Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
MMC/MTAS: The Chiefs have spun; now hear the people
- Morris J Brown, Peter Barnes, Anthony Barnett, Nick Boon, Nick Brooks, John Camm, Mark Caulfield, Shern Chew, Edwin Chilvers, Paul Corris, Pamela Ewan, Steve Franks, Jon Friedland, John Gibson, Peter Grant, Ashley Grossman, Alistair Hall, George Hart & 36 others (16 May 2007)
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Response to MMC/MTAS: The Chiefs have spun; now hear the people
- Anand K Patel (16 May 2007)
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Thankyou
- Simon J Hellings (16 May 2007)
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Bravo
- Raymond Anakwe (16 May 2007)
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MMC, self evident arguments
- Martin Talbot, S10 2JF (16 May 2007)
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BMA and MTAS
- John D Buchanan (18 May 2007)
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MMC/MTAS
- Chris M Laing (18 May 2007)
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Does MMC increase absenteeism?
- Mara Mattioli, Georgina Michulitis, Eugene P Perry (19 May 2007)
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Fortune's Wheel
- Nina Newton Butler (19 May 2007)
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Morris J Brown, Professor of Clinical Pharmacology University of Cambridge, CB2 2QQ, Peter Barnes, Anthony Barnett, Nick Boon, Nick Brooks, John Camm, Mark Caulfield, Shern Chew, Edwin Chilvers, Paul Corris, Pamela Ewan, Steve Franks, Jon Friedland, John Gibson, Peter Grant, Ashley Grossman, Alistair Hall, George Hart & 36 others
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In response to the recommendation that MTAS proceeds by single-‘first -choice’-interview without short-listing (1), a group of us called for a ballot (2). We were told that the issues were too complicated, and that the UK does not do referenda. Instead the Review Body has relied on Focus Groups and feedback from Deans. The aims of our poll were to ascertain relative support for the Review Body proposal versus alternatives; to determine acceptance of MMC; and to gauge appreciation of various august bodies and persons. Answers were stratified by seniority, specialty and location. The questions and results are at http://www.cai.cam.ac.uk/people/mjb14. Selected tables will be published as webextras to our Lancet commentary (3). The poll lasted 2 weeks from 21st April. 3544 doctors responded: 2550 Juniors, 873 Consultants and a few GPs and students. Analysis shows responses across all specialties, grades and locations. Fewer than 25% of doctors found the current proposal acceptable. Even in the devolved nations, which offer four interviews, the proportion in favour was only 35%. There was more variation among specialties, the highest being 45%. Partial reversion to Deanery-specific appointments received an average 60% support. The third option, all posts offered for one-year temporary training only in this round, was most popular among Juniors (51%), with little geographic or specialty variation. Overall, the preferences for the 3 options were, respectively, 14%, 43% and 43%. 80% want the 1st August deadline to be postponed. Almost 85% want a Consultant boycott of interviews. Asked about perception of MMC as an improvement upon current training programmes, only 10% said yes for SpRs, and 25% for SHOs. Among surgeons, 35% said yes for SHOs. The appreciation of Colleges, Deaneries, PMETB, Review Body, BMA, DoH, Secretary of State and CMO was universally low. 95% of respondents scored the last three as 1 out of 5 ("Miserable"). Except for the Colleges and Deaneries, who averaged 2, all other bodies scored even lower. 48% of Juniors scored the BMA as 1 out of 5. The respondents to such a poll, albeit the largest to date, are easily dismissed as the selected disaffected – especially by those who do not ballot their constituency (4). The clarity of our findings contrast with continuing official spin about MTAS (5): the demise of the computer was a fact, not a decision, and heralds a chaotic free-for-all among deaneries. Nevertheless, our poll will doubtless be ignored by leaders and institutions with too much pride or vested interests to contemplate change; by Trusts too weak to put long-term staff and patient interests ahead of short-term staffing concerns; and by a profession which lacks an exemplary track record of looking after our junior members. If MMC initially salved senior consciences about past years of neglect, it is now seen as an attempt to wrest responsibility for training from doctors, and create a permanent sub-class of under-trained specialists. May democracy triumph as Remedy joins battle in the High Court – David against Goliath, a Prague spring