Cambridge Medics Get Their MTAS Kicked

Patricia Hewitt, Secretary of State for Health, kicks me in the MT-ASS
(Yes, that's my sad face. Yes, I forgot to put make-up on, okay?)

I haven't blogged in a while*, and whilst I'd like to say that this is actually because I've been acting like a proper Cambridge medic and making love to Biochemistry textbooks in my college library, it's actually because I've been plain lazy. And just today I read another profound blog post that made me realise just why I'm being so lazy, but I'll save that for the next post, which will be a Hollywood-esque jam-packed tale of ambition, success, failure, and Donald Trump. (No, it's not going to be an Apprentice review, though good guess! These guys do a much better job than I could. --Editor)

Anyhoo, more MTAS bad news! All that I know about MTAS comes from the medblogs out there that do a terrific job of covering the madness it's unleashed on the wards. But it turns out that there's more to MTAS than just the nonsense affecting junior doctors. The geniuses behind it all, not content with culling working doctors, decided to get right to the root of the problem - medical schools.

As I learnt from the Cambridge representative to the BMA Medical School Conference, in addition to the questionnaire part and the reference part, there's an academic part for medical students to be ranked by their medical schools upon graduation. Once the students are ranked academically, they are divided into 4 quartiles.

Oxford and Cambridge reps to the Conference argued that this system is intrinsically biased against universities with more stringent admissions criteria and tougher exams, like themselves. This is because students at these universities would have to put in more work and sit for tougher exams than students at other universities ranked in the same quartile. Similar motions were put forward by both reps, but they failed to pass because, in the rep's words, "as you must understand the other British medical school representatives at the BMA were not very sympathetic with this idea".

Whoa whoa wait! Before you start lobbing rotten vegetables (and certain forms of animal excrement, for those of you who used up all your rotten vegetables after my last post --Ed) at me for being an arrogant arse, let me say that I do not actually know if Oxford and Cambridge have tougher exams than other universities. Certainly some people seem to think so. But from what I've seen of other universities' courses (and I've been to quite a few other unis - time away from Cambridge is like a drug holiday for an antidepressant user suffering sexual dysfunction --Ed) the only difference that I noticed was that courses elsewhere seemed more...enjoyable. To my clinical-starved self, at least.

So what does this mean? Does it matter? Will it make a difference in four years when we graduate and get spat out into the workforce? I don't know. Should I be bothered? Probably. But not right now, because it's almost 9am and I hear my supervisor coming. If anyone asks, I've been in the library all night.

*yes, I'm going to pretend that some of you out there actually care. I'm young, okay. Let me dream! --Ed.

MMC Big Daddy Resigns

Professor Crockard, National Director of MMC, marches out of the MMC bunker for good

I was online at FrontPoint Systems (yes, so I was procrastinating again. What's it to you? YOU AIN'T THE BOSS O' ME!* --Editor) when he broke the news that Professor Alan Crockard, the National Director of Moderning Medical Careers (MMC) has resigned. Read his full story here, and the full letter of resignation at Dr Rant here. (Link not safe for kids. Don't bother with noisy grown-ups arguing, li'l tykes, go play a Teletubbies game or something. --Ed)

Let's take a break from revision together, folks, and take a look at ol' Crocky's letter. In it he simultaneously plays both hero AND villain (a feat previously only managed by President Bush --Ed). He says "The principles of MMC are laudable and I stand by them. More patients should be treated by trained doctors, rather than doctors in training."

Forgive me, for I am but a humble overworked medic, not blessed by the abundance of brain cells required for a position of such great responsibility, but I fail to see how exactly we are supposed to GET trained doctors unless we LET doctors-in-training treat patients.

However towards the end he nicely states "But the overriding message coming back from the profession is that it has lost confidence in the current recruitment system." There we go. At least he's acknowledged that doctors don't bloody like MMC, without resorting to the whole ignore-doctors-won't-apologise-lalala-I-can't-hear-you stance of the Department of Health. If he stepped down in genuine protest at how the system is treating doctors in such a haphazard manner, and if he is not a traitor like the complaint lodged against him suggests, then he is truly worthy of applause.

So c'mon, folks, join me in celebrating by putting this on repeat on your playlist, courtesy of the brilliant DogHorse. Turn the volume up real loud - it's great for accompanying revision!

* unless you're my Director of Studies/Senior Tutor/supervisor, in which case, sorry, sir. I'm heading back to the library now, sir. Honest.

