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ss triple helix - spring/summer 2007,  Modernising Medical Careers

Modernising Medical Careers

Rantimi Atijosan and Eleanor Chiu look at the current situation

The implementation of the Modernising Medical Careers (MMC) programme is in a mess. Thousands of SHOs, amongst them many CMF juniors, are facing major career disruption and ongoing uncertainty. How did things end up like this? What's happening now? And how can we as CMF members respond?


Back in 2002, Liam Donaldson, the Chief Medical Officer, considered the reform of the Senior House Officer (SHO) grade.[1] Everyone agreed with him that change was needed, but there was much debate over how to do it.[2] Eventually, MMC, with its two main parts, was born: firstly, a two-year Foundation programme to replace the Pre- Registration House Officer (PRHO) year and the first year of SHO posts; and secondly, Specialty Training (ST), essentially a merging of the SHO and specialist registrar grades. Depending on the specialty, the ST training programme varies from six to eight years. More experienced juniors were invited to apply to skip the first one, two or three years of the programme (ie entering as ST 2, 3 or 4s respectively).


In August 2005 the Foundation programmes launched around the country. With anticipated completion of the first batch of Foundation doctors in 2007, the focus for implementation moved to ST. In February last year the MMC team released information on what the new training would look like. As information unfolded about the process, anxiety built up. Goal posts changed and juniors scrambled for the last old-style Calman training numbers.


January this year saw the Medical Training Application Service (MTAS) inviting online applications to ST posts commencing in August.[3] Two rounds of applications were envisaged, with the best candidates being offered interview in the first round, and other applicants in the subsequent second round. Unfortunately though, the application forms did not seem to take account of previously important short-listing criteria (for example further degrees) and a whopping 75% of the short-listing scoring was based on a 150-word repartee to clinical and ethical scenarios and questions about commitment and probity.

The catalogue of disasters began with the crashing application website, the changing of eligibility criteria during the application process and the need for an extension of the deadline. There were reports of lost application forms and of people being considered for specialties they did not apply for! Nonetheless, 32,000 applications - by both UK and overseas graduates - were submitted. Yet, subsequently, MTAS seemed to indicate that there were only 18,518 ST posts available, not the 22-23,000 jobs promised by the government.


When MTAS revealed who would and wouldn't get a first round interview, there was widespread dismay: whilst highly experienced juniors failed to be granted even one interview, others got multiple offers. Such was the outcry that the MMC review panel have now agreed to give all eligible applicants one interview for their first choice of post. Still, the future remains very unclear, although the Health Secretary Patricia Hewitt has now apologised in Parliament for the distress caused to so many junior doctors.


God is still sovereign and in control. MMC and MTAS have not taken God by surprise and so no child of his need fear that somehow they will be forgotten in this process.[4] However, truly acknowledging God's sovereignty means being willing to bring our lives into obedience to him. We have to resist the temptation to believe we have a right to practise medicine in the specialty and region of our choosing. God may give us the job we want in the place we want, or he may not. God may be calling us away from the direction we thought was ahead of us, even out of medicine altogether.


Prayer affirms our dependence upon God, acknowledging his capacity and willingness to intervene. Pray for everything from wisdom for professional leaders, justice in the selection process to guidance in our own particular situations. Pray for those around us in difficult situations because of MMC. I would encourage senior CMF members to seek out local juniors who are in need of prayer support, particularly in June when the results of the first round will hopefully be available. The West Midlands CMF held a prayer meeting in March in response to this issue and those who attended were very encouraged.


During the application process, there were many who were happy to exploit people's fears by charging exorbitant amounts for advice on completing application forms and on interview technique. Here is an arena where seniors can really make a difference. There are some people who will be going through interviews as you read this article. Others will have another round of applications and potential interviews coming up. Offers of interview practice are often very welcome.

This system is going to have casualties. Juniors who fail to get posts in August are going to need further help and seniors could be on hand to help talk through tough decisions.


It has been suggested that the medical profession needs a 'new and stronger political voice'.[5] In a year when we are celebrating the great work and achievement of William Wilberforce, we should consider which battles we should be involved in, both as doctors and as Christians. What can be achieved when we prayerfully take up arms? Our God is concerned with justice.[6] Is it really just to the individual and to the nation as a whole to put thousands of competent doctors out of training? We should not ignore the plight of colleagues who are marginalised by the system around them.

When the Nazis came to get the Communists, I was silent because I was not a Communist…When they came to get me, there was no one left to speak for anyone. (Martin Niemoller)

Interview with CMF junior, Eleanor Chiu

Eley, in a nutshell, what's your career plan?
Surgery, but I don't want to become a consultant. I'd like to work overseas in a developing country context but I'm not sure if that will mean short term or long term trips.

How has MMC affected you?
Badly! I'm one of the old-style SHOs who is over qualified for the level I'm applying for. But, because I haven't completed my membership exams yet, I can't apply for ST3.

What happened in round one then?
I applied to specific deaneries because, for healthrelated reasons, I was really keen to stay in Southampton. Moreover, I'm just tired of constantly moving round the country and feeling so unsettled. I like my current church and have only just started to feel settled and as if I am experiencing genuine fellowship. That is one of the hardest things about being a junior doctor. Because I applied at ST2 level, I was very limited in choice, so I only applied for two jobs. Unfortunately though, I didn't get shortlisted for either of them.

How do you feel about it all?
I'm frustrated at the government's lack of understanding and I'm struggling to trust God. This has been the biggest test of my faith so far. When I entered medical school, I never thought I would be facing unemployment ten years down the line.

What now then?
I'm praying and seeking support from others around me, trusting God that I won't be made destitute! I'm also going to go on an interview course in order to prepare for the new style ones.

Do you see any sign of God's hand in this situation?
To be honest it's hard to. And yet I know from my life experience that he is always faithful.

What are your experiences of MMC and MTAS? Tell us online at
  1. Donaldson, L. Unfinished business: proposals for reform of the senior house officer grade - a paper for consultation. London: Department of Health, 2002.
  2. Department of Health. Unfinished Business: Proposals for reform of the Senior House Officer grade - Responses to Consultation Exercise in England. London: Department of Health, 2003.
  4. Jeremiah 29:11
  5. Horton R. The unspoken issue that haunts the UK general election. Lancet 2005; 365:1515
  6. Isaiah 58:6
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