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The Daily Rhino
Wednesday, May 16, 2007

The beginner's guide to the MTAS fiasco

Originally published in the May issue of Medical Student Newspaper.


ARE you a bit muddled with this whole MTAS business? Do you nod along politely when people talk about ‘all those poor junior doctors’? Do you secretly not have a clue about medical training? Are you Patricia Hewitt?

MTAS is no more. People are happy. You should know why.

The history

Four score and seven years ago, Aneurin Bevan invented a work experience programme for Indian doctors called the NHS. Some British doctors joined in and then we had a health provider the world envied. This glorious period, where all the developed countries in the world tried to model themselves on our free health service was truly a wonderful time. It lasted an entire Wednesday afternoon.

After a few decades, the Indian doctors opened a whisky distillery in Sheffield and the Brits retired to Eastbourne. And so it came to pass that new doctors began applying for jobs.

They used an ingenious system the Romans used to call a 'resumé'. For many hundreds of years this system was used to select junior doctors. But sadly it all came to an attractive end with the famous case of Professor Fry's colorectal firm which consisted exclusively of nubile Swedish female SHOs and one androgynous Thai boy.

Some f*cking genius suggested current selection criteria is outmoded and unfair and the seeds of MMC were planted. That genius had good intentions, but I'd sure like to punch him in the mouth.


A new way of choosing doctors

Deep in the desert forests of Shropshire, a small band of vegan peoples started shaping the future of medical training. Out of clay. They deemed it appropriate to do away with millennia of tradition and replace the CV with a form made from Satan's flatus.

They say the man responsible for the form designed it with only one hand, as the other is chained to a pipe in his mother's cellar. They say he owns an extensive collection of mermaid porn and rubs soup into his face for hours on end.

MDAP was born, but was so hypoxic at birth it had to be transferred to NICU. An inexperienced F2 had a stab at intubating MDAP but tore straight through its pharynx causing it to die horribly and in great pain.

From its twisted and mutilated neonatal corpse rose the spectre of MTAS. MTAS was a healthier baby than MDAP and made it to school, where it had no friends. This year MTAS put thousands of SHOs in a big pot and shook them around a bit. A few thousand fell out and they went in the jobless pile.

MTAS took a look at the other doctors in the pot and chose a few budbud, whop, spik and bongo names to chuck out, even though they were all Brits. Then MTAS got bored and emailed credit card numbers, pant sizes and sexual preferences of junior doctors to crack dealers, the Klan and C.H.U.D.S.

A Big Medical Association a lot of us pay to represent us didn't do anything to begin with. They were playing MarioKart 64 and kept hitting the lightning before the jump.

A group of sewer-dwelling radioactive amphibians called ReptileUK tried to murder the MTAS staff and the Department of Health with sharpened baguettes.

Some splinter members broke off and realised the key to success was a Facebook group and a flash mob in London. RemedyUK got an unwashed mass of junior doctors together with the promise of blood doughnuts. They protested. Then the Big Medical Association weighed in with immaculate - and by that I mean woefully late - timing.

Patricia Hewitt, meanwhile, dropped her purse into the toilet and lost her library card. She went to the library and asked for a new card. For some reason she explained to the librarian she needed a new card because she dropped her old one in the toilet. As she left, she silently thought to herself "why did I tell her?"

In the deep West Midlands, the ST interview panel walked out. Patricia Hewitt said MTAS was a rousing success. New Zealand, Canada and Australia opened special British doctor immigration lanes at international airports to cope with the exodus from the UK. Patricia Hewitt said any minister that makes an error should resign. She kept on workin’.

Senior deanery staff walked out. Patricia Hewitt said pulling out of MTAS "was simply not a credible option since it would be impossible to place the best candidates in posts and fulfil the service needs in time for August using the old system."

Yet with a mighty slash from Occam's razor, MTAS was culled and lived no more. One day before court proceedings into the fairness of the system began.


A newer way of choosing doctors - the future

Medical Student Newspaper can exclusively reveal what will happen next. Sure, we're told hospitals will be using the old CV system to pick jobs, but we all know this is jive man, pure damn JIVE!

It does seem apparent that an elaborate new system of assessments will form the basis of selection for ST posts from next year. Obviously many of the skills required will remain the same.

For example, the requirements for a surgical ST1 job will still revolve around the basic tenets of managing the acutely unwell surgical patient, operative experience, watermelon seed spitting and Turkmeni dancing. Interviews will be replaced by three-stage contests between rival candidates.

The first round will consist of a barefoot jump-rope endurance challenge, with ropes made of glass and a floor made of knives. The second round is obviously ostrich wrestling, now a core part of most medical school curricula. However all trash talk must be in a broad Irish brogue.

Lastly, potential specialist trainee doctors will be selected according to their performance in the petrol gargling clinical governance contest. Only four things will be required prior to short-listing candidates.

They will want a plaster cast of your ear, your thigh circumference, a portfolio of every venflon you've ever inserted (specifying the colour and volume of saline used for flush) and finally fourteen DOPS, twenty two mini-CEXs and eighty five thousand CbDs.

