dr ordinary

so patricia hewitt has appologised on the radio 4 today programme. doesn't really mean anything though and she wasn't totally honest about everything. appologies don't mean much when they are spun through a web of lies. and it's all a bit 'too little, too late.'

she said that the new online system had caused “terrible anxiety” to junior doctors across the country and that it was “nowhere near where it should have been”.
and yet still it continues.

she said "junior doctors have been caused this absolutely needless anxiety and distress and I am very sorry indeed that has happened. We are now sorting it out."

sort it out how? by somehow making turning an already ridiculous system into one that is so unfair if it weren't our lives we were talking about it would be funny? how can anyone look at this system of application (either the original or the apparently revised - though we have still heard nothing) and think that it is fair? why shoulr junior doctors be limited to making only 4 job applications, with each application having to be in different vast geographical areas if they are committed to a particular specialty? why not let each applicant apply to individual departments within hospitals.

imagine if this system was implemented for lawyers for example. you could roughly select which area of the law you wanted to specialise in, then you could submit one application to be considered for every law firm in london that has such a department etc. the idea is ridiculous. especially with the level of competition being what it is now known to be.

every department in every hospital works differently. different characteristic will make one candidate ideal for working within a particular team while another who is equally qualified may be less suited. the idea that one interview allows fair and appropriate placement of every individual is ridiculous.

and that was all bad enough when we had the possibility of being selected for up to four interviews. now that it is one shot for everyone it has gone beyond a joke.

“The short-listing process didn’t work. We are in the process of sorting it out and we are now guaranteeing every junior doctor an interview for the speciality of their choice,” she said.

i have to say this idea of offering every eligible candidate one interview is nothing more than a gimic to try and push the debacle through with the least government embarassment possible. it has become a damage control exercise only. most people i speak to don't feel this is an appropriate solution. 'they' keep telling us that there has always been competition for jobs - as if somehow we didn't know that! the point is that there are fewer training posts and far fewer points of entry into a training programme than before. whereas previously you could apply for 100 jobs at a time if you so wished and if you were unsuccessful you could apply again 6 months later, having had the opportunity for feedback and therefore improvement of CVs and interview techniques. now it is one shot. one interview, one area, one chance for this year. and although we are being led to believe there will be some opportunity for recruitment into run-through training programmes in 2008, who knows what to believe.

no-one i know wants this guarenteed interview scheme. no junior doctors and no consultants either. it is totally impractical to interview every single candidate that applies for any job. i don't have a solution though. another shortlisting process would be ideal as a way of selecting candidates for interview, but as this week ticks slowly by and the MTAS Lords keep their golden silence i wonder whether time has run out, options have run dry and the broken, twisting, heaving monster that is MTAS will somehow make it beyond the finish line and all our protests will have been in vain.

Medical Training Anxiety and Stress disorder
A new psychiatric disorder is sweeping across the nation at an alarming rate. Officials have not yet been able to control the epidemic of a new condition that has been named Medical Training Anxiety and Stress (MTAS) disorder. The disorder, which appears to be affecting primarily junior doctors, is characterised by a previously unseen cluster of symptoms including thought disorder, hallucinations, escalating paranoia and obsessive behaviours.

Epidemiology and AetiologyIt is estimated that there have been as many as 34,000 new cases of MTAS disorder since January 2007, though this may be grossly underestimated. The lifetime risk for developing the disorder is thought to be as high as 100% in the at-risk groups. MTAS disorder appears to affects junior doctors at any stage in their careers and the severity does not appear to be affected by gender, race or duration of medical working life.

Clinical featuresMTAS disorder is characterised by a number of psychological and physical symptoms. Remarkably this disorder seems to be characterised by one common delusion; those affected are convinced that they are in regular communication with government officials via Internet websites and that their lives and career aspirations are being monitored. Thought insertion is a common symptom. Individuals describe government dictation of life plans, most specifically career choices. Many also report thought withdrawal, describing that previous career aspirations have been removed from their heads. Thought broadcasting is another common theme. Many individuals report that their thoughts and work-related experiences have been documented and broadcast via the Internet. Those affected have developed obsessive behaviours, repeatedly describing difficult cases they have been involved in, when their patients have made them feel upset or angry. Other obsessive behaviours have been observed; those affected are rendered incapable of being in the vicinity of a computer without trying repeatedly to access government websites describing grandiose ideas that they may be called to attend interviews across the lengths and breadths of the country at a moments notice.
Physical symptoms include disturbed sleep pattern, palpitations, tachycardia and those with severe obsessive behaviours have developed repetitive strain injury from overuse of computers.

Management
Early indications are that psychosocial therapies are ineffective in the management of MTAS disorder. Trials into medical therapies are continuing but so far anti-psychotic medications have done nothing to reduce paranoia, delusions or persecutions. The spectrum of symptoms is worsening despite frantic research and trials of therapy.