rolling through Tavistock Square. The people support and salute you, the future of medicine UK. Peter Barnes, Professor of Respiratory Medicine, Imperial College Anthony Barnett, Professor of Clinical Pharmacology, Leicester Royal Infirmary Nick Boon, President-Elect, British Cardiovascular Society Nick Brooks, President, British Cardiovascular Society Morris Brown, Professor of Clinical Pharmacology, Cambridge John Camm, Professor of Clinical Cardiology, St George's Hospital Mark Caulfield, Professor of Clinical Pharmacology, Queen Mary London Shern Chew, Professor of Endocrine Medicine, St Bartholomew's Hospital Edwin Chilvers, Professor of Respiratory Medicine, Cambridge Paul Corris, Professor of Thoracic Medicine, Newcastle Angus Dalgleish, Professor of Oncology, St George’s Hospital Pamela Ewan, Consultant Physician, Addenbrooke's Hospital Steve Franks, Professor of Reproductive Endocrinology, Imperial College Jon Friedland, Professor of Infectious Disease, Imperial College John Gibson, Professor of Respiratory Medicine, Newcastle Peter Grant, Leeds University Ashley Grossman, Professor of Endocrinology, Queen Mary London Alistair Hall, Professor of Clinical Cardiology, Leeds George Hart, Professor of Medicine, Liverpool Rod Hay, Queens University, Belfast Tony Heagerty, Professor of Medicine, Manchester Humphrey Hodgson, Vice-Dean, RFUCMS Philip Home, Professor of Diabetic Endocrinology, Newcastle Juan Kaski, Professor of Cardiovascular Science, St George's Hospital Kay-Tee Khaw, Professor of Clinical Gerontology, Cambridge John Lazarus, Professor of Clinical Endocrinology, Cardiff David Leaper, Newcastle Stafford Lightman, Professor of Medicine, Bristol Sir Ravinder Maini, Professor of Rheumatology, Imperial College Peter McCollum, Professor of Vascular Surgery, Hull Jim McKillop, Professor of Medicine, Glasgow John Monson, Professor of Surgery, Hull Steve O’Rahilly FRS, Professor of Clinical Biochemistry, Cambridge Mark Pepys FRS, Professor of Medicine, RFUCMS Philip Poole-Wilson, Professor of Cardiology, Imperial Stuart Ralston, Professor of Rheumatology, Edinburgh John Reid, Professor of Medicine, Glasgow Jon Rhodes, Professor of Medicine, Liverpool Jim Ritter, Professor of Clinical Pharmacology, Kings College London Brian Rowlands, President of the Association of Surgeons of Great Britain and Ireland Wendy Savage, Hon. Professor Middlesex University Neil Scolding, Professor of Neurology, Bristol James Scott, Professor of Medicine, NHLI Ron Singer, President Medical Practioners Union Peter Sleight, Emeritus Professor, Oxford Roger Sturrock, Professor of Rheumatology, Glasgow Robert Sutton, Professor of Surgery, Liverpool Roy Taylor, Professor of Medicine and Metabolism, Newcastle Raj Thakker, Professor of Academic Endocrinology, Oxford Douglas Turnbull, Professor of Neurology, Newcastle Hugh Watkins, Professor of Cardiology, Oxford Alistair Watson, Professor of Gastroenterology, Liverpool Robert Wilcox, Professor of Cardiology, Nottingham Mark Wiles, Professor of Neurology, Cardiff Sir Nicholas Wright, Warden, Queen Mary London Aknowledgement To Maki Lam for setting up the online questionnaire at short notice, and to the Computer Office of Gonville and Caius College, Cambridge for providing server capacity. 1. Modernising Medical Careers. Announcement to applicants. 16 March 2007, and Review Group letter to applicants, 4 April 2007. http://www.mmc.nhs.uk/pages/review (accessed on May 7, 2007) 2. Brown M, Camm J, Caulfield M et al. Time to junk the appointment system for doctors. 4 April 2007. http://www.timesonline.co.uk/tol/comment/debate/letters/article1610358.ece (accessed on May 7, 2007) 3. Brown MJ, Boon N, Brooks, NH et al. Medical training in the UK: sleepwalking to disaster. DOI:10.1016/S0140-6736(07)60754-5 4. BMA. MTAS statement from the Chairmen of the BMA and Academy of Medical Royal Colleges. http://www.bma.org.uk/ap.nsf/Content/mtas110507 (accessed on May 13, 2007). 5. BBC. D octor application system ditched. http://news.bbc.co.uk/1/hi/health/6657485.stm (accessed on May 15, 2007). Competing interests: Several co-signatories have sons or daughters who are medical students or junior doctors |
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Anand K Patel, Research Registrar Royal Hallamshire Hospital, Sheffield, S10 2JF
