What is it?
Modernising Medical Careers (MMC) was launched in 2003 to ‘modernise’ the way in which postgraduate medical training operated in the UK. This was largely in response to the Department of Health’s drive to provide for the future needs of the NHS.
What came before MMC?
Prior to MMC, medical graduates would undertake a year of postgraduate medical training as a Pre-registration House Officer (PRHO) before applying to progress to a Senior House Officer (SHO) grade. Applications were by CV and/or application form and a formal interview. Competition was fierce and the system was criticised for its lack of transparency. Progression beyond SHO was unclear with no limit to the length of time a trainee could remain an SHO. The lack of clear career pathways for SHOs led to them being dubbed ‘the lost tribes’. (Dillner L. Senior house officers: the lost tribes. BMJ 1993;307:1549-51).
MMC initiatives
MMC aimed to modernise the SHO grade by creating transparent and efficient career pathways to ensure that more of the NHS service was provided by trained doctors and consultants rather than those still in training.
In 2005 MMC introduced a two year Foundation Programme which followed immediately after graduation from medical school and a new system of ‘run-through’ specialty and GP training (in 2007). (See my Foundation and Specialty Training pages for more info. on how this works now). A national timetable for selection was introduced along with a centralised online application system and transparent national standards detailing the competencies required of trainees.
Diagrams showing postgraduate training pre-MMC and postgraduate training introduced by MMC are available on the MMC website.
What went wrong?
In its first few years of operation MMC came under heavy attack from critics. With a larger than anticipated pool of applicants (in the main due to increasing numbers of international medical graduates competing for training places), matching the number of applicants to training places available became a logistical nightmare.
Trainees and selectors alike held reservations about the shortlisting and selection process at specialty level. At the lowest point, the online application system for specialty applications (MTAS) suffered major security breaches resulting in a huge lack of faith in the process. The Department of Health requested a full review into the online application system which was carried out by the Douglas Review Group. Details of the report can be found on the MMC website.
MMC as it is now
Given that the system for application to foundation programmes operated without difficulty it was agreed that it would continue as a national, online process for application and selection.
It was also agreed that from 2008, application and selection to specialty training would be managed locally as opposed to via a national system.
An independent inquiry into the changes implemented by MMC was requested by the former Secretary of State for Health, Patricia Hewitt. A full report of the inquiry, entitled ‘Aspiring to Excellence’ led by Professor Sir John Tooke, published its findings and recommendations in January 2008. The Government has since responded to the recommendations for England, a full report of which can be found on the MMC website. The recommendations are currently under consultation with a full response expected soon.
