Personal Views: Online selection of junior doctors: a student's view
Authors: Nadeeja Koralage
Journal: BMJ (2006)

With finals looming, you would expect students in their last year of medical school to be revising hard and meeting up for the occasional last orders at the hospital social club. The one thing at the forefront of our minds should, as in previous years, be the exams that we have been working towards all our academic lives. However, the subject most talked about at attachments is jobs. Not surprising, you may think. But what is surprising is that not only do we talk, we also speculate and repeat rumours that we have heard while wondering if we will be able to work in England.

Final year students must apply for jobs through the Multi-Deanery Application


The noble aim behind MDAP—to move medicine away from its image as an old boys' network—has created a completely new set of tribulations


Process (MDAP). Online, they must answer a series of questions on topics ranging from academic performance and personal achievements to the qualities of a good doctor. But each question must be answered in just 75 words. Students are not called to interview, but ranked depending on their application form score (out of 48). In this year's first round, thousands applied, each selecting their top 40 jobs. Many obtained identical scores, leaving some students who applied for the more popular jobs unplaced.

Understandably, most students apply for jobs at the deanery where they have trained—so it's bad luck if you trained in London. Jobs in the capital are oversub-scribed now with equal opportunity laws giving any European Union applicant the same chance of employment. Royal Free and University College Medical School (RUMS) students seemed to come out the worst, making up 87 of the approximately 600 students without jobs. This has been put down to “RUMS-centric jobs” being among the most highly prized, such as those at the newly opened and publicity friendly University College Hospital.

In a letter to the Times newspaper on 4 March a group of leading medical professors protested against the application method. An adjoining article focused on how a few doctors allocated by this system last year were not able to fulfil their duties, detracting from the amazing achievement of those students who did obtain a job through this ridiculous system.

Last year, when a similar system was in place, some less popular hospitals had burnt fingers after employing large numbers of overseas graduates, who tended to have lower application form scores. As a result, some doctors fell below required language and clinical experience requirements and hospitals had to employ locums to supervise their work. Consequently, many UK students with impeccable medical school records now face further interviews to check their ability to speak English as well as their commitment to working in the United Kingdom, as a result of a poor score on their forms. Surely this further assessment is not required of a student who has trained in the UK and passed their finals?

It was recently discovered that if you simply added the word “admin” to the MDAP web address you could access the internal administration pages. Word spread rapidly as his or her references—easily accessible, changeable, and not even requiring a password to do so. And now, as some of my fellow students talk to employment lawyers about the validity of the application process, others speak to the press, in the hope that public embarrassment will push MDAP to improve its system.

I never thought I'd say this, but at this point in the year I'd rather be revising pathology than reapplying. But it is difficult for students to focus on revision when we have lost all faith in MDAP. We are taught communication skills and told to respect patients, yet we are shown little respect ourselves when it comes to obtaining information about our futures. On some of my attachments, not a single student has a job. What if we do not get a job in round two? What will happen in the clearing process that follows this stage? We can ask the administration, but the fact is, no one knows. This is not something that has yet been decided.

You can find numerous faults with the system, most of which we are resigned to accept. For example, we can't find out about the jobs that we are applying to, meet the teams we will be working with at interview, or, in many cases, visit the hospitals or even areas that we are now choosing to live and work in for a year. The noble aim behind MDAP—to move medicine away from its image as an old boys' network—has created a completely new set of tribulations for medical students.