New pathways into medical school "down under"

Australian medical schools admit graduate students from all disciplines

(ANT/NHPA)

Some historic shifts have been taking place over the past few years in the way a number of Australian medical schools have selected students for admission to their courses. After a century-long tradition of taking most students directly from high school, several medical schools have changed their admission process to consider only graduates of another degree course.

The University of Sydney was part of a consortium formed with Flinders University of South Australia and the University of Queensland to lead this change in the early 1990s, and all three now have students who have just completed or nearly completed the new four year courses. More recently, the University of Melbourne has adopted a hybrid admission scheme, with one stream of students entering with a completed degree.

What was the motivation behind this change from the traditional British pattern of undergraduate entry towards a more American model? One important factor was the widely held perception that high school results alone had not enabled the various faculties to identify those students most motivated and suited to the study and practice of medicine. There were also distinct imbalances in the demographics of undergraduate entrants, with a bias against students from rural areas. Observers felt that many medical students lacked the experience or maturity to make an informed career choice and that some even came to regret taking the medical path.

The medical faculties adopting a graduate entry programme are using new admission criteria. These include completion of a primary degree in any discipline at credit-average standard, good performance on a new test of knowledge and reasoning skills in the sciences and humanities (the Graduate Australian Medical Schools Admission Test, now used by St George's Hospital Medcial School), and a structured interview. In all cases, places have been made available for international fee-paying students, who go through a similar admission procedure.(See Figure 1)

All of the graduate entry schools have also redesigned their medical courses. Features of the new courses include:

• integration of preclinical and clinical learning
• emphasis on the clinical relevance of the basic sciences
• early introduction of patient contact and clinical skills
• longitudinal development of concepts in the population sciences
• an explicit focus on personal and professional development, including self-directed learning and group work.

The format of problem based learning (PBL) has proved valuable as a means for incorporating many of these developments, particularly in the first two years of the courses, though lectures and practical classes have also been retained to a varying amount in the different schools. Greater use of information technology has been integral to the courses, especially for teaching the computer skills required for evidence based practice.(See Table 1)

What is the profile of the new student body? Some statistics from the 1999 intake at Sydney illustrate some emerging patterns. Of this cohort, 58% are women, compared with about 40% in the last years of the former undergraduate programme. There is naturally a wider age range than in the previous system, but the majority are in their early 20s. While most students still come from the Sydney metropolitan region, an increased number have residential addresses in rural areas and there is more movement between states.

The table shows the types of first degrees undertaken by this group. The largest single group has a science background with an emphasis on biological science, while one third have completed a medical science or a health sciences course such as physiotherapy. A significant number of graduates are from the arts and law, many taking combined degrees, while there is a smattering of pharmacists, nurses, and engineers. To ensure that the advantages of learning from those with non-science qualifications are evenly spread, care is taken in drawing up the PBL groups to include students from a variety of backgrounds in each group, to the mutual benefit of all. The 10% or so of overseas students fit in well and add a welcome international perspective.

While it is clearly too soon to say how this new group will perform when they enter the health system, preliminary evidence from teachers in the senior clinical years is very promising. Everyone agrees that the students are interested and motivated in their studies and bring a depth of background and life experience that is welcome in clinical settings. They are more articulate and inquiring, and these characteristics have come to be generally appreciated. Certainly their interpersonal skills in dealing with patients and their relatives are impressive and reflect well on both the selection process and that part of the new curriculum that deals with communication and clinical skills.

We look forward to providing some evaluation data as our new doctors join the medical workforce over the next few years. We are confident that the report card will be good.

Michael Field, associate dean (curriculum), Faculty of Medicine, University of Sydney
Email: michaelf@medicine.usyd.edu.au

Jill Gordon, associate dean (education), Faculty of Medicine, University of Sydney
Email: jillg@gmp.usyd.edu.au


studentBMJ 2000;08:303-346 September ISSN 0966-6494