Friday, March 02, 2007

The Angry Medic Finally Gets MMC & MTAS

Wheel of Fortune: Doctors' Edition

Remember Wheel of Fortune? That game show where, given a hint, you had to spin a large wheel and win money by correctly guessing letters illuminated on a giant board by an inexplicably lovely assistant who was the subject of wet dreams and midnight fantasies everywhere?

Well the UK Government, capitalising on the gameshow's popularity and deciding that doctors' lives are too bloody bland and boring, has decided to introduce its own version for doctors in an attempt to spice up their lives a little (and get their lazy arses off those plush taxpayer-funded chairs --Editor). And they've called it MMC.

Go ahead. Look at the picture above. See if you can fill in the last letter for the win.

Before today, I had no concept of the horror of MMC and MTAS. Oh, I read about it all right. Any half-brained drooling numbskull looking at the blogs out there could tell it was horrible. HospitalPhoenix, a good competent surgeon who genuinely cares about his profession, lost sleep over it. SHP, the very sort of doctor keeping the NHS afloat, has lost hope. Even her partner has not been to work for fear of her breaking down. Dr Rant, being his usual self, has been mouthing off about it.

But I, being a mere medical student cosied up in his snug ivory tower, buried under piles of drug name sheets and obscure biochemistry named-after-car-license-plate molecules to remember, didn't understand. All I could do was pat them on the shoulder, drop a nice comment on their blogs, and hope that things would be better.

Until now.

Dr Crippen has finally put it in language I can understand. Here he posts sample questions with sample answers from an unsuccessful candidate who now has to emigrate to find work. And here are more example questions with sample answers from a more fortunate candidate.

I read the questions. I read the answers. And then it hit me. Because I had seen some of the questions before. Also on an arbitrarily marked, wishy-washy-waffle-requiring exam known as Preparing For Patients (PfP).

I have blogged about PfP before. The questions asked are rather arbitrary, marked not by doctors but by "communication skills experts". No one knows if they will pass or fail; I know gifted medics who spent hours slaving over their PfP reports, only to be told that they couldn't progress to the next year because they had failed this minor subject (because they didn't dot an I or misspelt a few words. No, seriously --Ed). Conversely, everyone knows someone who spent two hours on the last day typing up some crap, handing it in 15 minutes before the deadline and passing. (Not that I'd know anything about that. Ahem. --Ed)

In many ways, it is a lottery. Compare the questions from MTAS and from PfP:

MTAS: Describe a recent example from your surgical experience of a time when you found it difficult to make an effective judgement in a challenging situation. How did you overcome this difficulty, and how has this experience informed your subsequent practice?

PfP: Give examples from an interview you conducted with a patient to illustrate what you did that helped and hindered making the interview successful
a) From the viewpoint of the patient
b) From your viewpoint in terms of gathering information about the symptoms
c) From your viewpoint in terms of gathering information about the illness (the patient's perspective)

See the similarity? Both questions require wishy-washy bullcrap (or require you to become John friggin' Steinbeck). In fact, the PfP question stops just short of requiring you to bloody read the patient's mind. There are no correct answers; whether you pass or fail depends on whether the course organiser thinks you maintained enough eye contact or said "hmm" and "uh-huh" enough times in your patient interview. I have known students who, having run out of ideas, put down "I smiled at the patient" and "I patted his arm".

But PfP serves a purpose. I'm not complaining, because it gave me the opportunity to finally go to hospital and see real patients. And if you fail it, you can always resit it, and almost always pass the second time (unless you do something really stupid, like turn your patient's respirator off for kicks --Ed).

Look at the final paragraph of the successful MTAS candidate's answer to the above question:
On reflection, I realised the value of my clinical judgement, prioritisation, teamwork and communication. The experience increased my confidence in adopting leadership roles.
I know exactly what that is. Any medical student who has done PfP, indeed any student who has ever filled in a UCAS personal statement to apply to university, will also recognise that for EXACTLY what it is.

Pure and utter bullcrap.

Don't get me wrong; the candidate was very smart to write that. And indeed, it's simply because I'm so good at crapping that I got into university in the first place (that and the sexy eyelashes. --Ed) But it's still waffle. It's the waffle we come up with to pad our CVs/personal statements. It's the waffle we type into our PfP reports when we need to fill two A4 pages. It's waffle that hardworking, competent, caring doctors with families to feed and lives to save should not have to think up after shovelling through decades and decades of this:

Actual Cambridge University lecture material

Entire careers. All dependent on one lottery. I cannot imagine how it must feel like filling out that form. Knowing that everything you stand for, everything you've worked your entire life for, is dependent on what you put down. If you're a doctor who has recently gone through this, I offer you my admiration. I simply cannot imagine the hell you must be going through.

