Should All Medical Students Be Graduates First?

Main Category: Medical Students / Training
Article Date: 26 Nov 2007 - 0:00 PDT

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Most people in the UK enter medical college straight from school. But would changing to a single system of graduate entry medical schools provide the diverse workforce needed for the future?

Two experts debate the issue in this week's BMJ.

We must stop the headlong rush of pupils going straight from school into five year long medical courses, argues Ed Peile, Professor of Medical Education at the University of Warwick. If we do what we have always done, we will always get a niche medical workforce.

Graduate entry medicine can widen diversity, he says. Around 10% of UK medical school places are on graduate entry courses, which enable graduates to move from science or arts learning at university to the level of competence needed for foundation year work in medicine. They can also concentrate on developing professional study skills rather than acquiring tertiary study skills.

Although cost comparisons between graduate and undergraduate courses are difficult, graduates are probably more likely to complete the course, adds Professor Peile. US data also indicate that older graduates practice more readily in underserved areas and are more likely to work in primary care, while data from Australia suggests that graduate entry schemes better prepare doctors for the workplace.

A change to a single system of graduate entry medical schools in the UK should attract mature learners with high levels of motivation, independence of outlook, and orientation towards hard work. Graduate entrants have the additional maturity and strengthened interpersonal skills necessary to provide the diverse multiskilled workforce needed for the future, he concludes.

But Charles George, Chair of the Board of Science and Education at the British Medical Association argues that there is insufficient evidence to make this a criterion of entry.

We do not need to modify the current system by restricting entry to graduates, he says. It would be discriminatory to school leavers and to mature non-graduates to limit medical training to people who already have a degree in the absence of any convincing evidence of benefit.

School leavers are intelligent, multitalented, committed, and come with excellent study skills, and there is no evidence that graduate entrants make better doctors, he adds.

In fact, a study from New South Wales found no significant differences between school leavers and graduate entrants in terms of academic performance or in career positions obtained after qualifying.

Although graduate entrants increase the diversity of our future doctors, there is insufficient evidence to make this a universal criterion for entry. Finally, we should not forget that graduate and mature entrants are subject to additional stresses, such as balancing commitments and financial pressures, he concludes.

Head to Head: Should all medical students be graduates first?
BMJ Volume 335 pp 1072-3
www.bmj.com

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