Fastracking through medicine
Access to medicine is changing. Peter McCrorie explains how London is leading the way in the UK
The BBC is producing a sequel to the "fly on the wall" documentary series Doctors to Be. They will follow a dozen students as they embark on a brand new medical course in London. The documentary will track their lives first as students and then as doctors. The new style four year medical course for graduates begins this September at St George's Hospital Medical School. It will be open to everyone with an honours degree in any discipline (2ii or above).
Why graduate entry?
The academic constraints on graduates
entering the five year programme are too
rigorous - excellent science A levels
(including chemistry); good GCSEs, and a
2i or above in their degree.
There is an early enforced choice
between arts and sciences encouraged by
the A level educational system in England
and Wales (unlike the far superior Scottish
and Irish Higher systems). This enforced
choice results in a loss to the profession of
many potentially suitable students.
The wide range of career options pursued by graduates and the wealth of experience they can bring to the student body are invaluable.
The motivation of some school-leavers,
especially those excessively influenced by
parental pressure, is questionable.
The high dropout rate of medical students during and after their undergraduate studies is said to be lower for mature medical students.
The recommendations of both the
General Medical Council and the Medical
Workforce Standing Advisory Committee
(the Campbell Committee) support graduate entry.
How are applicants selected?
First of all they have to pass an entrance
exam. This is not easy. It is set, printed, and
marked in Australia (and therefore costs
£150 to enter). Australia has four years'
experience of setting such exams and has
got it down to a fine art. There are three
components to the assessment:
- Reasoning in the humanities and social
sciences - a bit like an English
interpretation test
- Written communication - two 30 minute
essays on fairly broad topics that require
quite a good deal of thought
- Reasoning in the sciences - 40% biology,
40% chemistry, and 20% physics
multiple choice questions (all based on
understanding rather than recall of
information).
Those who score the highest (the top 80
candidates in 1999) are then invited for
interview. Each interview lasts about 40
minutes and is highly structured, with all
applicants asked the same set of basic questions. The three person interview panel
(which always includes one person from
the local community) rates each applicant
independently on a scale of 1 to 5 for each
topic. Each interviewer also gives an overall rating. The panel spends about 20 minutes in discussion and then agrees on a final score and overall rating.
The final selection of 35 candidates is
made on the basis of overall exam score,
total interview score, and overall interview
rating. References and UCAS application
forms are read at this stage. Selection is
thus based on performance in the entrance
exam and at interview and not on A level
and GCSE results. The slate is wiped clean.
Arts graduates don't have to obtain science
A levels, but do have to acquire sufficient
understanding of biology, chemistry, and
physics in order to pass the entrance exam.
Course outline
The graduate entry programme (GEP)
design is broadly based on the experience
of the four year programme at Flinders
University in Adelaide. Problem based
learning is the central educational approach:
students study the curriculum through a
series of problem situations or "scenarios"
in groups of seven assisted by a facilitator.
In the first two years, the learning is centred on the topic of the week, for example
hypertension. Thus all teaching, whether
clinically, ethics, or community based,
relates to this chosen topic, putting all
aspects of learning fully into context.
In the third year of the course, students
are attached to a hospital for two periods
of 12 weeks. There they learn their general
medicine, general surgery and anaesthetics,
and some of the more specialised disciplines. Students' time will be tightly structured during these attachments. Problem based learning will continue, once a week, but will be based on real patients. As well
as the two 12 week attachments, students
have five weeks each of obstetrics and
gynaecology, paediatrics, and psychiatry.
Year four acts as a preparation for
becoming a preregistration house officer
(PRHO). In rotation, each student spends
four weeks in general practice, accident and
emergency, and in a training ward (an
orthopaedic ward for final year medical,
nursing, physiotherapy, and occupational
therapy students). Students will also be
attached to two hospital firms - one medical
and one surgical - to act as assistant PRHOs.
All students are entitled to a 10 week elective, which they can spend anywhere in the
world. It is hoped that a number of students
may choose to spend this part of their
course in Australia because of the partnership between St George's and Flinders.
Students also have to undertake special
study modules. In the fourth year, students
have a final four week special study module
where they will be encouraged to study topics outside of "normal" medicine, for example a language, complementary medicine,
history of medicine, or medical humanities.
While everything is in place to ensure
the course runs smoothly, last minute
hitches are always a possibility. Letting the
public in is a high risk strategy for the
school on an untried and untested course,
but one we feel is well worth taking.
Peter McCrorie, director of the graduate entry programme, St George's Hospital Medical School, London
Email: mccrorie@sghms.ac.uk
studentBMJ 2000;08:303-346 September ISSN 0966-6494
