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.