Joking aside, thousands of British junior doctors took up jobs in new continents, far from family and friends. Of those that remained in the UK, about 33,000 have been waiting to hear if they have one of 22,000 jobs or if they will fill a void by working in a short, stop-gap, non-training post. Worse still, they will be reported to the GMC if they choose to leave if offered a better post.

The £250,000 it cost the taxpayer to train each one of them and the streams of cash being poured in to try and rectify the situation are apparently collateral damage.

One can only hope that your year avoids the genuine heartache MTAS has caused. But spare a thought for those a few years above you, life’s been unfair.

If you really want to learn more about getting into the new medical training system, you need to buy The Foundation Programme: Getting In, Getting On and Getting Out. DO IT.

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Sunday, May 06, 2007

The student becomes the master. THE MASTER I TELL YOU.
Originally published in the April issue of Medical Student Newspaper.

F2 JOBS are out, huzzah! With nothing more than an arbitrary survey of me asking my friends, it seems as though most of my fellow F1s are happy with what they'll be hating next year.

Contrary to the February issue's prediction of becoming a McGP in Slough, I managed to land A&E, renal medicine and ITU at St. George's. I could not be more pleased. However there is one problem - I will have no one to boss around. I don't think I'll have an F1 for any of these firms.

My one consolation is that I might be lucky enough to have some hapless medical students to do my bidding. Although they must be the right type of medical students. The right type of medical student is one that loves bleeding people, sticking in venflons, writing TTOs and getting me food. It's the kind of student I was not. In fact, now that I find myself in the bizarre position of imparting knowledge (ha) onto students, I realise I would have hated to have someone as work-shy as me for a shadow.

I have a long and distinguished history of hypocrisy and you will be pleased to know I have continued it into my working life. Despite being a lazy and ignorant medstudent, I have no qualms violently demanding nothing less than complete dedication from my assistant house officers. Other people's students, however, I send home as early as I can.

"Finished lunch? Yeah why don't you head off? Your team doesn't need you this afternoon. Just tell them Rohin said you could go home."

The teams in question always seem 'annoyed' with me; I know they're just showing their affection in a male-acceptable way. When my students ask for the same courtesy, I have to work very hard not to throttle them with their new tourniquet.

"Have you checked the bloods, done a PR on the fat guy and got me a bacon sandwich? Nooooo? Chop chop then, get to it woman!"

Nowadays I stop short of physical contact, after the nasty business that occurred when I tried to encourage Valerie with a firm slap on the arse. The less said about that, the better.

The simple fact is that house officers are far more willing to help keen students as opposed to layabouts. I have discovered this too late. I cringe when I think what my house officers must've thought of me. Except for my firm at Medway. You'd be surprised how a hot SHO can motivate a young man to put in the hours.

Willingness to get involved with the firm isn't the only criterion upon which we rank students. During my first firm I had twelve students at one time. Twelve. At St. Peter's we open our doors to third, fourth and fifth years from both Imperial and St. George's. Thus I find myself in a prime position to make sweeping generalisations and unfair comparisons between the two medical schools.

Third years are uniformly a nuisance, whether they come from Gimperial or George's. They buzz around and get under foot like insects. Bad insects. Insects that carry some sort of disease. But not mosquitoes because they don't crunch when you kill them. Maybe cockroaches. But not that big. Like some disease-carrying medium-sized hard-shelled scuttling insect. Yeah.

I do feel sorry for the ICSM little ones though - they're abandoned on the wards for up to ten weeks with almost no instruction. They wander around like lost puppies and have to rely on the good nature of the junior doctors to teach them clinical skills and create educational tasks for them to do. So if they're with me, they're screwed.

Fourth years are, without doubt, the most accomplished skivers. I feel barely qualified to comment on their characteristics as students as I have seen so little of them. I prided myself on my unparalleled bunkalicious skivism, but some of these guys make me look like an amateur.

It is the final years with whom F1s have most contact. I have now had seventeen shadows and they break down nicely into three sub-categories. George's five years, George's four-years (GEPs) and Imperial (sixth years). Each group has their own idiosyncrasies and foibles.

The conventional five year St. George's final year is thoroughly competent, relaxed around patients and ready to get stuck in. I, of course, feel more than a little kinship with them as I was one just ten months ago. They're keen to absorb knowledge, which is just as well as most of them have plenty to learn. The best Venflonners by a country mile.

Imperial final years – though it pains me to say it - seem to be more book-smart. There are few experiences more humiliating than being shown up by a smartarse student, but it happens so frequently I have grown to expect it. And there are myriad ways for me to exact a horrible catheterising revenge. In contrast to their admirable knowledge, some Imperial medics can be deficient in patient skills.

Lastly, by far the most interesting category is the GEPs. While they are exceptional players of blood bottle bowls, they are either doddery to the point of comedy or utterly set in their ways. One of my recent students, a German chap in his mid-30s and post PhD, lacked any logical thought whatsoever.

