119:
consultant to advise on how to go about this, MMC failed to resolve how this would be implemented and handed the decision at the last moment in July 2005 to the deaneries. In the few weeks they were given to organize the assessment for their own trainees, thirteen deaneries and the small cohort of naval medical trainees opted to use
Healthcare Assessment and Training (HcAT), based at Sheffield Children's Hospital. A smaller number of deaneries opted to use the NHS eportfolio, based in NHS Scotland.
510:
Review Group was "entitled to reach the decision it did given the circumstances facing it at the time". Although he ruled against invalidating the interviews that had already taken place, Mr
Justice Goldring added that this judgement did not imply that junior doctors were not entitled to feel aggrieved, as "the premature introduction of MTAS has had disastrous consequences". Remedy UK have said they will not appeal the verdict, in order to avoid further uncertainty for junior doctors.
391:
99:
broader base for their ultimate specialism. This change ran entirely against existing and subsequent evidence that junior doctors do not know immediately what specialism they wish to pursue, with fewer than a third thinking they knew after F1 and with many forced to decide on a specialism without having had any opportunity to practice it. In keeping with these data, 66% of doctors surveyed felt
Foundation Training had not had a positive effect on clinical service delivery.
376:(MTAS) have been particularly criticised. In order to implement MMC, all trainees not appointed to specialist registrar posts for 1 August 2007 were required to apply for posts on the new MMC curriculum, with far fewer posts than applicants. However, the application process has had technical problems, and was criticised over the weighting and marking of the applications, with one London training school calling it "unfair and ineffective" in resigning from the process.
160:. Due to several system failures and political pressure, this was abandoned partway during the process. In 2008, following significant pressure from junior doctors, the MMC Programme Board for England came to an agreement to revert to a local application process determined by deaneries and specialties. Agreement was made that no further attempts would be made to introduce new selection methodologies without piloting, academic evaluation and professional buy-in.
597:
working patterns held by their human resources departments accurately reflected their actual working hours, and 55% reported being pressured to falsely declare their actual hours worked. More than two thirds felt the quality of their training and operative skills had deteriorated as a result of shift-working patterns brought in to meet working time regulations, and 71% felt the reduction in working hours had not led to any improvement in their
533:
74:(GMC) during the first year, with full registration taking place following successful completion of the first year of postgraduate training. At this point doctors move straight into the F2 year in most, but not all, foundation schools, without having to apply again. Under the previous system, doctors applied for SHO jobs within six to eight months of beginning work as a PRHO.
118:
Another principle of MMC has been that doctors from
Foundation level and upwards undergo regular assessment of their skills and activities while in practice. This would commence for Foundation level in August 2005, with the new intake of Foundation trainees. After spending extensively on a management
98:
This meant that doctors are required under the new system to choose a specialty midway through F2, after just one-and-a-half years of practice. Under the old system, doctors had the flexibility to try a variety of different jobs before deciding what to specialise in, and this allowed them to build a
518:
For the 2008 specialty recruitment, deaneries and Royal
Colleges were asked to arrange the recruitment for all specialities themselves, with particular deaneries or Colleges handling national recruitment for particular disciplines. Although the intention was to have a new version of MTAS operations
430:
launched a full review of the recruitment process for specialty training on 9 March 2007. On 22 March 2007 the Review Group issued a statement building on the recommendations they had made and guaranteeing interviews to all long-listable applicants. These recommendations were not found acceptable
81:
consists of two years training split into rotations of three or four months in different specialties. The programme features continuing assessments, and the introduction of a national curriculum intended to nationalise and standardise medical training. As part of this junior doctors are required to
90:
The next stage of training is the
Specialty Registrar (StR). This is a unification of the previous training grades of SHO (except for year 1) and the old SpR grade. The duration of StR training varies by specialty, but as with the Foundation years, all programmes have a standardised curriculum and
