Finding a cure for a limping system

October 24, 1997

The week after a scientist at the Medical Research Council won the Nobel Prize for chemistry, it is back to Earth with a bump for British medical research and education. Research is losing out on funds from the higher education funding councils (back page). At the same time, too few people want to be doctors - so much so that steps are being contemplated to allow graduates of any subject to wield a prescription pad after three years of training (see page 12).

John Walker's Nobel - the sixth for the MRC Laboratory of Molecular Biology, which is conspicuously located alongside but not in the University of Cambridge - makes the point that a well-resourced research centre with no undergraduate students is likely to become more of a powerhouse than a full university department. The free-standing general medical schools that have lost out in the aftermath of the research assessment exercise are being outpunched in research by specialist postgraduate research units and by the Oxbridge medical schools. The outcome may be that they will lose their independence or become graduate-only institutions.

Lord Flowers recommended as long ago as 1980 that medical schools ought to join mainstream universities and colleges. Medical academics, and their students, have a lot to gain from having biologists and social scientists nearby. In some institutions, first-year medics attend lectures alongside future veterinarians or agriculturalists, cutting costs and providing more of the big picture.

Few medical schools can, for example, afford a full-scale materials science department, but they ought to have access to one given the novel materials that doctors plan to place inside our bodies to replace our worn-out parts. At the same time, medicine is one of the few subjects where the debate about the validity of teaching-only university departments has not taken root - research activity is seen as essential to quality.

But in the no-holds-barred review of medical education that may now arise, perhaps even this position needs examining. The cost of medical research, and the ambitions of universities with no medical schools to become providers of medical education, point in the same direction - towards the provision of research facilities on a regional basis, as Dearing recommended for other expensive subjects, and away from the presumption that everyone who teaches medicine must also be a front-rank researcher. The RAE results suggest that institutions are going to have to run ever faster to stand still.

A more difficult question will be the professional status and ability of the doctors coming out of the conversion courses now planned by some medical schools. In law, conversion courses have worked well for years, although their graduates have less status in the profession than lawyers with law degrees. It remains to be seen whether medicine, another service where public trust is vital and errors very visible, takes kindly to the arrival of apparently less well-prepared practitioners.

The public, after all, thinks that doctors are well-prepared for their task by years of intensive training. But, as Liz Frayn says (see left), those doctors who train from the age of 18 already experience less traditional science-based teaching and more touchy-feely project groups. Whether it will be preferable to be treated by one of these doctors, or by a history graduate who has done a conversion course, is an open question.

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