However, I will freely accept that me repeatedly shouting "I’m a cybernetic organism", “you’re a CHOIRBOY compared to me, a CHOIRBOY”!” and "who is your daddy and what does he do?" in an Arnie voice cannot have helped. Austria, Germany...same thing, right?

The transition from student to competent doctor is a gradual one and it comes as something of a shock to find yourself suddenly obligated to teach mates you've been getting pissed with for the last five years. In between emptying alcogel dispensers on each other, stealing drug rep goodies and flicking elastic bands at nurses, teaching students is one of the highlights of being a junior doctor, for as one teaches, one learns. I feel like I should dematerialise on Dagobah after that line. Lastly, a special thanks to Davina Hensman and Matt Roe, the best students I've had!

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Patrica Blewitt
Originally published in the March issue of Medical Student Newspaper. just before the protest on the 17th of March.

THEY’RE calling it Black Monday. I had a stupid article all about bossing students around prewritten in my head, but felt there was no way I could ignore Black Monday and its implications. This month has been dominated by the plight of our SHOs.

Medicine is a career where both a strict hierarchy and a fluid camaraderie co-exist. The SHOs I work with are both my seniors and my friends. Mulling over their pathetic predicament genuinely makes me despair. This month’s news section details how thousands of SHOs have been shafted by MTAS. The almighty fiasco has been played out in the national media as well as in every doctors’ mess across the country. Black Monday was the 26th of February when seemingly all my SHO friends learnt they had not been shortlisted for any ST jobs.

Why has the system gone so spectacularly wrong? Why are so many gifted young doctors jobless? How could this country have caused thousands of its brightest to plan moving abroad? A catalogue of calamity has led to a situation where little can surprise anyone aware of what has been going on. When we hear that a Deanery has been using police cadets to shortlist the vast numbers of applications, we barely raise an eyebrow. It may or may not be true, but it’s hardly more farfetched than some confirmed details so far.

The news that the entire West Midlands surgical interview panel resigned en masse on the first day of ST3 interviews spread like wildfire. In some ways, British doctors have never been so united around one cause. Part of the reason doctors from every walk of life are taking an interest is that they were all SHOs once upon a time. GPs and hospital doctors were SHOs at one point. They often remember their formative years with fond nostalgia and that a generation is being robbed of their chance at medical training troubles many greatly.

When I was a student, especially in my pre-clinical years, actual doctoring was a world away and I had no concept of what issues juniors faced. Hence I wanted to try to convey the mood hanging over your future profession to you. I cannot recall any time in British medicine as dark as this. Countless doctors have written desperate accounts of how they don’t deserve to enter unemployment. I clearly recall my school careers adviser selling medicine to me as a field where I would “never be out of a job.”

In fact I recently ran into someone from my year at school, now an SHO. I took a gap year and did a BSc, he didn’t. He has not been given any interviews; I might well avoid this fiasco altogether. Two years of dossing around might have been the difference between being a doctor and signing on. The figure being widely quoted in the press is 30,000 doctors applying for 22,000 posts. However the number of training posts may be substantially lower as many are career grade non-training posts, into which MMC is trying to guide people.

There are specific reasons, other than impending dole queues, which have particularly angered SHOs. Government mouthpieces like Lord Hunt, the Health Minister, spouts lunacy like: “We know the system is working well in many parts of the country...Let's be clear, there has always been competition for these specialist training places and there ought to be because these are the senior jobs. It's important we get the right people.”

Getting the right people is laughably far from the reality. The minority of friends who have gained interviews have been allocated them in an inexplicable manner. My current SHO, a highly experienced and superb old George’s boy, has been given an interview in London, the most competitive of all Deaneries, but nothing in his three less-competitive backup choices.

Patricia Hewitt, the Health Secretary has been warned for years that the UK is forcing junior doctors abroad. Many of the Royal Colleges have been angered by the complexity of the scheme and statements by the government that the Royal Colleges were complicit with all plans. This prompted a rapid response from all the major colleges, to ensure applicants knew that the Royal Colleges had been kept in the dark as well.

The government has cynically utilised the fact that the vast majority of doctors are scared to leave the profession. Most jobless SHOs face three options. Some could emigrate, but this is impossible for many. The majority will not find alternatives in the UK but will not quit altogether simply because they want to be doctors.

Yet another factor unpopular with candidates has been the application form itself. Last month I gently poked fun at the F2 application form. However similarly inane questions make even less sense for ST posts. Doctors who have augmented their CVs with publications, courses and qualifications have found themselves no better off than those that haven’t. The system has earned itself a reputation as a lottery due to the conventional, tried and tested, system of a CV and references being scrapped. Only a few 150 word answers to generic questions determines your future.

Perhaps most embarrassingly of all are the number of errors. Some SHOs have received interviews in areas they did not apply to and a confidential booklet outlining selection criteria was leaked on the Internet. It detailed “methods & best practice for upskilling selectors”.

St. George’s and St. Thomas’ have written public letters of protest to Prof Elizabeth Paice, chairman of the Conference of Post Graduate Medical Deans, calling on them to "revoke the current fatally flawed system". Our friends are being treated like shit, show them your support.


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