Modernising Medical Careers

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Modernising Medical Careers (MMC) is a United Kingdom government-initiated review of medical training.

Contents

Historical Aspects

As far back the late 1990s, the senior house officer grade was sometimes known as the 'lost tribe', named as such because the older system could not guarantee career progression. There were several reasons for this epithet. Some doctors spent several years in the SHO grade due lack of career prospects and eventually had to change specialty or take on staff grade posts. The old system also allowed SHOs to try out different specialties. This, in itself was generally a good thing, but the lack of overall structure meant that trainees could not be guaranteed training appropriate to their stage and experience. Work-force planning was difficult and the time taken to complete specialist training, if indeed the doctor could get onto higher training in a chosen specialty, was unpredictable. This disrupted Many junior doctors' careers, causing understandable anger, which has flared up for example in the so-called Scot Junior affair.

Issues with MMC

Difficulties in Implementation

  • Practicalities (See MTAS)
  • Transition

Implications for Training

  • Reduced hours.
  • Over-specialised specialists?
  • Surreptitious introduction of sub-consultant grade?

MTAS

The largest cock-up to date in a series of health service IT disasters

The Medical Training Application Service (MTAS) was a national software system intended as a vehicle for the recruitment and selection of doctors for postgraduate medical training under the new MMC scheme.

Problems

Before

  • Lack of clarity at what level applicants of varying backgrounds and experience should apply to.
  • Lack of clarity of the number of posts in each region.
  • Restriction of choices. Only 4 choices: either 4 different specialties in one region, 2 specialties in 2 regions or 1 specialty in 4 different regions.

During

  • Application forms were based on poorly worded questions which many felt favoured candidates who were adept at describing their clinical experiences in good light.
  • A limited marking scheme was made available to some candidates which could have influenced the way people answered the questions.
  • At the point the on-line applications opened, the jobs published were not complete, with some jobs missing and some advertised jobs later being changed, e.g.
    • those who initially applied for ST2 Surgery in General found after submission of their forms that they had to chose a specific specialty, which significantly reduced the number of jobs available.
    • some jobs which regional directors knew existed were not advertised on the site.
  • IT failures
    • Web-site could not cope with demand, crashing in the days running up to the closing date, with some people losing data. The deadlines had to be extended.

Shortlisting

  • Shortlisting was late. This was attributed to the extended closing date for applications.
  • Despite having an on-line system, many deaneries had to rely on manually

printing out forms.

  • Lack of consistency in use of marking scheme.
  • Many candidates told "currently no interviews yet", with offers of interviews arriving up to 10 hours after shortlisting results should have been released.
  • Mixture of horizontal and vertical marking, with no consistency within or between many Deaneries.
  • Use of lay people and registrars, some untrained in shortlisting.
  • Missing forms. At least 90 in one Deanery area (North London anaesthetics)
  • IT failures
    • Mix ups of applications, e.g. a section on pursuing an orthopaedic career was read by a physician shortlisting for medicine.
    • Site could not cope with demand when all candidates tried to check the results of the shortlisting.
    • Oxford Deanery - attempts to book any type interview brought the applicant to a page for ST1 Anaesthetics (with no option to book anything).
  • Scotland decide to interview all Anaesthetics, ENT and Gastroenterology applicants.

Review and Changes

  • CVs to be considered, but not universally applied.

Formal announcements of suspension for 2007 and High Court judgement that process lawful

Protests

The flaws in the shortlisting process resulted in several consultants and organisations publicably declaring a lack of confidence in the system.

Glasgow Rally and London March

MMC glasgow rally.jpg

17 March 2007. Estimated 12,000 doctors march through the streets of London. A small number rally at Glasgow's George Square. David Cameron the leader of the opposition attends the London rally.

Root cause analysis

The above when it all resulted in the predictable disaster was fairly rapidly pulled together in a root cause analysis as the Tooke enquiry interim report. This was widely accepted by doctors and resulted in a Tooke enquiry final report[1] which was accepted by the Secretary of State for Health but with some key areas needing further review.


Royal College Advice

References