27 Feb, 13 | by BMJ Group
The junior doctor’s applications process has metamorphosed from an individual interview process, to modernising medical careers (MMC), to the foundation programme application system. There has been a big push towards centralising services for the majority of NHS training applications. This year has also seen a change with regards to the application itself. A two hour “situational judgement test” (SJT) now forms the basis of the application as opposed to the previous “white space” questions. Whilst this was previously heralded as a fairer and more accurate reflection of the abilities of each individual to manage complex scenarios, and therefore a better way of discriminating between medical students, there have been problems. The two key ones include a lack of foundation programme training positions for medical students to apply for, and the latest news that there has been an error with the marking of final year student SJT papers. This means that the thousands of medical students who received their deanery information yesterday may have been given incorrect scores and information about their futures.
And so the system fails us yet again. Once more, another cohort of final year medical students go through the turmoil of applying for junior doctor jobs only for their hard work and planning to go down the pan as a clerical error throws their fates to the Gods. Sound familiar? Perhaps a little melodramatic, but in essence how I imagine a huge number (if not all) final years must be feeling today. Calls for a return to the old days of interviewing for house officer jobs resound through seniors in the profession. Is that really the solution? Whilst a centralised system on paper seems fair and logical, when so many thousands of applications need to be processed at once and the past decade of attempts seem to have fallen short, where else is one to turn?
However, I feel the problem runs deeper than just what we see here, and it is why so many practising doctors not directly affected by the foundation programme errors are voicing their dismay on behalf of those students vying to enter the profession. It is outrage against the change in attitudes to the provision of training for junior staff which no longer feels like it is given the importance it deserves.
Most trainees embark on medicine as a vocation because, despite being a cliché, they do want to help others. With competition rates for university entry as they stand, the quality of students is high and the doctors that emerge increasingly academically able. Now that deciding to train as a doctor is inherently associated with even higher financial barriers of up to £9000 per annum tuition fees (I myself was of the first student cohort to enjoy the pleasure of such fees), the NHS needs to wake up and realise that trainees have made huge sacrifices, financial and otherwise, to enter the profession. Their training needs deserve to be met.
This is not to say that service provision should suffer. In fact, quite the contrary. Surely it is logical that trainees who are supported in achieving their professional goals are doing so to provide better care for patients. I can personally attest to the fact that my desire to gain as wide an exposure to medicine and surgery as possible is first and foremost because I want to fulfil my aspirations to be the best that I can be and, in so doing, enable me to provide the best care that I can. It’s the same for everyone: to fulfil our professional aims almost inevitably results in optimised patient care. Indeed this should be a win-win situation.
As a trainee myself, I am unfortunately acutely aware of the difficulties in training rife within the NHS. To the weary junior doctor it can feel like a perpetual uphill struggle, with one of the most difficult things to overcome being that often these problems are out of your control. The majority of doctors will agree that they enjoy their job. However, illogical and obstructive rules and barriers to training, coupled with the discourteous and unapologetic uprooting required to geographically scour for the next post, have left many disillusioned enough with the system to leave. Whether under the guise of taking a year out, as a clear decision to emigrate, or even leaving medicine entirely in favour of the private sector, the newspaper headlines do not lie. As a result, the NHS truly is losing thousands of highly motivated doctors with huge potential because of their failure to provide quality training. This foundation programme application error is just the latest in a long line of mistakes.
I wish I could tell our final year medical students that it gets better…
Anna Allan recently qualified as a doctor. She graduated from Gonville and Caius College, University of Cambridge in June 2012. She began her foundation year rotation in the North Central Thames deanery.