451:
apologised to junior doctors over the crisis, saying that the application scheme had caused "needless anxiety and distress". The BMA welcomed the government's acknowledgement of the problem but stated that "an apology isn't enough". Patricia Hewitt's apology was repeated to parliament on 16 April
407:
the chief medical officer for
England, Professor Crockard stated that he was increasingly aware that he had "responsibility, but less and less authority" and that "the overriding message coming back from the profession is that it has lost confidence in the current recruitment system". Professor
379:
There were also concerns expressed over the number of training posts available and the subsequent risk that trained doctors would be forced to emigrate or leave the profession as they would be unable to find jobs in the UK. Government claims that there were 23,000 posts for 32,000 applicants were
134:
While these principles received broad support, their implementation has not, largely because the
Department of Health has achieved an increase in the number of consultants by reducing the length of training required to reach the grade from an average of 21,000 to just 6,000 hours. This has led to
509:
from 16 to 17 May 2007. On
Wednesday 23 May 2007 Mr Justice Goldring ruled against Remedy UK, stating that "although far from ideal", the Review Group's decision on amending the appointments process after the first round of interviews was "within the range of reasonable responses", and that the
596:
reviewing research in 2009 and finding that there were not enough surgeons to fill rotas if they worked only 48 hours a week. They further noted that 90% trainees were exceeding their rostered hours on a weekly basis, 85% reported coming in to do operations on their days off, only 25% felt the
414:
On 5 April 2007 Professor
Shelley Heard resigned as MMC National Clinical Advisor, expressing her support for MMC in principle but citing the major problems with the recruitment process and concerns over the conclusions of the Department of Health's Review Group.
452:
2007, in which she stated that "the problems that have arisen relate in the main to the implementation process and not to the underlying principles of Modernising Medical Careers.". This was later disputed in the independent inquiry into MMC by Sir John Tooke.
608:
have stated that they believe 65 hours a week is required to gain the necessary training opportunities, and that 80% of respondents to a survey they ran would support an opt-out of the European Working Time Regulation (EWTR) to protect training.
485:
report stated that applicants had been able to see each other's files by changing two digits in the personalised web address given to each individual. At that point the Department of Health announced that this was a temporary suspension.
360:, among others that the reforms have not been fully thought through, may worsen the training situation for many junior doctors, and may be part of a covert plan to create "a permanent subclass" of cheap, undertrained subspecialists.
142:
In keeping with this accusation, just 1% of doctors surveyed in the Tooke Report felt that run-through training would have a positive effect on clinical service delivery, and 58% believed patients would not benefit from MMC.
70:(SHO) term, with the older titles nominally replaced by "Foundation House Officer 1" or F1 and "Foundation House Officer 2" or F2. In keeping with the previous system, new graduates are only provisionally registered with the
368:
A number of criticisms have been made about the new MMC system, and it was perceived sufficiently poorly within the medical profession that its implementation was ultimately boycotted by senior doctors around the country.
95:. In 2007 appointments were made centrally, but following the disastrous outcomes of that system, whereby some 14,000 junior doctors were left without jobs, many specialties have appointed registrars locally since 2008.
82:
maintain a "learning portfolio". Despite these notional benefits, 69% of doctors surveyed felt F2 was not an improvement on the first-year SHO experience it replaced, with experiences of the programme "very variable".
418:
The MTAS affair was swiftly followed by a purge of the remaining members of MMC, and by mid or late 2007 all of the senior members of MMC had been replaced, effectively forming a new organization.
728:
411:
On 31 March 2007, Alex Liakos, one of the student advisers to MMC, also resigned, citing widespread misgivings about MMC as a whole and "tokenistic" involvement of doctors in the process.
338:
127:
MMC was intended to "improve patient care by improving medical education with a transparent and efficient career path for doctors". This followed the publication of the
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for research, or a Clinical Fellowship for sub-specialisation. *due to competition for consultant posts, it may take longer than 8 years to gain Consultant status .