Prognosis
Though little known is known about MTAS Disorder it is thought to have a poor prognosis. The long-term effects are not known but there are indications of likely long-term psychological damage with significant destruction of morale, self-esteem and ambition. Experts have been called in but so far their efforts have been negligible. There are serious concerns regarding what is to become of the medical profession. The world will watch with scrutiny over the next few months as the disaster unfolds.

new BMA analysis of figures on the MTAS website shows that the actual number of UK specialist training posts available is 18,518* – not between 22,000 and 23,000 as the government has publicly indicated. An estimated 32,000 doctors have applied for them, and although some of these are from overseas, it is inevitable that a large number of UK doctors will not have training posts in August.

clearly the government need some 'rithmetic' lessons. basic adding up skills are lacking here.

i think the 32,000 applicants is actually a conservative estimate. the numbers i have heard more commonly are more than 34,000.

and what does it matter if some of the applicants are from overseas? they are still eligible for the jobs. this means that pretty much half the people applying will not have a training job, and there will be a high proportion of those that do who only get offered a one year training contract. that's not a lot of trained docs a few years down the line.

and so the nightmare continues. and who'd have thought it could get any worse.

still no bloody news. can't believe it. actually what i really can't believe is that i can't believe it. it is just so typical of the lords of MTAS. this week has made me so aware that time is just ticking by, and the longer things go on in this limbo state the more unsettled everyone feels and the less likely it becomes that any fair solution to this mess is found.

we were expecting a decision about the 'russian roulette' round on monday morning and so far there has been nothing. not a peep.

i wonder if it s a result of the legaltastic challenge against MTAS and the review committee's ridiculous decisions to date. perhaps the delay is because of the need for legal advice.

the problem is, time is running out. each day brings us closer to august, and each minute that goes by without word from the MTAS lords morale falls lower - if that is actually possible.

everyone is feeling so low at the moment. everyone is confused and helpless. noone can plan anything - and i don't just mean planning the big stuf like where to by a house, whether to by a house, finding out about schools for one's children. i also mean all the other crap that everyone put on hold from january until now. stuff like seeing families, having a holiday, having time off, going to weddings. how can we plan any of t when we have no idea if there is going to be a further round of interviews now?

with every day comes a new rumour which serves only to unsettle us all further. the latest i have heard is that some of the specialties within the deanery i'm working at the moment are not going to participate in round 1b because they are not able to reform the orginal interview panels and feel it would not be fair to interview under such different conditions for what will ultimatley be considered the same round.

another spanner in the works. wonder how many more there will be before this nightmare ends. (if this nightmare ends)

the latest advice is to join up to the NHS jobs website in the hope of finding alternatives. not sure what alternatives there will be, in that all training and non-training posts are currently prisoners of the MTAS lords.

perhaps they're recommending we change tack altogether. try our hand at something new. i wouldn't mind being a paramedic i guess. but that would need more training and time and money that i don't really have to spare.

so august will probably see more of us in the queues at the job centre.

i wonder what i could do as an alternative career.

i did always want to be the person who names all the stuff for ikea...

well, i fell for it again!

we were told the official reults of all the changes the review committee has recommended would be explained in full detail this morning. sadly not the case. not a single piece of new information at all. i'm not quite sure what led me to believe that if we were told the information would be out on monday morning it would be. i think i must be suffering from delusions.

feeling exhausted today. made the mistake of drinking 6 espressos yesterday afternoon (they were cunningly hidden in my lattes) so i was up til about 3am buzzing! i would never have guessed that so many espressos would make up 2 drinks! mental. having caffeine withdrawal today - or could it be MTAS withdrawal? haven't heard anything for quite a while now.

lots of changes in the last few days. prof crockard has resigned, remedyuk have served the review committee with legal papers, scotland and wales have pulled out of the new 'last chance saloon' MTAS process and it looks like northern ireland will soon follow. good for them. at least having recognised that the application forms were so shit they count for nothing they have done the only thing they can fairly do and agree to interview everyone for all they applied for. difficult practically but better than russian roulette any day. so it seems us lot in england are potentially the ones who will be totally buggered. the only ones who will be expected to have a one off gamble with our lives. excellent.

would be interested to know i more detail about this remedyuk legal challenge. i wonder how much of a chance we actually stand?

so, we are still waiting with baited breath for the next move of the Lord of the MTAS rings. i wonder if they will manage to mess it up any more. well, you may laugh but noone thought they would be able to do any worse, and then they came up with this lottery system: 'it could be you...but it probably won't.'

so, tomorrow is the day.

the day we find out officially what's next. it was expectd that tomorrow the review committee would announce that every applicant is entitled to one interview. this could either be an interview that has already happened, or we can opt to have an inerview somewhere we were not initially short-listed for. those who have had more than one interviews are to have all but their first choice discounted, so this really is last chance saloon.

and now that scotland and wales have opted out of the russian roulette round 1b, where does that leave everyone else? that means that some individuals will have four interviews that count, and others will just have one chance. and this was supposed to be a fair system. it has just gone beyond the ridiculous.

