AIMS AND METHODSThe recent Medical Training Application System (MTAS) has been fraught with problems. A survey of MTAS applicants from two London training schemes and a request for emails from trainees and trainers documenting problems with the system were undertaken with the aim of canvassing the views of candidates and shortlisters/interviewers about MTAS, and providing evidence of the system's failings.RESULTSA total of 101 candidates responded to the survey, and the first 92 emails sent to the Royal College of Psychiatrists were analysed. The majority of respondents (73%) were dissatisfied with MTAS and 63% thought the system unfair. UK and European Economic Area (EEA) applicants (71%) were more successful in being shortlisted than non-EEA candidates (48%). The majority of applicants (70%) planned to reapply in subsequent rounds if they failed to secure a training post.CLINICAL IMPLICATIONSBoth surveys showed clearly that the system was not working well. The trainees and trainers both felt that the system was flawed and that the reasons for the failure included a centralised system without any piloting, and the question design. In addition a lack of resources added to the stress and burden on both trainees and trainers.
Aims and methodOur aim was to follow-up on a cohort of self-referred doctors who attended MedNet. We used a two-point cross-sectional design. Measures included three standardised self-report questionnaires administered before and after consultation. Doctors were also asked to complete a service user questionnaire, and data regarding engagement and onward referrals were gathered through case-note review.ResultsA statistically significant improvement in scores on all three questionnaires was found after intervention; however, scores on one subscale, the risk domain of the Clinical Outcomes in Routine Evaluation – Outcome Measure, did not change significantly. Of the doctors at no risk of suicide at intake, nearly two-thirds (n = 41/70, 59%) were sufficiently helped by the consultations provided to not need further treatment. Of the doctors at some risk of suicide at intake, two-thirds (n = 34/51, 67%) did need an onward referral. Only one doctor required hospital admission, an outcome that suggests the approach used is containing and clinically responsive.Clinical implicationsThis paper highlights the efficacy, need and importance of specialist services for doctors in difficulty. We found that the bespoke consultation model provided at MedNet is valued highly by the doctors as service users.
Increasing numbers of doctors sought help from the doctors' mental health support service. More than half scored above the thresholds for burnout and psychological distress and these proportions were consistent over 10 years. Doctors may be more willing to seek help than a decade ago. Further research is needed to confirm the underlying reasons for this. More resource is needed to meet the increase in demand.
SummaryObjective To track the success rates in obtaining a specialist training (ST) post of a cohort of medical training application system (MTAS) applicants, as well as canvassing their views of the process and measuring symptoms of psychological distress during application and after job allocation.Design A follow-up cross-sectional survey.Setting Two large south London psychiatry training schemes. Participants 101 MTAS applicants.Main outcome measures Success in obtaining an ST post, respondents' views about MTAS and General Health Questionnaire-12 (GHQ-12) scores.Results 48 of the original sample responded to the follow-up survey. Data were available about post-MTAS job status for a further 41 trainees. 64% of candidates obtained an ST post. Of those, however, 12% were only offered a fixed-term post. Most unsuccessful candidates were doing locum (34%) or non-training grade (21%) jobs. UK/European Economic Area (EEA) doctors were more successful than non-EEA applicants in obtaining an ST post (odds ratio 5.5, 95% confidence interval 2.1-14.3), as were women candidates compared to men (3.7, 0.5-9.3).The respondents' views about MTAS were globally negative (even if they were successful in obtaining an ST post).The median GHQ-12 score for respondents was 7 out of a potential total score of 12. 79% of the sample scored above the threshold (GHQ-12 $4) for psychological distress and 21% experienced significant distress (GHQ-12 $8).Conclusions MTAS was a flawed system. A considerable proportion (36%) of candidates who had been on a Senior House Officer training scheme were left without a training post after MTAS.The system seems to favour UK/EEA applicants. Applicants suffered significant psychological distress during and after the MTAS process.
SummaryThe Clinical Assessment of Skills and Competencies (CASC) is the latest change to the MRCPsych examination. the CASC is a complex version of an Observed Structured Clinical Examination (OSCE) format, with paired stations, and is now the only clinical component in the MRCPsych examination. We describe how to organise a relatively inexpensive and workforce-light 1-day course and mock CASC examination by adapting a previously described method for running an OSCE workshop. We also evaluate the acceptability to trainees of a mock CASC examination and course, and describe their views on this new clinical examination format.
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