Just because I’m shortlisted doesn’t mean the system isn’t sh*t

I’m one of the lucky ones. Let me explain some facts.

There used to be an unlimited- at least 4-5 years worth of SHOs in the training system. There are only 3 years that you can apply for now. To apply for the first year you need less than 1 year of experience in that speciality. I am coming straight out of the new ‘Foundation Years’ so I the right amount of experience, so I can apply to year 1. The real comptition is for years 2 and 3.

 ’J’ Posted this comment to my blog – which I think sums it up perfectly:

 I thought this scheme was supposed to work in the favour of those doctors who have given years of dedication to their career. I have completed BST, MRCS, have several papers, audits and presentations and I have submitted an MD thesis. This was the recommended pathway for surgical trainees to get a registrar post. Having ticked all the boxes I now have not been shortlisted for any interviews. What was the point? What a waste of my time and all those who have spent time training me.
J

Interviews in No 3 and 4

I don’t care that I’ve been rejected by 1 and 2. I’ve got interviews for medical training in 3 and 4!

Reasons why the MTAS system is sh*t

I’m going to spend today decorating my back bedroom, as it looks like I’ll be putting my house on the market soon. I can’t see how I can possibly get a job in the current shambles. Remember that this isn’t like applying for a job with a bank, for instance. If you want to work as a Doctor in the UK and get to Consultant level this is the only system. There is only one employer.

Just some background – to apply to medicine there were a series of questions saying things like ‘give evidence of your commitment to this speciality’ and ‘tell us about a time when you worked in a team’. A lot of people thought this was a rubbish way to get a job – but it’s roughly similar to how industary select graduates. The way it was marked was meant to be secret.

However there’s relatively good evidence on doctors.net that some people had access to the marking scheme, one girl found it on the pavement outside the hospital, other people were ‘e mailed it by consultants’.

And now- it turns out that the deadline for the end of shortlisting has been extended. But an e mail leaked on Doctors.net suggests that if a speciality hasn’t finished shortlisting by Monday they are simply going to reject the ones that aren’t shortlisted.

This is a sole employer, this is our only option. Not being shortlisted is going to push thousands of doctors out of medicine entirely.

Being a Useful Doctor

I’m spending a lot of time doing ‘disaster planning’ at the moment, thinking what I’m going to do if I don’t get any interviews. The other day I was sipping an overpriced coffee in an overpriced coffee shop killing time before my book group when I started to think about the same thing.

What sort of Doctor do I want to be?

A Useful Doctor. One who can fix most things, I think we used to call them GPs. I want to be competent enough to be able to do most things that need doing in a remote rural hospital in Africa, or indeed Scotland, or to be a Ship’s Doctor. Including a bit of Obstetrics, enough to be safe, if not advanced, maybe very basic surgery, a wide variety of medical conditions and stuff. I may not be able to treat an MI with primary angioplasty but I should be able to give thrombolysis if I have to. After all the Consultant may crash his car on the way in to do the angioplasty.

So how do I become a Useful Doctor?

I am, among other things, partly home educated, in a left wing hippy way, not a right wing scary way. My parent was of the opinion that You can’t rely on The System to educate you properly – you have to do it yourself he decided this because I had made insufficient progress in reading at a state school when I was 5. He couldn’t afford to go private so he taught me himself- he was unemployed so it was easy. Even when I got bored and decided to go to school so I could meet other children I found that I didn’t actually learn anything new. Education was something I did myself in the evening, from ‘workbooks’ that my Parent was using with the siblings that were still home educated, with reading the Encyclopedia Britannica, and when I was older listening to radio4. I found a second hand copy of ‘intermediate level GCSE maths and worked my way through it. I went to school because I met some interesting people there, and because I couldn’t sit my GCSEs without going, and I knew I wanted to be a doctor, so it wasn’t enough just to know things, I had to prove I knew them.

And it’s true MMC isn’t going to educate me properly, not to the standard I want. So I’ll have to do it for myself. If I’m not getting enough on-calls I should do Locums. If there are skills I’m not getting I should find someone to teach me in my spare time. If I’m not getting the chance to do Ascitic drains on the Medical Admissions Ward, then I’d better go off to the liver unit and find someone to teach me.

