Casualties of the telly doctors

Students are fighting for medical school places, but have they chosen wisely and will the best applicants succeed? Andrew Houghton reports.

Competition for places at medical school has never been fiercer - more than 12 people fought for each place in 1994-95, the latest year for which complete figures are available.

Many medical school selection panels receive more than 2,000 Universities and Colleges Admissions Services application forms every autumn. However, there are growing concerns that many of these prospective medical students are making their applications with scant information about the course or what a medical career really involves.

Many sixth-formers complain that such information is hard to come by. Jessica Martin, now a fifth-year medical student at Nottingham University, says: "I found it very difficult to get good advice. The careers advisory service and my school teachers were not particularly well-informed because not many students from my school applied to medical school."

Many admissions tutors agree that this lack of information for prospective applicants is undesirable and point to the popularity of television medical dramas such as ER and Peak Practice for giving applicants an idealised view.

In fact, this has become such a problem that in March of this year 200 students attended a sixth-form and further education college conference organised by Dr Haroon Mann, a surgical trainee in University College Hospital in London, to discuss the realities of a career in medicine.

Even the task of choosing a medical school can prove difficult. Applicants have a choice of 26 medical schools in the United Kingdom, but comparing what each has to offer can take a lot of effort.

"There is a lack of information and we have to write away for an awful lot of prospectuses to compare the different medical schools," says Daniel Chiu, also studying medicine at Nottingham University. "Even then, it's not easy to find information within the prospectus."

Professor Sheila Gardiner is a member of the medical school selection committee at Nottingham University. She is concerned not only about students applying to medical school for the wrong reasons, but also about their lack of research into what different medical schools have to offer.

She said: "Most students are poorly informed about the courses available so it is not surprising that they are very blinkered in their approach to selecting a medical school.

"Judging by students' responses at interview, schools seem to be aware of this and try to overcome it by coaching. Many students have read the prospectus and mastered a few words and expressions they have seen in them, but there seems little understanding of what the course entails."

What can be done to remedy this problem? To begin with, there needs to be a shift away from the assumption that medicine is a "natural" choice for bright students. This attitude has, to some extent, been reinforced by the demanding academic targets set by medical schools in their conditional offers. There remains a heated debate about how to select medical students, however. After all, what measures can one use to predict which applicants will make good doctors? More fundamental still, what is meant by "a good doctor"?

In a study of Australian interns carried out by the University of Newcastle, New South Wales, the supervisors were asked to rate each intern's performance as a doctor. By comparing each rating with the information available when they were accepted by the medical school, it was found that academic marks were not a good predictor of performance as a junior doctor. In fact, the best predictor was a background in the humanities and science rather than science alone.

Sixth-form students also need detailed and, above all, accurate information about careers in medicine and the alternatives available. Most medical schools organise open days when prospective applicants can meet current medical students. Many hospitals are also willing to take on sixth-formers and college students for a few days' work experience, giving them an opportunity to experience life behind the scenes and ask questions of practising doctors.

Once students have settled upon a career in medicine, they then face the bewildering choice of which medical schools to apply to. In 1993, the General Medical Council laid down explicit new guidelines for medical school curricula in its report Tomorrow's Doctors. Most medical schools now have implemented the report's recommendations and, as a result, have broadly similar courses.

Nonetheless, significant differences between medical schools do exist. Many have taken the opportunity while revising their curricula to incorporate individual elements into their courses.

Aberdeen University, for example, now offers students an eight-week period to study a non-medical topic such as business skills on a foreign language. Bristol University allows students to spend up to one year of the course studying in Europe.

Many schools and colleges ensure information to students is comprehensive and up-to-date. Jessica Martin says: "My school did quite well in making sure all the prospectuses were easily available. Nevertheless, you can't compare medical schools because the information is scattered.

"You tend to rely on word of mouth and you are probably influenced By seeing a university's name in the paper a lot," she adds. "You assume that if a university is well-known then it must be good." As the competition for places at medical schools intensifies, schools have a lot to do if they are going to support their students with the best advice possible.

Dr Andrew R. Houghton is a specialist registrar at a hospital in the United States, and is co-author (with Dr David Gray) of Getting into Medicine, due to be published by Hodder Stoughton Educational in the autumn

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