Medical Training Application Service
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The Medical Training Application Service (MTAS) is the new system for selection and allocation of doctor's training-grade posts in the UK. [1] It was set up under the auspices of Modernising Medical Careers.
Please note that this article refers to "junior doctors". This is a slight misnomer. Junior doctors refers to doctors who range from those that have just graduated with no experience to doctors with many years experience who have not yet made it to "Consultant" level.
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[edit] MTAS Application Process
Under MTAS, junior doctors who have completed their inital training after medical school (formerly the PRHO grade, and more recently the FY1-2 grades), and those who already had up to several years of experience working at the old SHO (next grade up) level, were invited to submit an electronic application form on the MTAS website. Applications could be made to one specialty in four geographic areas called 'Units of Application' (UoAs), or to two specialties in two UoAs, or four specialties in one UoA. The application form consisted of questions with space for 150-word answers. One of the changes promoted by the new system was that little (25%) importance was given to past experience, achievments, or examinations passed in the specialties, while the majority of the weighting for selection was based on the 150-word answers in the electronic application form (75% weighting). Under the previous application scheme, past experience, achievements and examinations passed in the specialties were used to shortlist candidates for interview.
The completed application forms were used for selection for interviews. Candidates who were not eligible (for example, not having practiced medicine for a number of years, or not being registered with the UK General Medical Council were rejected at the 'longlisting' stage, with the 'shortlisting' stage designed to pick out the best applicants.
The interviews were again designed to be unbiased, in that, once selected for interview, the application form would be ignored, and CVs would not be allowed at interview. Instead, pre-defined questions with strict (tick-box) marking schemes, based on the candidate's ability to use certain phrases and keywords. Again, the emphasis here was on removing bias due to a candidate's past achievements and experience, and focusing only on the performance at the standardised interview.
After the first round of interviews, there was a plan for a second round of interviews. Candidates who were unsuccessful in both rounds would have no further opportunity to gain access to a training job in the UK.
The timescale was that that application forms were released in February 2007, with 2 weeks to complete and submit them. The first round of interviews were due to be carried out in February, March, and April 2007, and the second round occuring after this, finishing in late June 2007.
[edit] Proposed benefits of the new application system
The new application system centralised the application process, reducing the workload in consultants in shortlisting candidates for interview (previously more than 250 applications could be received for popular specialties in popular locations).
By centralising the system, the new application system was designed to select candidates based on their capabilities rather than the experience they may or may not have been able to gain within the system.
[edit] Concerns raised over the new application system
[edit] Problems with the Theory behind the process
Theoretical concerns behind the process include:
1) the system shortlisted candidates by taking the responses from one 150 word answer and asking the markers to just mark this question. Unfortunately, candidates were not informed that this would occur. Candidates had assumed the entire form would have been marked. Consequently, candidates that cross referenced their answers across the form (e.g. by writing "as detailed in my answer above") failed to score marks compared to candidates who did not do this.
2) The MTAS system was based on five academic papers (BMJ Paper and 4 papers (?LINK please)) The papers were based on a very small sample size and also state that the correlation between successfully completing the MTAS form and having the competencies required to be a successful doctor is 0.35 i.e. the correlation is low.
[edit] Problems with the execution of the process
1) The online application system frequently became overloaded which meant that potential applicants were unable to log into the site, complete or submit their forms. The application deadline was extended by 48 hours to enable candidates to submit their forms.
2) Some forms were "lost" in the online system. Over 1,000 West Midland deanery application forms were "lost" for a week by the system. They were "found" and graded. However, concerns were raised that other forms may have been "lost" by the system.
3) The "double-blind" system for marking failed. Each form should have been marked independently by two consultants. This system ensures that a mistake by one marker is covered by the second marker. Unfortunately, the MTAS system allowed the second consultant who marked the application form to see the mark the first consultant had given. "Anchoring" theory states that if this happens, there is a significantly increased probability that the second marker will give a very similar score to the first marker i.e. the reason for introducing a double- blind marking system is nullified. Further, the second marker had the ability to change the mark given by the first marker.
4) Not all forms were marked by consultants. Many deaneries asked non-medical staff to help them meet their deadlines. It is unclear at the present time whether these non-medical staff were appropriately trained to mark the papers.
[edit] Changes currently occurring
The MTAS system is currently undergoing a rolling program of sweeping changes, the outcome of which is currently unknown as many of the execution problems have been acknowledged.
The latest review has stated that everyone should be entitled to keep any previous interviews in hand and also have an interview for their first choice. This is the process for England. Wales and Scotland have decided to interview all applicants for all posts. The latest review can be downloaded here.
The previous review (http://www.mmc.nhs.uk/download/Review_Statement_22-03-07.pdf) recommended that the MTAS shortlisting process be ignored and that every "eligible" doctor should be interviewed at their first choice UoA only. Current estimates are that this will necessitate a minimum 30,000 interviews requiring at least 15,000 consultant hours of interview time.
This essentially gives junior doctors one guaranteed interview for employment in the UK. Should doctors fail to successfully pass the interview, they will have very little chance of continuing their training in the UK.
Issues currently unresolved include:
1) when is an applicant not "eligible"?
2) when will these interviews take place (given that medical positions need to be filled by August)?
3) the previous scoring system was 75% application form, 25% interview. Will this continue or will the new scoring system be 100% interview?
[edit] Current Political situation
The British Medical Association (which represents doctors' interests) has pulled out of the review panel after their latest announcement that each doctor would only be given one interview. Their reasoning is here (http://www.bma.org.uk/pressrel.nsf/wlu/STRE-6ZKEUG?OpenDocument).
The National Director of Modernising Medical Careers has resigned. In his resignation letter (http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/03/30/ndocletter130.xml) he states that he has "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".
It is as yet unclear what effect this resignation will have on the review process.