I think that ST training may help me become a useful doctor in some ways, but it’s not the only way there. I could do it by working in various jobs, there always going to be people off sick, people who pull out of jobs at the last minute, have babies, etc. Plenty of ways to get lots of experience.

The cool thing about doing locums in medicine is that I’m actually doing enough to learn. Whlist doing jobs in Public Health, and Obs and Gyne my skills in internal medicine have grown instead of shrunk. Actively learning as a locum is different from just turning up and doing the shift. I stay for the Post Take Ward Round, even though I’m not paid to, I follow up the patients on the ward in my own time. And I add things onto the two lists I keep in my little black book – ‘Things to learn about’ and ‘things to learn to do’.

So how do I become a useful doctor?

1. MRCP Doctors with MRCP are all very useful Doctors
2. A and E/Emergency Medicine or whatever they’re calling it now – for at least a year
3. Obs and Gyne. I’m already doing it but I need to know more about it. Again at least a year if I’m going to do a job that involves obstetric cover. Eg Medical Officer in a remote place.
4. Paedatrics, I don’t like children, but I should still do it.

I’ve applied for Core Medical Training, which will mean I can get MRCP, and become a half-baked ‘specialist’ in something medical. Hopefully HIV medicine, Doctors who treat HIV are very Useful Doctors. Anyway I can be a useful doctor without getting on the ST training treadmill. Ok I’ll be a staff grade and not a consultant, but if I’m in charge of my own training I could probably be damned better than someone who’s just come out of the MMC sausage machine. Although there won’t be many stand alone jobs, they’ll continue to exist, and when we run out of SpRs and only have less experienced StRs, we’ll have plenty of vacancies for staff grades and stuff.

To be a Useful Doctor, I’ll do some training abroad, and some here, and once I am useful I just need to find a permanent job and settle down – I generally think the world needs Useful Doctors.

B*ll*ck*

The shortlisting deadline for MTAS, is extended until Monday, and someones nicked my organic veg box. Dammit I was all psyched up to find out on Saturday that I was unemployable, and now I’ll have to wait.

Should we boycott 123doc.com?

123doc are a website that provides relatively good revision material for MRCP Part 1 and other exams. In my ‘exam panic phase’* I purchased a membership.

Just recently I got this e mail from them:

Dear Junior Doctor,

You have been invited to attend a half-day Specialty Training Interview
Course being held on Sunday, 18th February 2007 at the Royal College of
General Practitioners.

This course, presented by Dr. Malvena Stuart-Taylor, Associate Dean,
Severn and Wessex Deanery, is specifically aimed at developing your
interview skills and building your portfolio in preparation for the
Specialty Training Selection Panel. Practical demonstrations and Q&A sessions
are an integral component of the interactive course.

The course fee is £129.00. LIMITED SPACES ONLY.

Well I’m not a trainee in Sussex and West, but I would expect my associate dean to be giving me appropriate advice for free. It’s their job! What the hell is she doing by selling off her, probably insider, knowledge for £129 a shot.

There are two options here either:

1. This is common sense available from any book or assertive training course. I have no idea if £129 is a fair price for this. If this is the case why is a clinician the best person to teach this. Surely someone who is an expert in body language and stuff would be better qualified.
2. She is going to offer knowledge that perhaps people who weren’t Associate Dean for Severn and West Deanery aren’t going to have. If she has this knowledge shouldn’t she be sharing it with Junior doctors in Severn and West Deanery for free? Or is it knowledge that is going to give the people who have it an unfair advantage? In which case why should you be able to buy it for £129

During my next exam panic I won’t be giving any more money to 123doc.

Now a 2 month membership on 123doc.com for MRCP Part 1 costs £69.99. £20 can get you an entire year of Declan O’Kanes Medexam softwear which is
a) £20 for 1200 questions for a year, compared to £99 for 2009 questions for 4 months.
b) Has been written in his spare time, to help juniors, rather than profit from them. Ok I’m sure he’s hoping to make some money on it – but this is the result of one hell of a lot of work.

You could also join pastest or onexamination, both of which are very good.

*Yes, that phase where you are so scared of failing that you will part with any amount of money for pointless books and courses. I have a nice collection of once-used-rather-useless books on medicine.

