MMC Reforms: have they put paid to the pluripotent medical student?
Authors: Lara Howells, William Cook
Journal: Journal of the Royal Society of Medicine (2013)

Medical students appear to fall into two broad categories: the ‘pluripotent student’ who has yet to declare an interest in any particular specialty, and the ‘specialised’ student who shows a definite commitment to a known specialty, for example, orthopaedic surgery. They are equally ambitious, and undertake extra audits, presentations, and teaching opportunities to enrich their CVs. In a recent survey of 135 final year medical students, 95% agreed that it was not important to have decided on career speciality before graduation. Whilst this view resonates in medical student common rooms, the pressure for early specialization is becoming inescapable. Moreover, the pluripotent group worries that their specialised peers have the right idea. In 2005, the Department of Health implemented Modernising Medical Careers (MMC) – an initiative to address concerns about the UK medical workforce and postgraduate training. One of its aims was to streamline postgraduate specialist training by cutting down the time taken for junior doctors to reach consultant level. This demands that graduates commit to specialist training earlier and – only 18 months following qualification – they have to choose from over 60 specialties to which they may have had little or no exposure. A measure to address this issue – the ‘taster sessions’ offered during the foundation years – has been likened to ‘three-minute speeddating chats from which you have to select your life partner’. Because of the intensely competitive nature of specialist training, the time available to explore different career options is limited. A sign on our career paths should read: ‘No Loitering’. The need to stay on the straight and narrow is now unavoidable. Professional leaders and the Department of Health have discussed the consequences of the MMC changes. Crucially, the results have yet to percolate down to the next generation of would-be doctors. Medical students are not only encouraged to consider their bespoke career path, but to actively pursue these choices through undergraduate research, audit, and teaching opportunities. The drive to display early commitment to a chosen specialty could detract from traditional broad undergraduate training, with the result that medical students are less ‘pluripotent’ and more ‘specialised’ than hitherto. This disadvantage of early career choice and the lack of information about career planning available to medical students and trainees were not overlooked by the Tooke Report on the MMC reforms. Without reliable information, students may be unable to make informed judgements about the likelihood of realizing their career aspirations. There are, perhaps, advantages for the specialised student. These include a firm commitment to a specific discipline, a focused accumulation of knowledge in that discipline, and the possibility of networking opportunities in a familiar specialty. However, the decision to specialize early may rest on only limited experience in that field, or on the persuasive advice of others. Early specialization risks, as well, the development of a blinkered view of medicine, with diminished engagement in other specialties. Compared with the pluripotent student – who would be expected to have a wider knowledge base and skill set – the specialised student may be less well prepared for foundation year posts outside the chosen discipline. DECLARATIONS