Is studying for an intercalated degree a wise career move?

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.

Wai-Ching Leung, honorary lecturer in public health medicine, medicine, health policy, and practice, University of East Anglia, Norwich
Email: w-c.leung@uea.ac.uk


studentBMJ 2001;09:399-442 November ISSN 0966-6494

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	CAREERS Is studying for an intercalated degree a wise career move?       Wai-Ching Leung (November 2001)
	Daniel Aston (October 25, 2001)       Medical Student, University College London d.aston@ucl.ac.uk
	I am writing in response to Wai-Ching Leung's article concerning the intercalated BSc. Overall, I thought the article did not answer the question that it set out to: Is studying for an intercalated degree a wise career move? The only exception was if you are a student interested in going into research after medical school - in which case the article provided a fairly clear answer: Yes. However, if - like the majority of medical students - you have little intention of doing research - then the answer was not evident within Mr. Leung's article. He begins by pointing out the differences in the number of people doing intercalated degrees between medical schools - and therefore confirms student anxiety about there being competition between applicants with and without an intercalated degree. Potential benefits of studying an intercalated degree are more geared towards potential researchers than potential clinicians. Mr. Leung points this out. Also, the quoted research seems to imply that it is not the intercalated degree that imparts a deep and strategic learning style onto the student, but the reverse: That students are more likely to intercalate if they have a deep and strategic learning style. Therefore this point seems irrelevant to the subject of the article. Mr. Leung also says that medically qualified professors and readers in the UK are more likely to have intercalated. However, it is not clear whether this is because just a few years ago it was only the most gifted students who were allowed to intercalate - and were therefore more likely to become professors anyway. As the intercalated degree appears to have no impact on finals results, perhaps the only other way of looking at the problem is to ask the question - does having an intercalated degree make you more likely to get jobs? These jobs can range from PRHO posts to consultancies. However, as of yet no work has been published that attempts to answer this question. Mr. Leung appears to have decided that the question is irrelevant. He says: 'house officers at district hospitals are not necessarily disadvantaged compared with those at teaching hospitals'. Well, nobody is saying that they are. However, it is telling that consultants at teaching hospitals prefer those graduates with the highest finals results, and are therefore interested in the academic achievement of the candidate. It is therefore a highly relevant and interesting question to ask if candidates with an intercalated degree are more likely to be employed. It is also, I believe, the question that most students ask when con! sidering whether to intercalate. Some have suggested that it doesn't matter because 'everybody gets a PRHO job' - but what about after that when people are applying for SHO jobs? Or registrar jobs? Before Mr. Leung's article, the answer was elusive; it is now still no clearer.

	CAREERS Is studying for an intercalated degree a wise career move?       Wai-Ching Leung (November 2001)
	Daniel Sado (October 31, 2001)       5th Yr Medical Student, Southampton University dan_sado@yahoo.com
	I read with interest the article in Novembers issue of the sBMJ about intercalated degrees.[1] I completely disagree with the conclusion of this article and the letter by Mr Iqbal[2] suggesting that, since we all get PRHO jobs anyway, why should this be an issue? At Southampton we have just found out what jobs we will be doing next year. Although everybody will eventually get a job, those who did not get what they wanted are extremely disappointed by the possible prospect of having to do a job in a hospital in which they may not want to work in! Even so, I believe that there is more of an issue at SHO level anyway. One of the medical consultants at Southampton General I spoke to, told me that she will usually get over 100 applicants for her SHO job, all of whom obviously have a medical degree and most of whom have got good references from their house jobs. How, therefore, can she decide who to employ without looking at other features on a CV, like intercalated degrees and publications? Unfortunately, the evidence at present does not allow us to answer the question posed by this article "Is studying for an intercalated degree a wise CAREER move?" Because of the lacking evidence at present, we simply do not know how many consultants are using it as a criteria upon which to base employment decisions. Leung W: Is studying for an intercalated degree a wise career move? sBMJ 2001,9:418-419. Iqbal K: Are intercalated degrees better? sBMJ 2001,9:436

	CAREERS Is studying for an intercalated degree a wise career move?       Wai-Ching Leung (November 2001)
	Shankari Thiagamoorthy (October 31, 2001)       final year medical student, Guy’s, King’s and St Thomas’s School of Medicine, London shankari_t@hotmail.com
	In response to the article about studying for an intercalated degree perhaps we should be asking whether obtaining a BSc changes us for the better?1 Does it affect what we put back into the system? I intercalated a degree between the second and third year. Not only did I gain three letters to my name, it was without doubt the most character building, mind numbing, and delightful year that I had experienced. Having spent two years struggling to remember facts and not knowing how to separate the must know from the rest, I was finally putting my brain to work. Working with my supervisor and starting with a hypothesis, I was searching for arguments, counter arguments, extensions, extrapolations, implications. I was challenged practically, academically, and mentally. For those of you who appreciated the logic and sequence of events in maths, physics, and chemistry at school, you will be glad that you took a year out to see how that could be applied to your life in medicine. You will also realise that the journal section of the library is there for your use. But as the article pointed out, those who have done a BSc did not do significantly better in the clinical years. Also with the introduction of special study modules throughout the five years of training, students are now given the opportunity to do research and present work in an area of interest. The skills gap is now narrower. While an extra loan is a problem easily solved by another month as a preregistration house officer, some other things are not so easily replaced. The clinical years are most productive when part of a group of people is bucking each other up, a necessity where you are taught to be superficially friendly. If by staying behind a year you lose the friends that you started with as a wide eyed sweet 18 year old, your clinical years may never be as fun, or as easy as it could have been. But your decisions are not based on what those around you do, are they?