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Today's the day that thousands of junior doctors across the country start their new posts after being recruited through the hugely controversial Modernising Medical Careers programme. Birmingham consultant Dr David Nicholl offers a unique insiders view of the process.

Last Friday, along with 9 colleagues I interviewed 26 junior doctors for neurology training posts in the West Midlands.

It was the culmination of 8 months of work in getting the interview system that I wanted ie fair and rigorous, and not some wooly, indiscriminate method as was initially been proposed by MMC, the much derided junior doctors assessment system.

First of all, the term junior doctor is misleading. These were physicians who have often been qualified as doctors for 6 or 7 years and are now in their late 20s or mid 30s.

I was expecting hundreds of applicants, and was relieved that there were only 44, but still had to cut those down to a manageable 26 applicants based on their CVs.

The field was quite simply stunning. Some of the candidates had been doing neurology for 2 years or more, on top of several years of general medical training.

Half were either in the middle of their PhDs or MD theses and had already produced a diverse range of high impact scientific papers in “Brain”, “Lancet Neurology” and a number of top notch journals.

If I had put the clock back to 1993 when I decided I wanted to be a neurologist, I wouldn't have been shortlisted, never mind appointed.

I knew it was going to be a tough decision, so how did I plan it?

First of all, I spent an entire day with colleagues short-listing all the applications and designing an interview that would test the skills of these budding neurologists.

The applications were scored on solid evidence of academic achievements or experience - eg papers in neurology or their past experience, not the much derided MTAS questions.

The interview process was like “the Apprentice” but harder.

The candidate had to interview a patient newly presenting with epilepsy (an actress), come up with a diagnosis, treatment, management plan, discuss complications and also be a good communicator in 15 minutes - with 2 consultants and the actress scoring you on all these points.

Next, they had 15 minutes to prepare a teaching session on neuroanatomy for medical students, then present their research or audit findings.

Finally they were given a nightmare clinical scenario of 3 acutely ill patients who they had to prioritise, sort out and treat in the correct order.

If that doesn't bring you into sweat, nothing will, but I make no apology for designing a very tough interview - the next time this lot will be interviewed, will be for a consultants job, so it had better be tough.

One of my colleagues joked over coffee that the candidates were so good one of them had taught him something!

After almost 9 hours of interviewing, the panel sat down to sort out who would get the 7 posts on offer. As the scores popped up on the screen, you could have heard a pin drop.

Then I realised that the candidate ranked 7th had only scored 0.05% higher than the one at number 8 - a fair but somewhat harsh way to decide your career as a doctor.

Then we realised we could offer jobs to those people currently doing PhDs by planning for when the current trainees finish even into 2009 and 2010. In so doing we managed to make 10 excellent quality appointments.

The downside? There won't be any new neurology appointments in the West Midlands until 2009 at the very earliest - there are just so many excellent doctors around, we've been able to fill the lot.

This is fantastic news for me as an employer, but atrocious news for any bright junior doctor who wants to do neurology but is at the bottom of the ladder.

If they thought it was hard this year, it will be even worse next year and the year after- all the jobs have gone. So if you want to be a neurologist, come back and see me in 2010.

Otherwise, maybe its time to emigrate or rethink the career.

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