Ok, I only failed by 2.5%

Somehow that makes it better! I knew I was borderline, I know if I put the work in I can raise my game by, oooh, at least 5% by May.

Failure, of exams and organ systems.

I said the day before the exam ‘I don’t think I know enough to be a member of the Royal College of Physcians’ and it’s right, I don’t. I certainly put my heart and soul into revising – but I could only revise from books and websites and things.

‘So what’, you may say.

It’s been 18 months since I qualified as a Doctor, during that time I’ve only spent 4 in hospital medicine. With traditional training I’d have spent 12 months doing medicine. The exam was designed for people who have spent 12 months in hospital medicine, not 4. If I’d passed it would have been proof of dumbing down having reaching the Royal College. I’m glad it hasn’t. I didn’t deserve to pass. I knew I wasn’t a clear pass, if I had passed it would have been a ‘scrape though’. I seriously feel that if I’d passed I’d have felt a fraud*.

Take the condition of pericardical effusion – I’d vaguely heard of it at medical school, but just knew it was fluid around the heart. I knew it was something that tended to come up in the Part 1 so I revised it. I still hadn’t actually seen a patient with it so it was fairly abstract.

I did a locum shift as last weekend, and was asked to see someone in A and E who had come in feeling dizzy and his blood pressure was very low, after examining him something flickered in my brain, something I’d see on in a book whilst revising. Something being a Pericardical effusion, something which I now knew how to manage. Okay the management involved ‘get my reg quickly cos I don’t know how to drain a pericardical effusion’ rather than p*ss around looking for a source of sepsis. I hope if I hadn’t worked out the cause of the low blood pressure I would have still got the registrar as quickly.

So, he doesn’t know it – but there’s someone out there who benefited from my MRCP failure attempt- and they’ll be more people who benefit from my resit attempt.

The really key point is that I’d rather fail a prestigious exam than scrape through a pointless one. I got 100% on my driving theory test, but it means sod all.

I’m actually, sad git that I am, feeling rather motivated to start revising again for Part 1. I actually enjoyed learning the material and am genuinely interested in it.

I’m not sure if I’ll pursue the MRCP goal if I’m not shortlisted. I now need to get my head around not being shortlisted. I may accept that medicine, as in General Internal Medicine, isn’t the way forward for me. Or I may decide that my aim is a stable job rather than aiming for ‘Consultant-hood’. I like providing a service dammit! I may decide that if I’m going to aim for a staff grade job then MRCP is still a useful and valuable, and not-dumbed down qualification.

So I failed.

Ok. I failed.

Never Mind. I don’t know how much by.

There are resits.

Why I love this hospital…

I first came to this hospital when I was a third year medical student, after a placement at an enormous teaching hospital, I’ve worked here as a secretary whilst I was a student. I’m probably going to leave in August, and I’ll miss it.

I’ll miss the staff the Auxiliary Nurses who are better at actually caring for patients than some of trained nurses, the porters whose been here that long that he knows that chewing gum is also banned before an operation as well as swallowing. The cleaners who try and clean things instead of just running a mop over the place. I assisted in the delivery of one of our HCAs granddaughters, I’ve treated both halves of several couples. I know some of our ‘regulars’ so well that I can memorise their past medical history. .

I’ll miss the patients. 

 Put six patients in a bay together and within 20 minutes they’ll have introduced themselves, and got to know each others medical details.  Doing my ward round this morning it was obvious that after a few days on a gyne ward people had swapped photos of grandchildren and each others complete medical histories. As soon as I updated them on their progress it was shared with the whole bay, and there was a fair bit of ‘why do I need to have my catheter in for 48 hours when she had hers out the day after sugrery’. Two of the girls who had miscarriages were giving each other moral support and had promised to keep in touch.

But we’re being closed down ward by ward, in three years time we’ll be merging with the big hospital down the road. The one where no one knows anyone, where the nurses hate the doctors, and the midwifes hate everyone else. It may be a centre of excellent but it’s also an intraproffessional warzone.

District Generals like ours are on the way out – in is coming ‘centralised care’ and ‘community care’. What’s coming may be better in some ways and worse in some ways. But we’re going to loose something that can’t be measured or put into targets.