Wai-Ching Leung helps you to decide by discussing the evidence

Just over a third of all British medical students obtain an intercalated degree¹--mostly BSc degrees, with a few medical schools offering BMedSci--for example, Nottingham, Birmingham, and Newcastle--and BA degrees--for example, Oxford and Cambridge. The proportion of students taking the intercalated degrees varies widely among medical schools. In some medical schools it is obligatory--for example, Oxford, Cambridge, Nottingham, and some London schools. In other schools, it is open only to students who performed well in the first two years--for example, Liverpool. In medical schools where it is not compulsory, students need to decide quite early on in their careers whether to take up this option. However, the advice they receive is often conflicting and confusing.²

What subjects are studied in the intercalated year? Before the 1990s most students took basic science subjects, such as physiology or pathology, although a minority chose subjects such as medical law, medical anthropology, or even subjects unrelated to medicine. With the introduction of an integrated medical curriculum, a wider range of subjects including clinical subjects such as general practice gradually became available.³ The General Medical Council identified two main purposes for the intercalated year--the development of research skills and in depth study in areas of particular interests over an extended period.⁴ Currently, the degree is intercalated over a discrete time period, usually after the second or third year of study. However, the GMC highlighted that it could run as a thread throughout the medical curriculum. From information gathered from United Kingdom medical school websites, I have summarised a selective range of subjects currently offered, in box 1.

The potential benefits

Will it really benefit you educationally? For those who wish to pursue a medical academic career, the answer seems to be yes. In the United Kingdom, medically qualified professors and readers were more likely to have an intercalated degree. Furthermore, those with intercalated degrees raised substantially more research grants and better publication records than those without one.⁵ A study of medical graduates from the University of Queensland reached the same conclusions.⁶ Among all 1991 UK medical school applicants, those with intercalated degrees showed greater interest in medical research. Furthermore, students who completed intercalated degrees had deep and strategic learning styles, especially in medical schools where few students took intercalated degrees.¹

The benefits to their future clinical practice are much less clear. At Birmingham University, students with an intercalated BSc degree did not obtain significantly higher marks during their subsequent clinical examinations,⁷ although an earlier study at Edinburgh University found that students with a BSc in pathology performed better in their clinical years.⁸ Integrated degrees may also influence students' subsequent career choices. Those with an intercalated degree are more likely to enter academic and research careers,^{5 8 9} hospital medical specialties, and pathology¹⁰ but were less likely to choose general practice.

The potential drawbacks

Against these possible benefits, the two main potential drawbacks for students opting for an intercalated degree are time and money. The current lengthy period of undergraduate and postgraduate medical training often discourages students from studying an extra year at university. Will you be better off qualifying a year earlier?

Fortunately, the Department of Education and Employment changed the regulations relating to funding in June 1999, so that local education authorities can extend student awards to cover the intercalated BSc year, whether the programme was an integral or an optional part of the student's main course. Nevertheless, the current rising level of medical student debt to an average of almost £9500 in the final year¹¹ will surely put some students off this option. Would it be better to start earning a year earlier?

It's your decision

So should you take an intercalated degree? This must involve a careful balance between possible educational benefits on the one hand and your own time and financial considerations on the other. Students at Nottingham Medical School seem to enjoy the best of both worlds, as they complete both the BMedSci and their medical curriculum within five years. For others, it would certainly be a good idea if you intend to pursue an academic career. This is particularly true if your interest is in one of the laboratory based sciences, as the integrated curriculum nowadays gives little emphasis on the relevant research methods. The laboratory experience gained in the intercalated year would be valuable for completing a higher degree and becoming a successful scientist.¹² It is also useful for those pursuing clinical specialties which require a higher degree--for example, surgery. For those intending to pursue a clinical career in specialties not requiring a higher degree in laboratory based sciences--for example, psychiatry, general practice--you should consider whether your desire for intellectual stimulation outweighs the time and money constraints. Finally, for students who come to realise that they do not wish to follow the arduous path towards a medical degree after all, the intercalated degree is ideal, as it opens up opportunities to other professions and opportunities including teaching, law, industry, and the civil service.

Other options

Two other options must also be considered. Firstly the MB and PhD integrated programme available in several medical schools allows students to gain both a PhD and a basic medical degree in about seven and a half years,^{13 14} and is ideal for those with a clear interest in academic medicine or clinical career requiring a higher degree. Not only does this option take a shorter period of time compared with the two degrees taken separately, the integrated nature of the programme also minimises the risk of loss of clinical skills while undertaking a higher degree. Fast track intercalated or integrated doctorates were found to be effective in developing research orientation and academic leadership in the United States and Canada.¹⁵ However, such integrated MB and PhD programmes are open only to a few exceptionally gifted students. The second option available to all is to complete a part time masters degree immediately after qualification by day release, evening study, or distance learning, over about two years.¹⁶ This option is particularly suitable for those interested in studying clinical subjects to a greater depth. You earn more CV points than a bachelor degree, save a year, and this option is attractive from the financial viewpoint. However, it requires much more self discipline. Theoretically, there are no reasons why students cannot follow a one year intercalated masters degree at the end of their third or fourth year, as they would have earned the equivalent credits for a honours bachelor degree by then. Unfortunately, few medical schools offer such an intercalated masters degree.

Conclusions

But what would the consultants shortlisting your house officer posts application think?² The opinions of individual consultants vary, but it would be unwise to let this short term factor dominate your decision. There are no shortages of house jobs nationally, and house officers at district hospitals are not necessarily disadvantaged compared with those at teaching hospitals. It is more important to assess how an intercalated degree might affect your overall education and longer term career, and to consider all other options.