Some of my friends have advised me to switch to law and run whilst I can. I'm seriously thinking of listening to them.


dearieme said...

Communication skills? That lead to loo-blocking English like "From your viewpoint in terms of gathering information about the illness (the patient's perspective)". Christ on a bicycle.

the little medic said...

You do make me chuckle, although its not a funny situation! Its a disaster, i'm truly sorry for all those who have been on the sharp end of this MMC malarky so far. I keep hearing from people that we've got it all to come.

I too keep hearing that I should forget about being a doctor if thats the way they're going to treat us. Its certainly something to think about.

HospitalPhoenix said...

I'm gobsmacked at the number of people berating the successful candidate. All he did was play the game, whilst the unsuccessful one completely missed the point.

Playing the game isn't difficult, is it?

And for what it's worth, the successful candidate had some 'evidence' in his answers which was sorely lacking in the unsuccessful candidates. And you can't lie about evidence.

Vladimir Lenin said...

in soviet russia, game play you!!!

adam said...

methinks it's an "i"?

Eugene said...

Eh, aren't all the 'I' in the puzzle closed? How come only one 'I' is closed?

Ref: Wheel of fortune

kuhan said...

crapping = shitting no?

phish pharma said...

yeah, i noticed the similarity too. It is almost identical to PfP. I was tempted to start my own blog and post about it, but now you've beaten me to it. Balls.

It's true the successful applicant was a better bullshitter/waffler, but I have to say I thought my waffle-writing days were over when I came to study medicine here, to be replaced by real job interviews. Oh well. The game continues.

DundeeMedStudent said...

have to say I recognised questions aswell, we've done them in some of out clinical skills, comm skills sessions. Maybe by the time we get to MTAS stage we will have answered the bullshit questions so often that we will all get full marks?

And so once again I learned the importance of effective doctor-patient communication...

Mother Jones RN said...

It seems like those in power have found another way to make your life more complicated. What a load of crap.


Mother Jones RN said...

It seems like those in power have found another way to make your life more complicated. What a load of crap.


Cal said...

No, don't switch, you sound like you'd become an awesome doctor, angry, if you remember to take your anti-hypertensives.

This system is such a joke that it's unbelievable. I feel so bad for everyone having to go through this crap. It seems completely unfair.

I really hope that the system changes by the time that we're going through it...

Dr. Deborah Serani said...

Terrible how "healing" is no longer valued and respected. I wish a pox on these people. Then they will truly understand priorities. Similar here in the US.

Dr Michelle Tempest said...

Hospitals are really tough places to work in at the moment and I am sure to be a student in as well - the stress caused by the MMC/MTAS has filtered through every part of the NHS. But we need good medical students and good future doctors, so don't give up! Michelle

HospitalPhoenix said...

I agree with Michelle.

Don't give up!

Especially now you're booked onto a surgical skills course :D

Esme said...

Perhaps it's because my idealistic ways have yet to be crushed by the harsh realities of what medicine is, but I think it's quite inportnat for a medstudent to reflect on experiences with patients, and in a busy timeframe, maybe papers like that provide an incentive.

I was at work experience this half term, after managing to crawl through the other end of one of the worst bouts of flu I've ever had. There were med students from Manchester there, so I was allowed to pretend to be one (without actually sticking needles into patients) and helped with the post-opts. I did notice, especially with the older patients that there was often a communication gap as the questions on the form, although indicative of symptoms for disease, was misinterpreted by patients, and important symptoms were perhaps missed as trivial details were given. People for example often had trouble estimating how many times they went to the toilet. Past problems were brought up, and all sorts of other things which meant that to get the empirical answer you had to try and judge how likely it was that they were being precise etc.

If the patient is not aware of how you're interpretating their data, or the significance of it, then perhaps it would make the whole history taking process easier.

The questions are a bit wishy-washy though. They reminde me of the English Lit essay I have to right this weekend. "How does Miller create and atmosphere of calmness and normality and how does he at the same time indicate that all is not well?" It makes you think in different perspectives.

The Angry Medic said...

Dearieme: Ah, the sharp tongue of DearieMe strikes again. Language worthy of the toilet indeed. I hope the bastards who thought MMC up get stuck in the loo without toilet paper for the rest of their lives.

Little Medic: It's bloody scary isn't it? I'm shaking in my shoes. And Law does seem really attractive right now. I'm attending one of their lectures on Tuesday to check it out.

