Monday, March 12, 2007

"Modernising Medical Careers" Goes into the [Trash] Bin

We have posted several times, most recently here, about the controversy over the new system developed by the UK National Health Service (NHS) to select physicians for senior specialty training positions, called "Modernising Medical Careers." Now, after having a spokesperson say "it would be irresponsible to halt the interview process at this late stage," the NHS has decided to cancel the whole new system and go back to the traditional method of selection. As reported by the Guardian,

The computerised application system for the training posts that lead to consultant jobs was scrapped by a review set up this week to establish why many of the best-qualified candidates had been left without a single interview.

The review, led by the Academy of Medical Royal Colleges, took just three days to bin the online system, which was supposed to deliver a centralised and fairer application process. Junior doctors who have not got interviews in round one will be re-assessed the old way, through scrutiny of their CV and a structured interview.

Last night the Royal College of Surgeons said the computerised selection process had 'clearly failed and has caused deep distress.'

The article gave a bit of insight into what was wrong with the new system.


The online application form, (Medical Training Application Service) was supposed to be fairer. Doctors were scored for their answers to generalised questions about their attitude, motivation and approach to their work - which had to be answered in 150 words. Shortlisters saw the responses to a single question without the context of the rest of the form. More weight was given to these questions than to the CV.

In some parts of the country, the scoring system was leaked, enabling some candidates to tailor their answers.


To make the folly of the Medical Training Application Service (MTAS) system clearer, take a look at some of the questions a surgical candidate would have to answer, as found in a post by the redoubtable NHS Blog Doctor:
  • B6 What experience of delivering teaching do you have?
  • B7 Which of your research or audit studies has made the greatest contribution to your practice and why? Clearly describe your level of involvement and the outcome.
  • C1 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?
  • C2 Provide a recent example from your surgical experience of when you have had to co-ordinate the activities of a team in a critical situation. What approach did you take to get the best out of the team? How has this experience developed your ability to direct others effectively?
  • D1 Mistakes can and do happen in medical practice. Describe a specific example where the outcome of action you took in response to a clinical mistake/error (made by you or someone else) caused you to reassess how you subsequently dealt with similar situations. What action did you take at the time and how has your practice now changed?

Each answer was limited to 150 words. The system had no capacity to verify the truthfulness of the responses.

An editorialist in the Telegraph summarized the problems.
With the new computerised system, which also encouraged numerous applicants from abroad, already hard-pressed consultants were frequently asked to plough through 500 or 600 applications. Instead of being trusted to use their well-honed professional judgment, they were required to grade these applications according to a bizarrely rigid, illogical points system. Many of the questions were somewhat pious and woolly, and consultants thus found it almost impossible to discern the best candidates from the answers. [And that assumes that the answers were completely honest and accurate, which could not be assured - Ed] The result is that many extremely competent candidates weren't shortlisted for any job in any region. Now 8,000 British junior doctors, each of whom cost the British taxpayer £250,000 to train, have been left jobless and deeply demoralised. Growing numbers of principled consultants are flatly refusing to interview shortlisted candidates because the process thus far has been so fatally flawed.
The editorialist, Jenny McCartney, summarized some of the larger issues.
But surely no one can have seen this disaster coming? Yes, they did.

Last summer, the British Medical Association openly pleaded with the government to delay the MTAS, on the basis that the reforms were incomplete and that "information necessary for selection will not be adequate." A contemptuous Department of Health ignored the warning.

This fiasco contains virtually all the elements that have contributed to the dismal failure of numerous Blairite policies: the urge for sweepingly radical gestures without intelligent planning for the aftermath, the failure to listen to experts in a given field and the naive enthusiasm for vast, unwieldy, centralised computer systems.

The political mediocrities in New Labour are instinctively suspicious of professional elites, whether those elites are composed of Oxbridge dons or hospital consultants. No matter that members of such elites are largely there by dint of cleverness and hard work: this Government's instinct is to wrest decision-making power from them in the name of 'fairness.'

'Fairness' - as the Government dully conceives of it - essentially means that the direction of one's life is determined not by graft or intelligence but by crude chance.

The Government's abject failure to understand such basics makes me think that in Britain we have got matters entirely the wrong way round. Instead of doctors being forced to obey rules set by politicians, should we not have politicians compelled to follow the time-honoured rules of doctors? After all, the most famous edict of medicine is the very one that New Labour so constantly and disastrously forgets: 'Primum non nocere: first, do no harm.'
I don't want to comment on British politics, which would be like stepping into quicksand for an American. But I would conclude by noting that the faults attributed to "Blairite" policies by this editorialist also describe in general a lot that has gone wrong with American (and probably other countries') health care.

The idea of breaking the medical "guild," and handing power over to managers and bureaucrats (see here for the American version) has had terrible consequences for every health care system to which it has been applied.

Kudos, though, to British doctors, who were willing to stand up and refuse to take any more.

1 comment:

Zara Gaspar said...

Hello,
Am wondering if any of the bloggers who are doctors in the Uk can help me. I am a journalism student currently doing my masters and would like to speak to doctors about their thought on Blair and what he has done for the NHS in the last 10 years. If you are willing to help me please could you email me at zlgaspar@uclan.ac.uk My article will not be published without your permission as it is mainly for my dissertation. Thanks