Monday, 2 April 2007

PMETB letter - have it!

This well crafted letter has been sent to the PMETB and it outlines rather well how the PMETB cannot back MTAS any longer, if it is to remain consistent with its claims of ensuring that any application process is fair to all candidates:

"Dear Professor Rubin,

It is with great concern that I write to you in your capacity as chairman of PMETB. The scale of the crisis facing trainee doctors, and indeed the NHS as a whole is beginning to become apparent. This, of course, relates to the catastrophic failure of the MMC admission process run via MTAS.

I have read with interest the statement made by PMETB on the 19th March. It is clear that PMETB also have serious concerns with this process and are closely watching developments.

I learnt of the resignation of the National Director of MMC last Friday. In his resignation statement Professor Crockard makes it clear that he believes the current compromise solution adopted by the MMC review group to be unfair to applicants, and raises the question that this compromised process might run contrary to employment law. Indeed, a legal challenge has been launched by RemedyUK on behalf of trainee doctors. This seeks to question the legality of the compromise solution currently in place.

In addition, I have also read with interest the letter from PMETB to CoPMED dated 21/9/06 which followed a presentation given by CoPMED regarding the arrangements for recruitment into specialty training. PMETB clearly state that a presentation was made by Professor Patterson regarding the methodology of selection. It is now clear that her research is highly questionable and many have expressed serious reservations that such limited evidence should be used to design such an important selection process. Not least, such selection methodology has been met with ridicule by many consultants experienced in shortlisting and interviewing for junior doctor posts.

In this letter, PMETB make their role clear; the conclusion of the letter reading:

‘…these proposals, evaluation of which will, in due course, form a part of PMETB’s quality assurance work as the regulatory body’

Undoubtedly it is therefore the role of PMETB to assess the adequacy and fairness of the selection process for specialty training.

This is confirmed via the PMETB document ‘Principles for entry into Specialty Training’ dated January 2006. Point two reads:

‘The selection process must be fair to all candidates who may apply, whether UK, EEA, or IMG’s’

It is clear that PMETB must be satisfied that selection to specialty training is fair to all applicants. It is therefore the duty of PMETB to withdraw education approval for all specialty training posts if a fair application and selection process for all applicants is not adopted. ‘Fairness’ must also include full compliance with current employment law.

I would suggest that the current applications process does not meet these criteria. The current system is a hybrid one, partly shaped by original design yet significantly altered by the MMC review group. It might be suggested that the current process is deficient for a number of reasons.

-Varying interview format. Some interviews have been conducted to the original (Patterson) specification without the benefit of CV’s, some have been conducted using the original format but with CV’s, and some have been conducted with CV’s and using ‘Probing questions’. Under the current proposals, all first choice interview scores will be used for selection, irrespective of their format. This is clearly unfair and I believe this disparity forms one aspect of the legal challenge mounted by RemedyUK.

-There have been reports that the Royal College of Physicians issued a statement to interview panels suggesting that the scoring system for interviews be changed midway through the process. Evidence can be supplied.

-There have also been reports of the format of interviews being changed midway through the interview process, specifically the format of 3 x 10 minute interviews being switched to 2 x 15 minute interviews. Again, such a change in format is clearly unfair.

-The abandonment of shortlisting makes the system unfair. Traditionally jobs are offered following both shortlisting and interviewing. These processes assess different criteria, with shortlisting focusing on past achievements and relevant experience, and interviewing focusing on personality, the ability to think and react to questioning, and an overall assessment of suitability. To omit one of these processes makes the system unreliable. A candidate who might have been shortlisted anyway could complain with justification that to interview everybody would unfairly diminish their chance of success. This is particularly true as interviews conducted without shortlisting struggle to assess traditional ‘CV data’ due to time constraints.

-There are reports of HSMP holders being refused interview on the grounds of ineligibility. There is widespread confusion regarding the status of HSMP holders via this ever-changing process.

-Currently any application to either Wales or Scotland will result in a guaranteed interview. This policy has not been adopted in England. This clearly discriminates against those candidates who applied within England only.

-The policy of only being allowed one interview appears contrary to employment law. No limit may be placed on the number of job applications a person might make, and no limit may be placed on the number of applications which might be considered.

-The numbers of posts advertised via MTAS for any given UoA have been unreliable, and have often changed without notice being given to applicants. This has led many applicants to make inappropriate application choices.

-Furthermore some applicants applied to generic programmes (such as General Surgery), only to be later informed (Following the submission of their application) that they must specify particular specialties. Consequently their application form was not tailored to their applications. Clearly this is unfair.

-Under age discrimination law a person may not be excluded from consideration for a post on the grounds of over-experience. To exclude applicants with over one years experience from ST1 applications appears to run contrary to this law.

-MTAS application processes were designed such that different specialties ran their application processes simultaneously. This is important for applicants who included different specialties amongst their four applications. For the process to subsequently differ amongst specialties (in particular hospital based specialties and GP) may result in applicants accepting lower choice job offers in response to the widespread anxiety of looming mass unemployment. For MTAS to be fair, it must run concurrently.

-There is also the suggestion that all applicants to GP will have their application considered. This gives some GP applicants (applications to GP + other specialty) ‘two bites of the cherry’ whereas most applicants may only have one. This is clear discrimination.

I believe that the current application process can clearly be demonstrated to be unfair. Therefore this process does not meet the principles that PMETB demand for entry into specialty training. It must therefore be concluded that PMETB must withhold the educational approval of these posts until a fair application process might be adopted. Educational approval must also be withheld pending the results of the ongoing legal challenge.

Should it be the considered opinion of PMETB that the current processes are fair, then I would like to request how this decision might be challenged, i.e. who regulates PMETB.

The pressure we are under to find a solution by august is immense. However such pressure must not force us to accept an unfair compromise solution. The importance of fair appointment into specialty training is simply too important to get wrong.

Mindful of this, I believe it is the duty of PMETB to inform relevant parties (such as the MMC team, Department of Health, CoPMED etc) that educational approval for all specialty training posts will be withheld unless a fair application process is adopted. Such a communication would be helpful as it would inform decision making at this difficult time. It might therefore be necessary for PMETB to suggest that the onset of specialty training is delayed whilst such a process might be devised.

I should also make it clear that I intend to publish this letter and any reply I receive on Doctors Net, and possibly other media.

I await your early reply,

Kind regards,"

I eagerly await Professor Rubin's response, I wonder whether he will ignore the question of admit that the PMETB have let juniors down. The former is far more likley but miracles do sometimes happen.

1 comment:

vinay shanthi said...

i know people who have been told at interviews that they didnt have time to go thru the application forms !!! and the candidate was asked to go thru his cv and when he did he was told that he was too experienced and should apply for another level. but as per the person specification and his individual situation the level he applied for and was interviewed for was the correct level. so does this mean he was discriminated against for being more experienced. is it legal to set maximum experience limits. when advertising jobs are they not allowed legally to insist only on minimum criteria aand technically anyone able to do that however experienced should be eligible for that as per current age discrimination laws. looks like there is one law for all other professions and another for nhs