HospitalPhoenix: No no, I wasn't insulting the dude who got the questions right. He's a smart bum, good for him for managing to play within the DoH's arbitrary rules and win.

I find playing the PfP game really tough actually...but maybe that's just the brain damage acting up.

And aww, thanks. I'm going to check out a law lecture for fun though. But yes, the surgical skills course will definitely help! I'm still only on the waiting list though :P

Adam: Why, however did you know? Brilliant, man, brilliant! A million pounds for you!

Hope I'll have as much good luck as you though when it's my turn to spin the MMC Wheel of Fortune.

The Angry Medic said...

Eugene: Hohoho, nice work. I was wondering if anyone would pick that up. The empty space there is just clever censoring. Kids read this blog, you know. (And my mom. Hi mom!)

Phish Pharma: Ooh, sorry to steal your thunder there mate. But don't let this prevent you from starting your own blog, man! Grow a pair and start one up. You at Cambridge too? I'll link to you. We need more Cambridge bloggers.

Glad someone else noticed the similarity too. And it's sad, isn't it? I thought my bullshitting days were over too when I handed in my PfP report to that cute secretary at Path. Now it turns out we're not off the hook yet. Better start practising those "hmmm"s and "uh-huh"s now itself...

DundeeMedStudent: Hahahahaha....that last line gave me a chuckle. You have to spew bullshit up there too eh? Guess we never really run away. Like I said above, we better start practising. I'm getting a bigger mirror.

Momma Jones: I know! Maybe I should just give up now and become a nurse. Better pay, more reasonable hours, and it turns out, more respect from the UK government too.

The Angry Medic said...

Cal: I know. I dread to think of graduating into this horror. But thanks for the kind words...I prolly won't make nearly as compassionate a doctor as you will (if only for the urges to bludgeon irritating patients/co-workers/consultants/myself) but hey, I might actually ENJOY law. Or nursing.

I noticed you got the first comment on Dr Crippen's MTAS post though...someone was paying attention :) that must've shot your visitor count up.

(Feels weird addressing you simply as 'Cal'...)

Dr Deb Serani: Sounds like it's the same over the Atlantic too eh? You're absolutely right about healing no longer being respected. Because the health system in the UK us nationalised, we're at the mercy of non-medical government meddling. I expect emigration to jump among doctors...someday you might see me working in your local hospital!

(Especially if you live in New York. I love Donald Trump.)

Dr Tempest: As always, honoured that you dropped by. (Although it's a bit scary to think that someone so senior in Cambridge is reading me!) Thanks for the words of encouragement...don't be surprised if you see me working in your local law firm someday :)

Esme: *cliche alert!* Ah yes, I remember when I was like you. I too thought that things like MTAS might actually have a good effect, and in theory, it might. But the implementation has simply made a mess of medical careers everywhere, and fools out of the government. Still, keeping a positive outlook, this IS the first year, and maybe things'll improve in the years to come.

Good luck with your A-Levels and your uni applications!

Anonymous said...

As an alternative to law, you could become a painter. Painters can change black to white too.

And they go to heaven.

Chrysalis Angel said...

Too nice for law, stick with your plan man.

ah beng beng said...

become a beggar. won't go wrong one.

DundeeMedStudent said...

Hey Angry
Stuff Law- I reckon you could be the next Dr Phil Hammond.

zewt said...

too complicated for a finance person like me....

running to law? are you sure you wanna read legislation after legislation?

Anonymous said...

can't beleive you think the Path receptionist is cute. she's about 50 years old... *gak*

But i have to comment that i personally think that this method of application (wishy-washyness) is a good thing. I mean think about it, if it was purely on a academic basis and references by out DoS and tutors, where would that leave us socially inept dumbasses?

at least this way, i would have a say in the application, to prove that i am worthy of contention, even though there are prizewinning medical geeks out there.


Spirit of 1976 said...

Dear God, this MMC business sounds absolutely horrifying.

Morale among newly-qualified and nearly-qualified nurses is also pretty damn low at the moment, because as with medicine there aren't enough jobs for the new graduates. But at least we don't have to go through something that looks like a cross between a UCAS form and a selection process for a Stalinist commissar.

Michelle said...

Hey, I think I'm actually studying that lecture material this weekend.

Anyhoo, did you get my e-mail? Do you think I'm just a loon now? I wouldn't blame you, haha.

Bohemian Road Nurse... said...

Kind of reminds me of the nursing board exams, where you had four choices of responses---and sometimes all four responses might be incorrect (in which case you were to choose the one which was the "most incorrect") or else all four were correct (in which case you were to choose the one which was the "most correct" one)....aaargh...frustrating.

