Mmc:Mass medical culling
From Mmc
MMC: mass medical culling
March has seen the meltdown of the new computerised system for junior doctors applying for specialist training in the UK NHS. The Medical Training Application Service (MTAS) was so flawed that some consultants refused to interview short-listed candidates. The Department of Health has U-turned, and applications submitted for the first round will now be given the opportunity to be reassessed. An independent review of the process in advance of the second round of applications in April is also underway. But, this is all too little too late. The fatally flawed MTAS should be suspended until the process has been comprehensively piloted and evaluated, and the Department of Health should use this opportunity to re-think the Modernising Medical Careers (MMC) curriculum.
The proposal for radical reforms in medical training was set out in a report by the Chief Medical Officer for England in 2002 and has been led by the Postgraduate Medical Education and Training Board, which is accountable to Parliament. Under the previous system, it took about 14 years to become a consultant. In 2005 this was streamlined under the MMC curriculum, with graduates completing a 2-year foundation programme, then immediately entering specialist training, lasting 3–7 years depending on specialty. MMC is currently in the transition period, where trainees from the former system are competing for specialist training posts against those in the new foundation programmes. The competition is fierce, with 30 000 applicants for 22 000 jobs.
MTAS is the central portal through which a trainee can apply for up to four specialist training posts. The first round of applicants was short-listed at the end of February, 2007. From the outset MTAS has been plagued by problems: the computerised system failed, and trainees complained that their practical experience and academic qualifications cannot be reflected adequately in the generic application form. Some interview dates clash with scheduled professional examinations, leaving applicants to make the difficult choice of which to attend.
Consultants have also expressed their lack of confidence in MTAS, with concerns that the most suitably qualified candidates have not been short-listed for interviews because of the computerised selection process, and that the application form is geared primarily to foundation trainees. These worries will not be addressed merely by reassessing first-round applications.
But the shambles of MTAS is only one aspect of a larger problem. MMC itself is failing. Trainers and trainees are concerned that the new system will produce consultants with inadequate experience. The fast-track production of consultants is compounded by the effect of the European Working Time Directive. Previously, surgeons underwent approximately 30 000 training hours before becoming consultants—this will now decrease to 6000. There is no clear guidance on how these MMC consultants are to gain adequate experience, or who will supervise their ongoing professional development.
MMC and MTAS have suffered as a result of inadequate planning and expediting a system that was not thoroughly tested. Increased numbers of medical students combined with poor workforce planning have resulted in a massive shortfall of jobs. Doctors have been systematically disempowered and are being herded through training to produce a consultant-led service. But, worryingly for patients, these doctors will not have the experience of today's consultants. MMC—or “mass medical culling” as it has now become known—has betrayed a generation of doctors and the society they serve. Any other employer would cherish these trainees for their dedication, effort, and skills. Doctors in the NHS are now re-thinking their choice of career, with some moving abroad or changing profession.
The independent review of the current crisis is welcomed, although there is little time to implement changes for the second round of applications. There is no doubt that the former training system was in need of an update. However, MMC and MTAS should be re-evaluated, with the focus on training and employing skilled doctors to provide high-quality care of patients.
Doctors and the Royal Colleges should reclaim autonomy of training, uniting against the debacle that is MMC. Sadly, only 10% of trainees feel represented by the Royal Colleges and 6% by the British Medical Association. Remedy UK—a movement of doctors who lack confidence in the current reforms—is leading marches in protest against MMC/MTAS in London and Glasgow on March 17. At the time of going to press, 8000 doctors, including consultants, have signed up for the demonstrations. Perhaps the MMC/MTAS furore will be the stimulus to finally unite doctors in taking an active lead to value professionalism in the NHS.
