Doctors
Posted by jameslacey on Monday, 05 March 2007 02:05:45
I am in the second year of my training as an SHO in Psychiatry, currently working for the St Mary's training rotation. I am passionate about my chosen discipline, and my ambition is to continue as a career psychiatrist. I did not choose Psychiatry on the basis of simply needing a position, or because it is perceived as unpopular, and therefore easier to get into, or to back-up more general training; I wish to specialise because it is my vocation.
I competed with other doctors for a place on the rotation, via application forms and interview process. Subsequent to my appointment, I successfully completed each 6 month post, leading up to the present. As part of my training, progress has been formally assessed at intervals, by each Consultant I have worked with. I have been judged overall as above average, and I give a direct quote from an example comment: "James has been an excellent trainee. He is very highly regarded by the team and myself."
In the normal turn of events, I would have approximately another year to go before completing my SHO training, subject to passing Parts 1 and 2 of the Membership exams for the Royal College of Psychiatry. I would then be free to apply for further, higher training as a Specialist Registrar, ultimately leading to becoming a Consultant.
In my recently completed post in Old Age Psychiatry, my Consultant and myself incorporated assessment techniques from the new system, beginning in August. This marks a change in approach to more structured, and continuous means of assessment; for example, a Consultant will directly observe a trainee doctor's interaction with a patient, and mark them using a pro-forma, downloadable from the Royal College website. I was found to be above the expected standard for my level of training.
In my background, I achieved an Intercalated BSc, extra to my MBBS medical degree; in support of that BSc, in reflection of my previous exam performance, I was awarded financial aid in the form of two scholarships. As part of that BSc, I gained valuable experience in laboratory-based research. All the above should enhance my employability.
Prior to embarking on specialisation, I worked for a year as a Foundation Year 2 SHO, in a pilot scheme for the new system now in place nation-wide. This position allowed me opportunity to demonstrate that I had gained "core competencies" of a junior doctor, which again, should make me more, not less employable in terms of the new system.
Previously, when time came to apply for another job, one had the option of applying to many individual hospitals within many different regions. Some prospective employers would ask for your own CV, others relied on application forms, though still allowing a high degree of self-expression in selling your self. If offered interview, then this was likely with the very people who would be your seniors in the work place.
With the introduction of MMC/ MTAS, I found myself obliged to essentially reapply for the type of position I had already secured, and done well in, for the last two years. Many raised fears about the impending change and new, untrialed application system; reassurances were made that these were unfounded. Now things look different.
Applying on-line, I was faced with a series of stock, confusing, polythematic questions, as a way of ‘proving' my suitability for (continued) training. The idea seems to be to look at the person specification for the level of training you are applying for, work out which key phrases and attitudes are expected from each question, and try to include them in your answers. Hopefully these are picked up when scored according to a tick-box protocol. The choice of places to work is now limited to a maximum of four, from broad geographical divisions of the country; once successful in interview, you will be able to list a preference for where you are ‘sent' within the region that wants you. Subsequently it has become clearer that past experience, extra achievements, degrees, good references, etc. are very much subsidiary in this new way of assessment; answers to the questions are key.
The process was plagued with glitches of numerous kinds; the crunch came when several Regions could not meet an extended deadline by which to finalise their shortlists for interview. The impersonal computer system informed me that so far I was unsuccessful in any application, but this was still subject to delayed announcements. Days after I had worked it out for myself, I was finally put out of my misery with a confirmation of emphatic rejection. Informing my Consultant referees, one said that they found it disappointing and surprising, agreeing that it was unfair, the other expressed amazement that I had not even been short listed. There is no opportunity for feed-back, support or appeal in this eventuality, from the faceless, mechanised MTAS.
This system is an unhappy mixture of rigid, State control, and pseudo-market forces with artificially increased ‘competition', in the sense that little provision has been made for doctors in the old system, versus newer doctors coming up through the ‘modernised' system. Arbitrarily, the new system will be loaded in their favour in the name of ‘fairness'. Behind this seems to be an almost ‘1984' turn of mind: a circular argument where the new system is defined as ‘improved' (because it is the new system), so those trained in it are, de facto, more desirable employees; it may also be cheaper in the short term.
Competitiveness only makes sense on a level playing field. It is alleged that somehow, a few applicants were able to acquire copies of the ‘secret' marking scheme for the assessment questions. Thus they had unfair advantage in being able to tailor their answers accordingly. Some have paid agencies to write their answers for them. I am aware of a colleague who had part of their application written by a more senior doctor. The unseemly rush to mark the underestimated number of applications, apparently leading to some not even being looked at, or being scored by non-medically trained individuals, builds the case for injustice.
An example of one of the application questions, (the emphasis is mine):
D1. Give a specific example of a time when you became aware that a clinical mistake had been made, either by you or someone else. How did you deal with this situation and how did your actions contribute to the outcome?
Apparently, though not clear from the question, a reply detailing your own mistake, as opposed to someone else's, received a higher mark. As it is a question about ‘probity', one is expected to realise that this is an opportunity to demonstrate your willingness and ability to learn from mistakes; detailing someone else's error is more suggestive of denial of blame. A politically correct mea-culpa might give you the edge. My own answer described a situation of shared culpability: perhaps a more explicit confession of my fallibility, despite my elitist professional status, would have been more acceptable?
Naturally, one can assume that those implementing these questions will be able to quote studies, the statistics of which endorse their efficacy in accurately and objectively discerning aptitudes deemed prerequisite in a doctor. Curious then, that such consistently reliable tools should lead to a situation where one person can be rejected across the board, but other individuals receive a range of ‘yes' or ‘no' answers to their applications.
Following the outcome of the current round of interviews in late April, there will be a second round of applications. It has already been made clear that by this stage, most full training posts, of up to six years duration will have been filled. Some remaining posts will be a new form of stand-alone, year long placements. These will count for training, but once you are out of the main system, it will be increasingly difficult to re-enter as time passes, as ‘new' doctors continue to progress in the hierarchy. I remember attending a seminar where a spokesperson for MTAS attempted to address this concern, by implying that posts in full training will always become available, due to the eventualities of illness or maternity leave.
As has always been the case, some posts will not be recognised for training, and are merely for service-provision. To remain employed, there may be no option but to accept such a post, but again there is now greater risk of resultant career stagnation. If made redundant second time around, I may have to offer my skills abroad, or with bitter regret, leave my medical career behind.
Public money has been lavished on my training as a doctor: in a sense there is a contract between myself and the State. I, and my family, invested much in this venture; I still have to complete repayment of my student loan. Now my primary means of fulfilling my social obligation, and satisfying my private debt, is in danger of removal by the same system that trained me. Does this breach my human rights?
The uproar that has resulted from MMC/ MTAS has so far been met with bland platitudes from the Authorities, thinly masking a pitiless indifference. The bleating protest of a profession over which this Government now has a near monopoly of power is unlikely to make much headway, I fear. What to expect, when it has consistently demonstrated shameless, craven venality in much wider arenas of control?
MMC MTAS