The Lancet:Modernising Medical Careers, Medical Training Application Service, and the Postgraduate Medical Education and Training Board: time for the emperors to don their clothes
From Mmc
Modernising Medical Careers, Medical Training Application Service, and the Postgraduate Medical Education and Training Board: time for the emperors to don their clothes
There are moments in history which great leaders capture, but which others let slip only to become history themselves. Such a moment was the impressive junior doctors’ march in London, UK, last Saturday, when an estimated and probably unprecedented 12 000 doctors showed what they thought of the attempt to run medical education and training by Government diktat.RemedyUK, which in a few weeks organised a larger gathering of doctors, with more unity of purpose, than any other senior medical college, academy, or association has achieved, is a lesson and inspiration to the profession. The clock cannot be turned back to last week, when civil servants in Whitehall or even medical Royal Colleges dictated how, when, and where young doctors will be trained. It is now the turn of senior doctors to respond to the heart-rending appeal from their trainees; to show them that they have not been abandoned by those for whose protection they have prayed and paid; and thwart at the 11th hour the coup by evangelists at the Department of Health, who in 2004 enabled an Act to destroy regulation of medical training by those with experience and responsibility under Royal Charter.1We are but a few private citizens among many in the medical profession; and it may seem presumptuous of us to speak on behalf of this many to those with real power. However, since publication of our March 7 letter in the British Medical Journal (BMJ) offering support to the juniors’ cause,2 the BMJ website and our own inboxes have been inundated by harrowing stories of injustice that in scale and complication seem unlikely to be rectified by the Medical Training Application Service (MTAS) review body’s well-meaning attempt to turn a sow’s ear into a silk purse.More importantly, our letter drew attention to an online poll we established of the profession’s wishes and views about Modernising Medical Careers (MMC) and MTAS.3 Of 2150 responses received since the reported Government “climbdown” on March 9, includ-ing 542 from consultants, 87% of consultants and junior doctors wish the current round of interviews to be aborted, 85% wish a second round suspended until there are agreed major changes, and only 13% indicate a belief that MMC offers improvement over the current system of training. Asked to score the performance of MMC/MTAS from 1 (low) to 5 (high), the average was 1·13, and the Royal Colleges might blush if we mentioned their average score for protecting the interests of their members. 93% of respondents would like the architects of MMC/MTAS to resign. More plausibly, 66% of respondents would like the appointments committees to stop being the unpaid hand-maidens of MTAS and to follow the lead of a few to date by resigning. Our poll largely echos the views of the Lancet editorial last week.42150 responses may seem small from some per-spectives, and we recognise the obvious confounding behind the respondents’ decision to complete such a poll. However, it is unlikely that a poll of the 12 000 attending the march would yield very different results. We have suggested to the review body that in response to the apparent gulf between the juniors’ anger (and widespread disquiet by consultants involved in the process) and Junior doctors march in London, UK, March 17, 2007 and the reassurances from the Department of Health, there should be an immediate ballot on the latest offer from MTAS about appointments, and the wider issue of the MMC training reforms themselves. We understand, however, that the MTAS review body considers the issues too complicated to put to a ballot.Such an argument has often been used to legitimise non-democratic usurpation of individual rights, and seems to epitomise the whole MMC/MTAS process. There are indeed so many confusions about the dif-ferent but overlapping responsibilities of MMC, MTAS, and the Postgraduate Medical Education and Training Board (PMETB) that it has been difficult sometimes to find the main culprit. Maybe MTAS really is a short-term problem that can be fixed, but it has dramatically opened the window to the grave short-comings of MMC and PMETB. We are not against changes in medical training or appointments, but these changes must be undertaken by experts, and with consultation and humanity.We still hope that individual Colleges will wish to ballot their members, and call on Deans and members of Appointments Committees to support a ballot if they are to continue their roles. If there is no ballot, and our poll is the only available measure of the medical pulse, let individuals examine their conscience and take a stand. Edmund Burke’s oft-quoted phrase is all too prescient here: “All that is necessary for the triumph of evil is that good men do nothing.
Morris Brown, Nick Boon, Nick Brooks, Edwina Brown, John Camm, Mark Caulfield, Edwin Chilvers, John Gibson, George Griffin, Ashley Grossman, Alistair Hall, George Hart, Tony Heagerty, Philip Home, Humphrey Hodgson, Richard Horton, Richard Hughes, Kay-Tee Khaw, John Lazarus, David Leaper, Peter McCollum, John Monson, Stephen O’Rahilly, Brian Rowlands, Julian Scott, Robert Sutton, Roy Taylor, Hugh Watkins, Nick WrightUniversity of Cambridge, Cambridge CB2 2QQ, UK (MB, EC, K-TK, SO’R); British Cardiovascular Society, London, UK (N Boon, N Brooks); Imperial College, London, UK (EB); St George’s Hospital Medical School, London, UK (JC); Queen Mary College, University of London, London, UK (MC, AG, NW); University of Newcastle, Newcastle upon Tyne, UK (JG, PH, DL, RT); University of Liverpool, Liverpool, UK (GH, RS); University of Leeds, Leeds, UK (AH, JS); Royal Free and University College School of Medicine, London, UK (HH); The Lancet, London, UK (RH); University of Manchester, Manchester, UK (TH); Kings College London, London, UK (RH); University of Cardiff, Cardiff, UK (JL); University of Hull, Hull, UK (JM, PM); University of Nottingham, Nottingham, UK (BR); and University of Oxford, Oxford, UK (HW)'
mjb14@medschl.cam.ac.ukWe declare that we have no conflict of interest.
1 Statutory instrument 2004 no. 3410. The Postgraduate Medical Education and Training Board (members—removal from office) rules order 2004. 2004: http://www.opsi.gov.uk/si/si2004/20043410.htm (accessed March 20, 2007).
2 Brown MJ, Boon B, Brooks N, et al. Raging against MTAS. BMJ Rapid Responses, March 7, 2007: http://www.bmj.com/cgi/eletters/333/7579/0-f#161670 (accessed March 20, 2007).
3 Questionnaire re MMC/MTAS. http://www.cai.cam.ac.uk/people/mjb14 (accessed March 20, 2007).4 The Lancet. MMC: mass medical culling. Lancet 2007; 369: 879.