Dan said...

svna: don't you know by now that he likes older women? i mean OLDER? :P

it is time. good luck to you all tomorrow at kicking oxford's smelly ass at the oxbridge games.

i am too lazy to go, our pistol team have kicked their ass a few weeks ago; i've done my part. :P

Anonymous said...

Hey Angry Medic,
I remember that lecture - he was actually quite good considering the amount he had to go (or run) through...

JustCallMeJo said...

Sounds awful.

On days I'm more cynical it seems like in the US, it's a fairly simple process to become a nurse. They check your pulse. If you have one, you're hired.

I am sorry it's a painful process that doesn't seem directly tied to what matters about patient care.

UKRacismWatch said...

Please kindly also sign this Online Downing Street Petition about General Medical Council (GMC) Racism :

If we don't get the message across to the GMC now , then Eastern European Doctors are going to be doomed as well - in addition to those many thousands of African and Asian Doctors who have already suffered such rabid discrimination by the GMC.

UKRacismWatch said...

URL Link Correction :::

Please kindly also sign this Online Downing Street Petition about General Medical Council (GMC) Racism :

If we don't get the message across to the GMC now , then Eastern European Doctors are going to be doomed as well - in addition to those many thousands of African and Asian Doctors who have already suffered such rabid discrimination by the GMC.

Dan said...

spam!! although the cause is just, the execution isn't!!

don't spam!

HospitalPhoenix said...

Yeah, don't spam

Spamming is naughty

Spammers will be spanked

The Angry Medic said...

Chrysalis Angel: Aw thanks. Are lawyers any less nice than medics though? They seem okay, at least on TV.

DundeeMedStudent: Oho! So is that where the 'Trust Me, I'm A Doctor' on David Tennant's t-shirt in your display pic comes from?
I have actually looked into combining medicine and comedy. Don't think my supervisors would like it too much though. Better than law though eh? *ducks to avoid lawsuits thrown by lawyers*

Zewt: Complicated? really? Aww, I tried to write for as general an audience as possible. Sorry if I got too technical, but basically, the UK government has asked all doctors to sum up their entire careers, experience and contributions in answers to some politically correct, Pendidikan Moral-type short questions, and is allocating jobs (and decidine futures) based on that.

And hey, if someone has a passion for something, then even tedious jobs become easy, right?

Svna: You actually SUPPORT MMC? Whoa. I can see where you're coming from, but looking at the multiple systemwide computer crashes, the lack of flexibility in the answering system and the arbitrary-ness of it all, I don't think they're doing it right. The advantage HAS been taken away from the soulless nerds, but it hasn't been given to those of us with a life but without literary genius either :(

Spirit of 1976: Whoa. Nurses too huh? Ah, nice to know that the government doesn't discriminate which medical professional it screws over.

Got your email, by the way. Thanks!

Michelle: Nope, I DID get your email. And I've replied. Sorry for the delay, it's been a busy week with the Medics Revue coming up :P

The Angry Medic said...

Bohemian: Whoa! Evil exams! I hate diabolical marking systems like that. We get negative marking this year. Dante should have come up with a level of hell specifically reserved for idiots who come up with evil marking systems like these.

Anonymous: You thought so? I, uh, didn't attend that lecture. I had a problem with an alarm clock. Yeah.

(I'm so screwed during Easter aren't I.)

JustCallMeJo: Hahahahaha...that made me chuckle. Very well put, but then again, you ARE a great writer. And there's a nurse shortage practically everywhere nowadays isn't there?

Dan: Agreed. But that wasn't spam, like the previous one...this one was simply a mass-message typed in by a person, as can be seen from the link correction. And it's a cause I support, so I'll leave it up. I hate racists. They deserve to have hot coals shoved up their bums. Or anal surgery performed by Patricia Hewitt.

HospitalPhoenix: Oo, I never knew you were THAT kinky, Phoenix. New side emerging eh?

*horrible mental image of you sitting a fat bald middle-aged computer geek spammer on your lap and spanking his barely-covered hairy arse*

Cal said...

Gutter mind!!

zewt said...

yeah, even the tedious stuff. but i always find my job tedious and i am so lack of interest... does that mean i have no passion? hmmmmm

Dr Vegas said...

I like the pic. Hopefully by the time you graduate this whole steaming pile of MTAS crap will have been refined into something more useful. Until then, hundreds of doctors and their families are going to be screwed over.

Bryn said...

I love your blog and this post. It just summs up everything wrong with MMC at the moment. Hope you don't mind but I have linked to you. B