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On completion of these training programmes, trainees will be awarded a Certificate of Completion of Training (CCT) and will be entitled to enter the
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MMC refers to both the programme itself, and also to the temporary organization, formed in 2003, responsible for its nationwide implementation.
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38:" (CCT). It has been dogged by criticism within and outside the medical profession, and an independent review of MMC led by Professor Sir
403:
On 30 March 2007, Professor Alan Crockard resigned as national director of Modernising Medical Careers. In his letter of resignation to
408:
Crockard asked that this be urgently addressed "in the interest of the most important people in the whole process, the junior doctors".
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Training may be extended by pursuing medical research (usually two-three years), usually with clinical duties as well
648:"Aspiring to Excellence: findings and recommendations of the independent inquiry into Modernising Medical Careers"
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after the suspension of the MTAS website due to security breaches that she described as "utterly deplorable".
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said that after the first round of recruitment, the system would only fulfil a monitoring role that year.
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432:
357:
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Brown M, Boon N, Brooks N, et al. (2007). "Medical training in the UK: sleepwalking to disaster".
505:, who demanded that the appointments process should be scrapped altogether. The case was heard in the
435:'s junior doctors committee and they pulled out from the negotiations with the government on 23 March.
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for the 2009 recruitment process, again this is being handed over the colleges and deaneries.
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in 2005. The programme replaced the traditional grades of medical career before the level of
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800:"Remedy UK Response to: Recruitment to specialty Training Proposals for improvement in 2008"
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revealed by subsequent work to be 4,500 out, with the actual number appearing to be 18,500.
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House of Commons debates, Oral Answers to Questions — Home Department, 19 March 2007
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Daily Telegraph, "Expert in charge of doctors' jobs fiasco resigns", 31 March 2007
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accusations in the press, from regional medical selection committees, and from
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The Herald, "System for recruiting junior doctors in crisis", 28 February 2007
729:"Babies 'will be put at risk' as experienced doctors are replaced by trainees"
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accused Ms Hewitt of failing to express genuine regret over the situation.
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In 2007 appointment to this level of training was facilitated using the
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On 15 May 2007 MTAS was shelved by ministers due to security breaches.
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Daily Telegraph, "Doctors' training system 'a shambles'", 3 March 2007
997:. The Association of Surgeons in Training. 2007-03-05. Archived from
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384:
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26:) is a programme for postgraduate medical training introduced in the
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Guardian, "Junior doctors driven abroad by new system", 2 March 2007
992:"Failures of the Medical Training Application Service (MTAS) system"
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has had an effect on patient care and on medical training with the
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On 17 March 2007 doctors marched in mass protest orchestrated by
34:. The different stages of the programme contribute towards a "
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Archive of the Medical Training Application Service website
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Archive of the Scottish Modernising Medical Careers website
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Channel 4 News report (Hewitt blasted over training fiasco)
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A judicial review of MTAS was requested by pressure group
775:"Junior Doctors Committee newsletter and update on MTAS"
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From 2005 new medical graduates embarked on a two-year
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idwl.info, Remedy UK loses High Court battle over MTAS
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BBC, "Doctors abandon talks on job row", 23 March 2007
1074:"BMA concern regarding availability of training posts"
895:"BMA junior doctors leave talks on recruitment system"
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On 1 May 2007 Ms Hewitt made another apology in the
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1376:Archive of the Modernising Medical Careers website
1355:. Royal College of Surgeons of England. 2009-01-23
1409:- protest organisation founded in response to MMC
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226:(SHO) a minimum of 2 years, although often more.
93:Postgraduate Medical Education and Training Board
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1402:Archive of an online survey of doctors about MMC
1203:MMC360 transcript from parliament, 16 April 2007
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481:website was suspended on 26 April 2007 after a
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66:(PRHO) term and the first year of the former
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139:that it has been a "dumbing-down" process.
16:UK postgraduate medical treatment programme
1269:BBC News, Doctors taking jobs row to court
1258:BBC News Doctor application system ditched
944:"Resignation from MTAS Appointments Panel"
556:. Please do not remove this message until
387:against the system in London and Glasgow.