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As a junior applying via the shambolic MTAS system, I would like to thank the esteemed authors and co-signatories of the article for conducting this valuable survey. The research confirms what most juniors already know and unfortunately each new (almost daily) change has added further inconsistencies and increased the unfairness of the recruitment process. It is unsurprising that most people directly involved with the process simply want it to end at all costs. Each alteration has also been accompanied by a smoke screen of misinformation and spin which has further added to the confusion of all involved and served to delay any meaningful progress in this year’s recruitment process and helped add to a feeling of disenfranchisement amongst junior doctors. The shoddy and unprofessional manner that many dedicated professionals have been subjected to by this process and the ensuing demoralisation is likely to be hard to undo; and the damage done to the profession, careers and NHS by the handling of MTAS/MMC is likely to be far reaching and remains difficult to quantify. Competing interests: None declared |
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Simon J Hellings, SHO Anaesthetics M21
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The list of senior consultants from around the country who are standing up for junior doctors and our horrendous predicament is heartening. They underline that this is not just an issue for a group of junior agitators but is of huge importance for the future of medicine in this country. Many people oppose the flawed implentation of MTAS and MMC, but few have put their names to it. Competing interests: None declared |
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Raymond Anakwe, Spr Orthopaedics Edinburgh EH16
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Bravo Competing interests: None declared |
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Martin Talbot, Medical Educationalist Sheffield, UK, S10 2JF
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I FULLY support the response above in its opposition both to the discredited MTAS but also MMC. Competing interests: I will be 60 nest birthday and statistically will become more reliant on a properly-trained specialist workforce |
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John D Buchanan, Consultant Pathologist Portsmouth NHS Trust PO6 3LY
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I am deeply disturbed by the letter in today's Times (17th May)from Dr J Johnson and Professor Carol Black. It implies that the BMA tacitly supports a continuation of MTAS Round 1 and also implies that a Round 2 will follow based on the same flawed electronically submitted documents. There is no mandate for this from the overall BMA membership and certainly no mandate from the Junior Doctors. He needs to explain his position if he is to retain any credibility and prevent further loss of confidence in the BMA. Competing interests: My daughter is an F2 |
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Chris M Laing, SpR Nephrology and Intensive Care Thames Deanery
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I applaud Morris Brown and colleagues for their efforts to introduce democratic debate into MMC/MTAS. As for Remedy UK, I wish them all the very best in their court action this week. I have not met a single colleague who does not support my view. Brown and Remedy are right. It is highly likely that the vast majority of long term training posts will be given away on round 1. MTAS has been so discredited that appointing long-term trainees through round 1 is unfair, unsafe and potentially illegal. Short term appointments for service needs, with retrospective training accreditation following formal appointment, was the only viable solution here. The Royal Colleges and BMA have sleepwalked into this. Faced with this debacle they have not sought their memberships views or effectively campaigned for redress. Instead, at a critical juncture - the High Court Action - they have made representations against Remedy UK in court and in the press (1). Across the country junior doctors are cancelling their BMA subscriptions, and I can't say I blame them. The credibility of the Royal Colleges has been seriously dented. I suspect there will now be a grass roots movement to end the BMA monopoly on doctor representation and the Royal Colleges monopoly over administering postgraduate education. (1). http://www.timesonline.co.uk/tol/comment/debate/letters/article1800798.ece Competing interests: None declared |
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Mara Mattioli, SHO General Surgery Scarborough General Hospital, Woodlands Drive, Scarborough, North Yorkshire YO12 6QL, Georgina Michulitis, Eugene P Perry
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The last few years have seen radical changes in junior doctors training. Modernising Medical Careers and the European Working Time Directive with the introduction of increased supervision, structured training and reduced working hours were reasonably expected to increase the level of satisfaction of junior doctors with their training and working life. Absenteeism is
an excellent surrogate marker of job satisfaction(1,2,3).
