February 15th, 2009
Medical Educator authors marched in 2007 to support the rights of junior doctors and to protest about what became known as the MTAS fiasco. “A bungled reform a day keeps the Junior doctors away” was the verdict form the Telegraph newspaper. But what was behind the story of MMC (the Modernisation of Medical Careers), who were the individuals involved in supporting the rights of those doctors, and what is the state of play now, nearly 2 years on from doctors marching through the streets of London.
Richard Marks, Consultant anaesthetist and representative of RemedyUK
A representative of RemedyUK, the key organisation behind the junior doctor movement speaks to Medical Educator. Dr Marks is a Consultant Anaesthetist, former training programme director, and spokesperson fro Remedy UK. Here he speaks to James Bateman, from Medical Educator.
Thanks for speaking to us Richard. You got involved with RemedyUK after you were disappointed with how the Government had handled the MTAS situation?
Yes, RemedyUK started in November 2006 and I joined it in January 2007. Of the key 6 people who started it, I was the last one in…..
When I came in I had spent the whole of 2006 trying to get our local training rotations to work under MMC [modernising medical careers], but I simply couldn’t make it work. The recruitment system looked like it was just going to be a big mess. I was feeling despondent, but then I went to a meeting of RemedyUK. They were planning a protest march, and I thought, if anyone’s going to sort it, then these guys will.
I think the march had a very large impact on doctors at the time. The vast majority of junior doctors in the UK were either aware of the march in 2007 about MTAS (Medical Training Application Service), or on it. Do you think the campaign has reached medical students?
Not really. We have medical students in the hospital that I work at. I don’t think that most of them are aware of what the problems are.
We tended to agree from our own experiences of contacts with students. We then asked Dr Marks to tell us a little about the current legal campaign. He highlighted the background to the MTAS enquiry following the march in 2007. He went on to describe the potential problems with dealing with a regulatory body (the GMC) and the existing organisation the BMA (British Medical Association) who had been perceived by many junior doctors to be less vocal in the defence of its members. He went on to say:
MTAS was technically just a computer system but it was the whole application process around the recruitment which was the disaster. The BMA had called for it to be stopped, but didn’t really do much more than that.
There was then some legal proceedings between thee two organisations which we will not cover in any more detail here. Dr Marks also commented:
The bad thing was that for the first time run-through training was being offered, which meant that the stakes for getting or not getting a job were higher than ever before.
Dr Marks makes a point here that resonates with colleagues who are junior doctors: the failure to get onto a training programme was almost seen as a “one shot” approach: failure meant that you were then destined to pursue a different speciality.
The process by which you would get or not get a job seemed to be less fair, and there were a lot of issues around the recruitment process. We thought it should never have been allowed to happen.
This is echoed by the grass roots support of RemedyUK by junior doctors. Want to see for yourself? Ask a doctor that you work or train with! Dr Marks then highlighted a series of reviews that cast a damning verdict on the MTAS process. Read more about them here, or listen to the podcast. The summary of the verdicts was as follows…
All the independent reviews said in various ways that was a complete disaster.
The role of the regulatory body for doctors in the UK, the GMC, was then discussed.
What we (RemedyUK) then thought was, why hasn’t the GMC taken a view on this? On two grounds…
Dr Marks went on to explain the rather poorly-defined concepts of professional misconduct and deficient professional performance.
At the end of last year we wrote to the GMC to say we thought they should hold an enquiry into this. There were 1600 signatures to a letter; but the GMC wrote back and declined to hold an enquiry.
RemedyUK, acting on behalf of British Junior Doctors
As a result of this, and following legal advice taken by Remedy, the issue of the GMC’s role in the regulation of the management issues and application process is going to be scrutinised. The process is complicated but summarised on the Remedy Website as the following:
The pain, insensitivity and incompetence that MTAS created has not gone away. Neither have the people responsible for it, who continue to cling to their positions of power and responsibility. Last year we wrote on behalf of 1600 signators to the Fitness to Practice Directorate of the GMC, calling for an enquiry into whether those responsible were guilty of misconduct and/or deficient professional performance. The GMC refused our request, since it was apparently the wrong kind of misconduct.
We intend to challenge this decision. We intend to take the GMC to court, and seek judicial review to determine whether or not they have acted unlawfully in making this decision. Our lawyers believe there is strong case law and precedent which supports our view; we have already issued a Letter Before Action and are awaiting a reply.
Good lawyers are not cheap, and we aim to raise £20,000 to cover our legal costs. We are hoping to raise this from ordinary doctors – not only those directly affected by MTAS but from others who were appalled at the level of managerial incompetence, the lack of accountability of those in ivory towers and the failure of the GMC to grasp this nettle and show leadership. Should those entrusted with the highest responsibilities in medicine be immune from charges of deficient professional performance? Or are they as accountable as the rest of us in our own individual fields of practice? Do the concepts of accountability and revalidation apply to some but not to others?
We have mobilised our legal team and our fund-raisers. Many of our regular supporters have already contributed to our fighting fund, for which we are immensely grateful. But we have not yet raised enough. We are asking for a one-off donation of between £10 and £50 by you to make this happen. We also need help in bringing this campaign to the attention of consultants, GPs, retired practitioners and others who are not yet aware of what we are doing and who would be interested in helping.