1280:BBC News, Junior doctors lose court fight
576:Learn how and when to remove this message
447:'s Today programme, the Health Secretary
372:The transition to the new system and the
337:Training may be extended by obtaining an
91:assessment model that is approved by the
1345:
948:The Central London School of Anaesthesia
552:Relevant discussion may be found on the
443:On 3 April 2007, during an interview on
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1423:Medical education in the United Kingdom
646:Professor Sir John Tooke (2008-01-08).
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1225:BBC Hewitt attacked over jobs website
1141:Alex Liakos's resignation, MMC360.com
679:"Johnson: Recruitment reform bungled"
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36:Certificate of Completion of Training
594:Royal College of Surgeons of England
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374:Medical Training Application Service
158:Medical Training Application Service
606:Association of Surgeons in Training
237:in a hospital specialty: 5–8 years
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1099:"Junior doctors protest over jobs"
700:"The Past - The Principles of MMC"
588:Obliging doctors to adhere to the
496:
14:
1439:
1369:
1247:BBC on Suspension on MTAS website
777:. BMA. 2007-06-15. Archived from
303:total time in training: minimum 7
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1192:BBC Article on Ms Hewitt apology
1163:MMC Review group recommendations
920:"Review into doctor recruitment"
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348:Concerns have been expressed by
62:in place of the former one-year
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288:total time in training: 5 years
273:total time in training: 4 years
42:criticised many aspects of it.
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619:Modernising Scientific Careers
439:Secretary of State's apologies
394:MMC & MTAS march in London
204:Pre-registration House Officer
64:Pre-registration house officer
1:
865:10.1016/S0140-6736(07)60754-5
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422:Department of Health response
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243:in general practice: 3 years
1407:Archive of Remedy UK website
1123:BMJ blog, "MMC Head Resigns"
897:. 2007-03-23. Archived from
681:. Channel 4 News. 2007-07-25
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339:Academic Clinical Fellowship
122:
48:
7:
1387:Modernising Medical Careers
805:. Remedy UK. Archived from
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558:conditions to do so are met
433:British Medical Association
358:British Medical Association
193:Modernising Medical Careers
20:Modernising Medical Careers
10:
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727:Griggs, Ian (2007-06-17).
473:MTAS website taken offline
1027:29 September 2007 at the
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317:total time in training: 7
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241:Specialty Registrar (StR)
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235:Specialty Registrar (StR)
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110:Register as appropriate.
108:General Practitioner (GP)
1101:. BBC News. 2007-03-17.
457:Shadow Health Secretary
405:Prof Sir Liam Donaldson
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72:General Medical Council
922:. BBC News. 2007-03-07
754:"Dumbing down doctors"
395:
1390:- publication by the
1303:"Recruitment Process"
901:on September 26, 2007
702:. MMC. Archived from
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175:Medical Career Grades
1392:Department of Health
830:History of Remedy UK
756:. Spiked. 2007-05-18
428:Department of Health
284:General Practitioner
269:General Practitioner
252:Specialist Registrar
224:Senior House Officer
213:Foundation Programme
79:Foundation Programme
68:Senior house officer
60:Foundation Programme
54:Foundation Programme
545:of this section is
177:
1168:2007-09-27 at the
1152:BBC action network
1128:2007-05-25 at the
835:2008-06-28 at the
523:Impact on training
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254:: 4–6 years
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114:Medical Assessment
86:Specialty Training
970:External link in
599:work/life balance
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1338:2009-01-17
1328:"MMC FAQs"
1313:2009-01-17
1084:2007-04-16
1008:2008-03-31
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625:References
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215:: 2 years
189:New System
184:Old System
104:Specialist
40:John Tooke
32:Consultant
566:July 2012
554:talk page
514:Aftermath
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352:, in the
350:Remedy UK
328:Optional
321:10 years*
137:Remedy UK
123:Rationale
49:Structure
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