NEWS FOCUS:How can we ensure the right students get to study medicine?, asks MAURICE NELIGAN
THE GREAT physician and teacher Sir William Osler is reputed to have said to his colleague William Welch in John Hopkins Hospital in Baltimore: “Welch, it is lucky that we got in as professors, we could never enter as students.”
Criteria for medical school entry change over the years. In my time you had to have the Leaving Certificate which had to include Latin, Maths and English. Oh, and your parents had to pay the fees.
Free third-level education removed that stipulation but with the passage of years the academic requirements steadily increased. In the purely Irish setting, the points required to do medicine became almost stratospheric for those wishing to join the profession.
Unfortunately, the all-pervading necessity to obtain the required points began to obscure the vocational aspects of a doctor’s life. You do not need a plethora of points to be a good doctor. You do need to really want to be a doctor.
The multiplicity of points showed that you were clever and capable of application and hard work. That’s all it meant and for those whose heart and soul wanted to study medicine, it was more than enough.
It opened the door also to some who simply did medicine because they had the required scores and had no real feeling for the subject.
The same Sir William Osler used to tell his students annually; “We are here to add what we can to life, not to get what we can from life.”
So how do we select those of reasonable and appropriate academic standard who have also a genuine calling to be a doctor?
All sorts of suggestions have been made over the years including indepth interviews, work experience in a medical field, and that points harvesting should be restricted to core subjects having medical application like maths, physics, chemistry, biology, English and possibly Latin.
The rationale for this is simply that in this era, medicine is a complex scientific subject. I am not sure that in these days, when graduate entry to medical school is a fact, that a primary degree that does not encompass a scientific background is a good preparation for the study of medicine.
Now, for the time being at least, the requirements for undergraduate entry to medical school have been set at 480 points in the Leaving Certificate plus a satisfactory score in the Health Professionals Admissions Test or HPat. This is a multi-faceted aptitude test and is similar to UMAT, the Australian model and is administered by the same group; ACER.
It consists of a two-and-a-half hour paper with three sections. Firstly, there is logical reasoning and problem solving. The second is labelled as interpersonal understanding. The third section is described as non-verbal reasoning. The test has a multiple choice format. It is held only once a year in several centres in the State. I have serious reservations about this latter point as several compelling reasons could prevent a student presenting on the given day.
Otherwise, it all sounds very logical and has drawn favourable comments from the medical schools on its first year of operation. It appears, however, that a certain amount of tuition would be required to allow a candidate approach the test with any prospect of success.
I looked at the sample questions and I feel many who had qualified before would have some difficulty attuning to this examination. So the students would have to be taught and since this is not a formal subject, the teaching may attract people giving grinds on how to pass the test.
This is not necessarily a bad thing, since the questions and problems are capable of almost infinite variation and thus not amenable to rote learning or cramming. However, books of questions will appear and claims of institutions achieving x% success in the exam.
It is hard to see a way around this and it is said to have achieved consistent and fair results in Australia and in the UK medical schools. If it lessens the proportion of square pegs in round holes, it will be an advance.
Such selections are incapable of certainty and one can readily imagine a sense of grievance in some students who might have obtained very high marks in the old regime, but who performed poorly in the HPat and, accordingly, missed a place in medical school. They may well have made fine doctors.
Early observations on its first year in existence would indicate that it has gone some way towards adjusting the gender balance among medical students. In earlier years the profession was predominantly male. In recent times the split has been 70-30 in favour of female students. Now it has come back to 50-50.
It would appear that the lads might be better at solving the problems posed. We shall see. Personally I am reluctant to enter that particular minefield. Irrespective of gender, we need caring committed doctors who perform to the best of their ability.
This is the first step and it appears a reasonable way to select our future doctors.
I will leave the last word to Osler. “The hardest conviction to get into the mind of a beginner is that the education upon which he is engaged is not a college course, nor a medical course, but a life course, for which the work of a few years under teachers is but a preparation.”
- Maurice Neligan is a cardiac surgeon