We have just a few weeks to raise the money – time is of the essence.
But what about the medical Students: we asked Dr Marks about his perspectives on how students can get involved. His answers were as follows: awareness of the current situation can only empower medical students applying for jobs in the current market. Perhaps more worryingly, junior doctors may not be willing to come forward for fear of damaging their own career prospects. Dr Marks commented
RemedyUK publicises its campaing for further scruitiny of MTAS
We even get fairly regular emails saying, dear Remedy, can you do something about me because this something has happened……then they write back and say, actually, don’t because I don’t want to get into trouble, and I don’t want to make things any worse for myself.
Overall there are grey clouds and blue skies over the application processes for jobs. Advice for students? Dr Marks had the following advice for the current crop of specialist trainees: his words may seem frank, but reflect reality.
I say to them all- in 5 years time you are going to be competing against each other for consultant jobs – make sure that you’re better than the next person… We are moving into a competitive market.
Overall Medical Educator supports the goals of RemedyUK and we encourage all our readers to become informed about the organisation from their website accessible here. You can also follow them on Facebook and Twitter. Donate to their legal challenge here.
To date, remedy Have raised £15 000 of the £20 000 needed for their legal challenge.
Listen to the remedy interview here
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February 2nd, 2009
James the site has been development for some time: how do you feel the site has gone so far?
James Bateman, one of the founders of www.medicaleducator.co.uk
We’re really quite pleased about how the site has been used by medical students – we want to help people revise on exams – be it medical finals, an OSCE or an end of year assessment. We’ve resisted the temptation to use the site to market questions to lots of different users (e.g. doctors sitting their MRCP or General practitioners sitting entry examinations for interviews) – we stick just to medical student revision which makes things a lot simpler and our content much more focussed. We can remember what it was like doing those exams!
Have you enjoyed developing the content?
We’ve got MCQs, EMQs and short answer questions on examinations, and it’s been fun editing the questions whilst getting to know a new range of people associated in education. We tried to develop the revision site in the form that we would have wanted it when we were medical students. That’s why we’ve got the mix of videos, questions, MCQs, EMQs, even downloadable guides on exam technique etc. We really feel passionate about it: once you subscribe you get everything, and any new developments.
A lot of our users have made several great suggestions to improve the site. I like these ideas, it’s about the ethos that we’re looking to create, and we’re actively looking into them to improve things for the students.
People that know you tell us you just like to teach. Do you enjoy it?
I’ve played a part in a number of educational roles as a Specialist Registrar including work as a Royal College tutor, Clinical Teaching Fellow and Trust Medical Education representative. The people that help write for the site want to be involved in education: we do it for the fun of it. I like to teach – we regularly run morning sessions for doctors in training. Having regular contact with medical students on exams helps to keep things in perspective, and realise what a privilege teaching is.
What do you think the most common mistake made by medical students is?
It’s difficult to call it a mistake but when you consider how much pressure students are under its easy to understand why nerves can sometimes get the better of students when they are in an exam or an OSCE situation. Composure in this aspect is important. Helping students to prepare for this pressure cooker environment can be key. Consider the following:
“On examination there was a symmetrical peripheral inflammatory deforming polyarthropathy predominantly involving the metacarpophalangeal joints”
“On examination there was swelling over the metacarpophalangeal joints of both hands, which is warm to the touch”
“On examination there is disease affecting the hands, the metacarpophalangeal joints look red”
The findings may be identical, but calmness under pressure is important to learn as a skill. If you don’t present something you’ve seen, you don’t get marks for it.
What are your views on exam technique – is this just something you can learn?
Not really, its more complicated than that. The pressure from a medical exam, or medical finals and the revision leading up to that is intended to prepare medical students for the real world. In the United Kingdom, this is as a foundation year doctor, but students training anywhere from the US, Europe, Canada, United Arab Emirates, or India will be expected to perform under a difficult environment. So in part, preparing to present clearly in this stressful and high stakes environment is very important.
You scored 55/56 in the MRCP PACES exam, the second highest mark ever scored in the contemporary history of the exam. Is it just technique!?
The PACES exam is basically an OSCE style exam, and to pass any OSCE you need to adopt a sensible approach on examination and presentation. Knowledge is important, but any candidate needs to optimise their performance to get the best out of an examination/finals etc. I’ve taught many experienced junior doctors, and it is important to be able to demonstrate that you have good clinical skills.
Where do you See Medical Educator going in the future?
Medical educator isn’t just an exam revision site, or a multiple choice question site for medical finals: it’s a resource with videos, podcasts and more to help people get the most out of their medical training. We’re now on ITunes, Facebook, YouTube, Twitter and a few other social networks. We want students to contribute to our content, we want to produce interactive OSCE stations, deliver more content from anaesthetics, emergency medicine and expand on exam content to date. We have lots of goals, but we’re young, flexible and highly adaptable. The team of contributors that we have assembled is willing to adapt. We’re willing to put educational theory into practice for the benefits of our own students.
What about the feedback from Medical Educator users?
