Father and son Carl and Lewis Gray compare and contrast their experiences of medical school

1972-8
Our entry requirement was three Cs at A level but most people did better than required. We were selected without interview from the then called UCCA form. I joined at age 17 and the year of about 130 people contained mainly science students totally lacking communication skills. No one checked whether I could read or write. I certainly had zero caring qualities but this did not matter. The weekly curriculum was densely packed with lectures and practical classes in biochemistry, physiology, anatomy, and something I still don't understand called "man in society."

We dissected the entire cadaver apart from the foot, with special classes in neuroanatomy. This has proved very useful in later life. We did live physiology on real rats, dogs, cats, rabbits, and each other. We did every enzyme reaction in the book--such as grinding up rat's liver, adding white stuff, then watching it go blue. The word "enzymology" still makes me ill. The experience of insulin induced hypoglycaemia while on ß blockers was one to remember. Still, these experiments were fun and nearly everyone survived. Exams were rigorous and fact-packed, with a fortnightly viva in anatomy.

There was no clinical contact until year three, when simultaneously we had to get our hair cut, wear a tie, and call people "Sir" unless they were "Sister" or "Miss." Often, teaching was in the hands of ill equipped junior doctors and there was a culture of teachers not turning up. We were encouraged to attend pathology, radiology, and anaesthetics departments and to stay up all night on "acutes." Some students taught themselves by getting stuck in. I did three student locums--since abolished--in which you really did the absent junior doctor's job while knowing nothing and learning everything and injecting into the patient whatever the sister handed you. We did miles of suturing in accident and emergency, and ritual humiliation was usual in surgery. We can reminisce about especially grisly occasions with a sadist at the bedside. It was always the prettiest girl who had to handle the most whopping scrotum and the most bashful youth (me) who had to heave immense breasts across the chest to find the never before detected apex beat.

I had a substantial grant, for which I was grateful. Without it I would not have done medicine. I have still had no training in communication skills.

2000-
The entry requirements these days stand at a staggering two As and a B for most medical schools. Soon this may even rise to a three A entry requirement. Such a high asking price for entry into medical school is a big change from the past. Also there is a greater preference for people with caring qualities in addition to science based intelligence. Competition is very high these days for entry, but once you're into medical school, unlike the House of Commons, your seat is relatively safe provided that you do some hard work.

My year has 240 places in total. The curriculum has subtly evolved over the past 30 years to include much more psychology, sociology, and epidemiology; but slightly less anatomy than most students probably need. There are restrictions on the use of live animals and real fellow students for experimental work and this reflects public opinion and health and safety norms. There are still foundation modules in biochemistry and metabolism, but much less than before. This is not deemed to be a bad thing by both students of today and of the past. There is scope for variety in the elected special study modules, including non-medical subjects such as Spanish and art in medicine.

Our course remains almost equally divided, imitating the traditional preclinical and clinical divide. However, there is an increasing amount of clinical work being phased into the preclinical side. With basic examination skills, communication skills, and "patients in the community" schemes introduced early in the first year, we first year students have met many real patients and their families. Patient contact at an early stage in medical training, although daunting for the students and possibly the patients, can only be of great help in the long run. The more experience, the better the doctor. Communication skills can be improved only with practice.

Further examination skills are taught in the second year and these, as well as initial weekly ward experience, all add to the increase of clinical work at this early stage in the course. Modern students are no longer allowed to do locums except under the strictest supervision. Perhaps the students have less opportunity for vivid experience in real clinical settings. Thankfully our exams involve less list learning and more problem solving.

The non-academic side of student life seems much more expensive these days. What with the abolition of student grants ("don't pay it back") and the introduction of student loans ("pay it all back eventually"), funding is fraught. The average student pint retails at a superinflated price of £1 to £2. However, there also seems to be a lot more fun to be had these days. There are so many more activities: medical students these days are spoilt for choice.