and no-one knows what northern ireland will do.

i don't have a solution. i don't know what is best from this point. i think probably the only fair thing to do, having deemed the application form and thus the short-listing process not fit for purpose, is to offer everyone all four of their interviews. having said that, i cannot imagine how that would be possible in practice.

will this rollercoaster never end? or are we to expect another huge twist, another unpredictable turn...and all at break-neck speed.

i think most of us knew that this would be a difficult time. i'm not sure anyone imagined quite this catastrophe.

as time goes on and the goal posts change, the deadlines are moved, the rules are modified the feelings of despair and hopelessness grow.

has anyone given any consideration to how this is affecting our families? i am married. to another doctor who is obviously also going through this nightmare alongside me. this feels difficult enough but i really feel for those who have young families and mortgages to worry about. it seems those in charge have conveniently forgotten that we are people with families and ties to particular areas. that people need time to sort out accommodation and schools and jobs for non-MTAS partners. that realistically it is pretty difficult to up-sticks and move half way across the country at very short notice.

they need to stop and think. think about the worry and anguish this is all causing. for us, our partners, our children, our parents. the uncertainty, the constant changes and revisions, the modifications that more and more deaneries are opting out of, thus disadvantages huge groups of doctors. thay need to consider the impact that this is having on every individual involved.

i suppose i was one of the lucky ones. i did get offered an interview. only the one, but at least it was a chance. it was for paeds in my second choice deanery. not my first choice, but i wasn't complaining.

i did all the usual guff before the interview. got a new suit, had a haricut, thought about what they might ask and what i might say. sorted out bits and pieces for my portfolio that i had been assured repeatedly would be a major focus of attention in this new climate of proof and evidence.

the interview was ok i guess. quite tough questions but i managed to pull together an answer of sorts for everything they asked. it was more complicated and more clinical than i had been told to expect but i think i just about coped.

however, under the new guidance of the review committee, everything is going to change. the powers that be have now decided that everyone will be entitled to one interview, ad one interview only. they feel that as the aplication form was so flawed it cannot be allowed to play any part in the shortlisting for interview process. as a result everyone should have interviews but i guess they have decided there is not enough time for everyone to have interviews in all four if their nominated deaneries/specialties so instead we are all to have one chance only.

how is this fair? one shot! it is like russian roulette. i don't think anyone in charge of this fiasco has any idea how frustrated and angry everyone at 'grass-roots' level is. i don't think anyone has stopped to consider how stressful this is for every single junior doctor in the country, not to mention their families and the consultants who are having to put in an enormous amount of extra work for a process few of them have faith in.

so now we are faced with a decision. how do we decide which should be our first choice? should we try and make sense of the ratios 'helpfully' published, that will all change as soon as this new twist in the never-ending rollercoaster takes effect? should those of us who have already had an interview stick with it even if it wasn't our first choice? should we go for what we really really want, all guns blazing, or should we pick the least popular specialty in the least popular area in the vague hope of securing a job?

MTAS has turned into a game show. some have likened it to Deal or No Deal. we are all at a cross roads in our careers. we are all trying to secure the future we want and deserve. we are all want the NHS to employ the best doctors it can.

and we are all being asked to gamble...with the rest of our lives.

so...MTAS. Medical Training Application System.

what a disaster. i think everything that could have gone wrong with it has gone wrong with it.

firstly it is a rubbish system. the idea that junior doctors across the country should be selected for interviews based on their ability to answer ridiculous questions that do nothing to prove their clinical competencies is unbelievable. who would you rather have treating you? someone who has attended courses, taken exams, has previous experience in the field, or someone who can describe in under 150 words how they communicated effectively with a patient.

the application form asked a series of case-study type questions about communication skills, working as part of a team, and demonstrating professional integrity. the questions were not based on any evidence suggestion one could actually learn anything about an individual from their answers, and according to the marking scheme the answers earned far more 'points' for their eloquence and creative writing skills than for membership exams, previous degrees, clinical courses attended - you might say anything that actually demonstartes that you have the appropriate skills required to work in your chosed specialty.

to make matters worse it has since come to light that many applicants were leaked a copy of the mark scheme before they submitted their applications. that is to say nothing of those who paid companies to write their answers for them.

the system was plagued with other problems as well. the website through which applications had to be submitted could not cope with the volume of applications and crashed several times - leaving some applicants unable to submit their forms before the deadline and so being disqualified from this years chances of a job. there are also rumours that application forms went missing for days during the short-listing process. deadlines for the submission of forms and then subsequently the offers for interview had to be extended, some applicants were initally offerd interviews which were later withdrawn, others did not hear about their offers for many days after the date given for details to be released. many applicants at all leves received no offers for interviews at all.

you might argue that all is fair in love and MTAS because the whole thing is so ludicrous. however all application forms have now been scrapped as the result of a decision by the review committee that they were so flawed that they must not be taken into account during the job aplication process. the process continues to spiral out of control with no real hope of a satisfactory solution to this mess being found.