Table 1 shows the data regarding sickness absence of PRHO/FY1 doctors in
Table 1: sickness absence per year amongst PRHO/FY1
doctors in * Data for 2007 refers to 3 months only. Days of leave
per year calculated on the base of first 3 months absence. In coincidence with the introduction of shift working and Foundation Program there has been an increase of at least 3 fold in average days of sickness leave taken per doctor per year. All is not well with junior doctors’ training. Are Modernising Medical Careers and the European Working Time Directive breeding a generation of undervalued, poorly motivated and dissatisfied junior doctors? Mara Mattioli, SHO E P Perry, Consultant Department of General Surgery, Address for correspondence: mattioli@doctors.org.uk References. 2. D Farrell. Exit, Voice,
Loyalty, and Neglect as Responses to Job Dissatisfaction: A Multidimensional
Scaling Study. The 3. 1. E R. Greenglass1, R J. Burke, L Fiksenbaum. Impact of restructuring, job insecurity and
job satisfaction in hospital nurses. Stress News January 2002 Vol.14 No.1 Competing interests: None declared |
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Nina Newton Butler, SHO University College Hospitals London NHS Foundation Trust
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The headlines of this week’s BMA News (Saturday May 19, 2007) declare, “Relief after MTAS jettisoned”. Can this really be true? Of course not: round 1 interviews will stand, and training posts will be offered based by Deaneries on little more than Fortune’s wheel: I had hoped that doctors, and especially their leaders, were blessed with moderate intelligence, but I am dismayed by the evidence. First, to enter specialist training candidates were asked to complete a creative writing exercise pertaining to their specialty/specialties of choice. While waiting for information about the reliability and validity of the scoring criteria for this exercise, candidates were selected (or not) for anything up to four interviews based entirely upon this talent*. Then, after soul-searching with regard to specialty and location – not to mention assessing likely odds of success - candidates were told that only first choices would count, and that everyone who was unsuccessful in the creative writing contest would have a prize anyway. So two months after successful candidates had their interviews, roll-up the runners-up, to be interviewed by the same interview panel – or not, as the case may be. We have all heard about ‘primacy’ and ‘recency’ effects? What! - you mean MTAS has not? Well, there is a lot of published information about these phenomena (made much of by the legal profession when addressing juries). Put simply, when people have to make a decision about candidates/defendants immediately, they tend to favour the last information/person they heard or saw. If having to make a decision about information heard some time ago, they tend to favour the first information/person they heard or saw. So where does that leave applicants for specialist training? I am astounded by Carol Black’s, James Johnson et al’s, muddled thinking in allowing Round 1 interviews to stand – whether via MTAS or via the Deaneries. This year there is a concertiner-ing of six-seven years of doctors into three years. For many this will be their only realistic chance to enter specialty training. “Relief after MTAS jettisoned". It hasn't been - yet! * Of course, the scoring must be reliable and valid, after all, hardly any candidates were chosen by the same specialties in the same four Deaneries! Competing interests: None declared |
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