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?

Reform

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).

Foundations

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.

Applications

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.

Distress

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.

Control

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

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.

Advice

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.

Justice

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)