Prescription needs altering

September 5, 1997

Would devolution aid Scottish higher education? Was Dearing right about Scottish participation rates and medicine?

"NOTHING much here for me" was my first reaction to a skim through Dearing. Perhaps as a medic working in an ancient Scottish university I should not have been too surprised. After all, medicine has always sat rather uneasily with other undergraduate activities. Our course is longer, much more expensive, primarily pass-fail and we do not have long vacations. Most teachers are not university employees and our graduates are all virtually guaranteed lifelong, well-paid employment in the NHS through government manpower planning schemes. The public understands what we do, is supportive, and gives generously to support research.

Perhaps, then, Dearing was right to focus almost exclusively on other university activities. I think not. It is a great pity that the opportunity to diagnose our problems and prescribe remedies was not taken, for problems we have. Of paramount importance is the research in medical schools, its funding and its relationship to teaching.

The basic principle at stake is whether medical education should be conducted in an environment whose orientation is primarily clinical, or primarily university. In the latter, it has always been assumed that teaching would take place in an atmosphere of research - in the former certainly not.

It is easy to justify the need for teachers to be active researchers. The pace and degree of change continually forced on doctors by the implementation of research findings in medical practice means that they must know about research in order to understand it and judge its findings. Because of the importance of the tacit elements of the scientific method this can only be taught by the researchers themselves.

What does Dearing have to offer in this regard? A step back into the past. He suggests that units scoring 3b and less in the research assessment exercise should cease to receive research funds. This proposal would affect 15 of the 25 United Kingdom undergraduate medical schools in at least one of their three clinical units of assessment. It would go a long way towards demolishing the research enterprise in many of them. After all, most already run deficits and cannot buy their way out of a financial squeeze by increasing teaching loads because the Government caps student numbers.

Another problem faced by medical schools comes from their failure in years past to negotiate the overheads to cover the indirect costs of externally funded research projects. Dearing at least acknowledges the problem, but neatly side-steps the most glaring anomaly - the point-blank refusal of the medical charities to pay overheads at all. He seems to accept their excuse, which is that they will not pay until universities account in detail for these expenditures.

Dearing's cop-out is very serious for medical schools, not only because it is highly unlikely that they will ever be able to meet the charities' requirements, but because of charities' dominance in funding university medical research. But the Catch 22 is that accepting charity-funded research grants, a must for the RAE, costs universities and medical schools lots of money; the more grants, the higher the cost to the institution.

What about Scotland? Insult is added to injury with another attack on the office of rector in the four ancient universities. The proposal that the holder of this student-elected office should no longer chair the university court is an insult to students. Since the arrangement was regularised in 1858, students have provided us with many distinguished rectors, such as John Stuart Mill and Thomas Henry Huxley, who have played key roles in curricular reform and institutional development.

Taxation without representation is generally agreed to be a bad thing. But demolishing the office of rector and asking students to bale out the universities by paying fees amounts to just that. The Government has already moved on fees. Leave us with our rectors, then.

Hugh Pennington Professor of microbiology, Aberdeen University.

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