The Empire Is Struck Back Against, Part II

Aboard the MTAS Death Star, Emperor Blair and Darth Hewitt try to get themselves out of hot soup

After last Saturday's widely-publicised march in London by junior doctors protesting against MTAS, Patricia Hewitt has gone into hiding and left behind her henchman Lord Hunt, the Health Minister, to face the music and gibber incoherently. Dr Crippen wonders where she's gone; I suspect she's hiding on the MTAS Death Star.

And since my last post on the MTAS debacle (which was picked up in last week's BritMeds due to my use of the word 'wankpile' to categorise it; I don't think that's weird at all, do you? --Editor) Opposition Leader David Cameron has finally got it through his thick head that hey, thousands of doctors protesting could actually be a good time to campaign for votes:

David Cameron gets a clue

But you have to admit, his speech was stirring. It made doctors feel something they haven't felt in a long time -- like they were valued. You can watch it here.

Comments under the original post here please.

The Empire Is Struck Back Against

Aboard the MTAS Death Star, Emperor Blair and Darth Hewitt find that the Force is no longer with them

The doctors have begun to strike back against the injustice that is MTAS.

Earlier last week they turned to David Cameron, Opposition Leader. They looked to him as a saviour, someone who would use the huge political stick that is the MTAS fiasco to beat Tony Blair on the head and secure several thousand votes. So great was the call that MTAS became the top question on Cameron's Open Blog, where the Conservative leader responds to the top 5 posts every week.

Sadly he has let them down. His response, viewable here, saw him sidestepping the issue like a Labour politician. This idiotic political move is already costing him votes, as an be seen from the responses on his blog.

Doctors wait in vain for David Cameron to save them

But the doctors aren't done in yet! What do good, honest UK citizens do when civil rights are threatened and evil greedy government types screw them over? Why, march, of course. This Saturday's 'March in March' is hoped to raise more media pressure on the government to fix the situation.

The deaneries themselves have spoken out. Some have resigned in disgust. The Royal Colleges have condemned it. In fact, several of the UK's leading doctors have spoken out against it, including, I am proud to add, several of my lecturers here at Cambridge.

Dudes who have spoken out against MTAS

But all this is above my humble medical student head. All I know is that the future suddenly looks a lot bleaker, and unless all these angry people in white coats can convince this woman to change her mind, I'd better start looking for jobs in Australia.

So what can I do? Several things. Firstly, I've done my part to educate the international community on what is happening here in the UK by writing a post on it for Medscape. Do check it out and leave a comment or two, if only to confirm what's happening, as the editor left out the BBC news links I gave her (either that or she thinks I'm a loon, which isn't too far from the truth. --Editor).

I also blogged here about the tragic passing of Laura Case, a former medical student at Cambridge who was killed whilst delivering medical aid in Uganda. Her father has written to me with a heartfelt letter that he has sent to The Times, saying how Laura disagreed with the current system of training junior doctors:

My daughter, Laura Case, was a medical student who was killed in Uganda while working there in a hospital as part of her final year training. (Times 20 February).

Like most medical students, she was committed, but not particularly idealistic. Nor was she political. She was, though, angry about the failings in the training and selection of junior doctors. Admittedly her experience was only her own hospital area, but she thought the central organisation and supervision of her training poor, and when on six weekly rotations round various hospitals and GP practices found, with some notable exceptions, that students’ training was often chaotically organised, and students tolerated rather than involved. The view of senior doctors seemed to be that it was better now than when they were young, so ‘get used to it’

She found the failure of government to plan effectively for the requirement for doctors dispiriting, as it lurched from creating new medical colleges, and then in the face of ‘overcapacity’ ditching non EU doctors that had been encouraged to train here, and now admitting an oversupply of newly trained doctors due to ‘changes in the system’. The actual selection process, which has been marginally improved from last year when humans were more or less replaced by computers in selecting junior doctors for posts, is still so useless that a group of consultants recently refused to conduct job interviews on the grounds that the process was unfair. (Times 6 March).

The Department of Health and Downing Street both defend the position with weasel words, but junior doctors, not usually a militant bunch, are so incensed that they will stage a march on March 17^th to protest at the position. (www.remedyuk.org). My daughter was well aware of the cost of her training both in terms of taxpayer money and her six years of study; let’s hope many more join the thousands of young doctors planning to march to highlight this cavalier handling of investment and talent, and the government’s inadequate response to the problem.

The medical profession has spoken. We will not stand for dictatorial high-handedness with a policy that looks like it was dreamt up by a bunch of baboons in a doughnut shop with John Prescott. Like this comment says from a friend of Laura's:

Compassion is fine but Laura would have wanted you to fight. Stick a card in front of the complacent - 'Laura Case died because she cared enough to be a doctor.'

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.