Clinical training provision is about a lot more than numbers, writes Dr Muiris Houston
With the Leaving Certificate results just over a month away, there is good news today for the many students who will inevitably be disappointed at not gaining entry to medical school. They may yet get a second bite at the cherry as graduate students when the recommendations of the Working Group on Medical Education are implemented.
The report by the expert group, chaired by Prof Patrick Fottrell, has come out clearly in favour of an entry system that would see 40 per cent of medical school places devoted to graduate entry.
In which universities and how quickly these places will come on stream is not specified. However, sources have said that Minster for Health Mary Harney and Minister for Education Mary Hanafin are well disposed towards its findings.
Management consultants Indecon, which advised the Fottrell group, have come up with somewhat benign figures for the added cost of a new model of medical education.
The report estimates additional annual costs of €11 million to cover increased teaching time and additional educational resources.
Separately, a fee of €5,000 per annum for graduate students is used in calculating the costs associated with graduate entry, a surprisingly low figure in the context of non-EU student fees of up to €34,000 per annum.
Before recommending an annual intake of 725 EU students, Prof Fottrell and his fellow experts state "it has been estimated that an annual intake of between 700 and 740 EU students would be required to achieve self-sufficiency [in manpower]".
In other words, if we want to be able to provide enough GPs and consultants for the health service in the future, we need to enrol over 700 (mainly Irish) students in some form of medical education each year. In contrast, over 60 per cent of the 782 students accepted into Irish medical schools were from non-EU countries in 2003/2004.
But it is not just a question of ramping up the numbers. Medical education in the Republic is not in good shape.
It has a major capacity problem when it comes to clinical or "bed-side" teaching. With too many students and not enough teachers the working group's comment that "radical reform of clinical training provision and capacity is an absolute precondition for any increase in overall numbers of medical students" is apposite.
And if that observation does not worry the healthcare consumer of tomorrow, how about the following? "It is not feasible to sustain a situation where clinical training . . . is effectively invisible to those responsible for ensuring that the overall undergraduate education programme is achieved in a verifiable way".
In other words, the working group is saying that the quality of medical education in different medical schools cannot be measured in a transparent way. Which begs the question: how can patients be sure that their doctors have been trained and assessed to a uniform standard? Such a level of uncertainty in the light of recent scandals such as Neary and Carmody is clearly unacceptable. It suggests there is an urgent need to get the Republic's medical house in order.
The report fudges a number of issues relating to student intake. While stating that secondary students would not rely on Leaving Certificate points alone to gain entry to doctor training, it does not specify what other criteria should be used.
And its recommendation "in order to maximise the educational experience for all students, undergraduate, graduate and non-EU students should be allocated across all schools" should not be allowed to interfere with the well developed plans for the introduction of graduate only medical schools in the Republic.
The representatives on the working group of the State's five existing medical schools could have been more generous to the aspirant plans of their colleagues in the University of Ulster and the University of Limerick.
However, the fates of Limerick and Coleraine are far from sealed. With the process about to move into the political domain, their clout may yet be felt. Mary Harney has made it clear that she wants to see a significant increase in the number of doctors qualifying in the Republic.
If new graduate medical schools enable this demand to be met more expeditiously they could yet get the nod.