Our feedback is encouraging: form our subscribers, over 95% would recommend us to a friend and the comments so far have been very kind. Our users understand what we’re trying to do, but I’d be the first to acknowledge problems with the site as it stands. We want to do more, and we’re not going to rest or let the site stagnate. We’ve not relied on exam sponsorship, large amounts of money, or support from the pharmaceutical industry. Whilst we would consider appropriate sponsorship, to date you won’t find any advertising on the site.
What about the mix of students using the site?
We try not to focus on the year of training; just on what constitutes good knowledge for a final year student. Our revision material is targeted at clinical problems that students will face in ‘real life’ along with what they will get in their medical finals. That goes for students from the UK, the US, Australia or anywhere else! We’ve had accesses from >100 countries and rising, so we have a good perspective on the international scene at the minute.
January 26th, 2009
Alan Mortiboys is Professor of Educational Development at Birmingham City University, United Kingdom. He talks to James Bateman from the Medical Educator team about learning theories.
Professor Alan Mortiboys, Tutor for Educational Development at Birmingham City University
Professor Mortiboys lectures at BCU on educational development and also on formal “medical education” programmes to doctors and health professionals including the Masters in Medical Education at the University of Warwick. His publications include Teaching with Emotional Intelligence (Routledge 2005) and The Emotionally Intelligent Trainer’s Toolkit. (Fenman 2004). He is also a Fellow of the Royal Society of Arts.
Thanks for talking to us Alan. You came to the attention of Medical Educator after we heard you speak on learning styles. We write a little about this on the site: From your perspective on teaching, where do you see the typical doctor falling into in terms of the ‘pragmatists’, ‘theorists’ ‘reflectors’ and activists? Have any patterns emerged from your own experiences?
Many doctors I have met have the characteristics of the ‘pragmatist’ – asking ‘What’s the implications of this?’ or ‘How do I prepare to put this into practice?’ I guess this reflects the work that you do, normally called upon to make decisions, plan and act, often under pressure. If you want to behave a like, say, a reflector, you need plenty of time to step back and think things through thoroughly, with no compulsion to act, only to arrive at conclusions. I have not met many doctors whose working situation allows or encourages that. Here’s a question for you – do pragmatists set out to become doctors or does being a doctor make you a pragmatist?
Do you think people teaching should always have consciously have these concepts in their minds?
The case has been made that although the idea of these four learning styles has aroused a great deal of interest, there is no solid evidence to back up the theory. Nonetheless, teachers have found the idea very useful. Awareness of these different styles can usefully inform your planning for any episode of teaching. You can say to yourself, ‘If these learning styles do exist, what will there be in this session that I am planning which will engage each of the activist/ reflector/theorist/ pragmatist, given that they each look for something different as a learner?’
Others have suggested that you should help your learners become aware of their learning style and assist them in developing their less favoured styles. That means to help the activist, for example, to know how to respond productively when they are in a situation in which there is no opportunity to learn by doing, by trial and error.
The question for you as a teacher is, do you set out to acknowledge and accommodate people’s learning styles, or to develop and shape them?
I was intrigued when I first heard your comments on multiple intelligences. Most medical students won’t know what this means: tell us a little about it.
Howard Gardner‘s idea of multiple intelligences challenged the notion that there is one form of intelligence which incidentally can be measured by an IQ test. He suggested back in the 1980′s that we have seven intelligences, each of which is developed to a greater of lesser extent in every one of us. We each have our own intelligence profile. The question is not, ‘How intelligent are you?’ but ‘How are you intelligent?’
The seven are: linguistic, logical mathematical, spatial, musical, bodily kinaesthetic, interpersonal and intrapersonal.
Like learning styles, the evidence for the existence for these intelligences has been questioned. Like learning styles, the idea has proved very popular in some sectors of education.
How do you see multiple intelligences applying to student and junior doctors as they go through their training?
As with learning styles, the first step is to become aware of your own preferred/dominant intelligences and then decide – are you going to play to your strengths or are you going to improve your less developed intelligences? It can be liberating to recognise that you are never going to learn well by reading about things (linguistic) but that by manipulating objects and experimenting with them, you will always learn rapidly(bodily kinaesthetic).
You also write on emotional intelligence. Is this an important characteristic for medical students?
My chief interest in emotional intelligence is in how it applies to teaching. I am convinced that the effective teacher has to use emotional intelligence, that is, put energy into:
- Encouraging an emotional state in your learners that is conducive to learning
- Recognising and responding to the feelings of both yourself and your learners in the classroom, in order to make you both more effective in your respective roles
Daniel Goleman’s definition of emotional intelligence, which is not specific to any occupation, is:
Professor Alan Mortiboys: Teaching with Emotional Intelligence
“The capacity for recognising our own feelings and those of others, for motivating ourselves, and for managing emotions well in ourselves and in our relationships’. You cannot avoid the emotional dimension in your work, whether in dealing with patients or with colleagues, and a developed emotional intelligence will help you to function more effectively, giving you more energy to tackle problems and more resilience when under pressure.”
Medical Educator Would like to thank Professor Alan Mortiboys for his contribution.