A new regime for medical students

July 31, 1998

Higher education is set to expand student numbers by 20 per cent in the next seven years - but only in medicine, where the intake in England and Wales is on its way up from 5,000 to 6,000 by 2005. And it will surprise nobody that the long-awaited announcement about the extra places has not been accompanied by a statement that there will be 20 per cent more money for training future doctors. Although the comprehensive spending review has opened the door to the expansion, and the English and Welsh funding councils are likely to find money for it, the Department of Health's budgets are under too much pressure for it to meet its side of the bargain in full.

One result will be further concentration. Imperial College has strengthened its hand in the forthcoming bidding by taking over most of west London's medical training. The planned alliance of Liverpool, Manchester and Keele will mean more pooled resources in the north-west. This will mirror developments in medical research.

But new institutions and new methods will be needed to cope with the increase in numbers that has now been ordered. This is a chance for innovation, and one whose results might in time spread beyond medical education.

England's medical schools are prestigious but have never been subject to a Teaching Quality Assessment. When one is carried out, it may show that not all are using modern teaching methods effectively.

The arrival of new actors on the scene, such as Keele and the Open University, and the basic rethink of medical education by big name schools like St George's, will reinforce trends such as scepticism about the big set-piece lecture. Many of the new doctors will be trained by time-honoured methods but others, especially those coming via the Open University, will take it for granted that distance learning is an effective way of getting technical material across.

Because the new places will be allocated on the basis of financial bidding, there is bound to be an emphasis on less personnel-intensive teaching methods. This approach may not be ideal for training professionals who are required to establish rapport with anyone choosing to walk into their surgery. However, the planned increase means that serious thought will at last be given to the issue of how long a medical degree ought to take and what it ought to contain. It is already common for first-year medics to be taught alongside biologists - perhaps one should say other biologists - before their training separates out in later years. The most ambitious of the schemes now under consideration would turn medicine into a postgraduate specialism, with a couple of years of theory and practice turning graduate biologists into medical practitioners.

The proponents of this option may well have underestimated the work it will mean for the students. They will have to absorb vast amounts of formal information and also learn how to deal with patients and with members of other medical professions. But the effort of constructing such courses and making them work is one that should be undertaken, if only because it should widen the pool of people willing to become doctors.

But the first doctors produced by such unconventional routes will find that they have to work hard for acceptance by old hands who sweated for years from the age of 18 to qualify by the traditional route. As well as coping with simple prejudice, they will have to show good patient skills and the ability to keep up with best practice during their careers - a tall order which their traditionally trained colleagues do not always meet perfectly.

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