A second-chance career

Sue Leonard reports on the St Andrews Pathway to Medicine scheme that is pumping fresh blood into the NHS in Scotland

WAITRESSES USUALLY dream of becoming actresses, but Cassandra Smith always wanted to be a doctor. Ten years after leaving school, the 28-year-old mother of two and former hotel waitress is back at college to realise her dream.

Cassandra is one of four students on a pioneering new programme which aims to open up careers in medicine to mature students who have not been to university.

The Pathway to Medicine scheme enables students who complete an HNC in applied sciences at Perth College to go to St Andrews University and begin a medical degree, all fees paid.

While enjoying every minute of her course now, Cassandra confesses that academic achievement was not one of her priorities when she was at school.

"I got three Highers but did not really work hard enough at school to do anything with them," she says. "I got a B in biology and Cs in music and English. They were not great marks, nowhere near enough to get into medicine. I definitely thought I could not become a doctor. I had other things on my mind at that point, like earning money and having a good time," she says.

Then there was motherhood. Cassandra had her daughter, Ellen, when she was 20 and her son, Brynley, four years later. "Once you start a family, the last thing you think about is going to university. I do not have any regrets, though. I think I am going into it as a 28-year-old with a far better attitude. I am willing and prepared to work."

Competition to study medicine is fierce. This year 1,100 applicants fought for just 140 places at St Andrews. To get in, students normally require three As and two Bs at Higher level. Many get five As.

The scheme, which started in September, was a direct response to the Calman Report 2005, which called for new initiatives to address the shortage of doctors working in the NHS in Scotland. It found that only 55 per cent of students graduating from Scottish medical schools stay north of the border after completing their studies.

The Perth-St Andrews initiative is based on the belief that most would-be doctors from non-traditional backgrounds in Scotland will ultimately choose careers in the Scottish NHS.

Starting this year, St Andrews will set aside up to five places on its six-year medical programme for Pathway to Medicine students.

The scheme is open to people over 21 with no tradition of university in their family and who have a least one Higher in a science subject at grade A-C or equivalent.

The intensive year-long course includes chemistry, microbiology, cell biology, human physiology, maths and a science project. Students have to pass 15 exams, including six in which they have to score a mark of at least 70 per cent. They can then do a three-year BSc Hons at St Andrews, followed by three years' clinical training at medical school.

Perth College received more than 40 applications from would-be doctors for its first course, but only 12 satisfied the criteria and just four were selected.

Cassandra's fellow students are also in their twenties and come from England, Fife and Ayrshire. One was a secretary and another an events organiser.

"I think it is a fantastic opportunity," says Robert Boyd, programme leader for science and environment at Perth College. "This should tap into a pool of talent."

Andrew Riches, deputy head of Bute Medical School at St Andrews and professor of experimental medicine, believes the mature students will bring a range of skills and experience from good communication to a gentle beside manner - something that may be lacking in trainees coming straight from school. He says the students now learn these skills from the first year of their degree.

"The important thing is to try to get people from different backgrounds and perspectives on life," says Professor Riches.

"Certainly, people entering the course have to be well motivated because they have to be prepared to cope with the rigours of medicine, and if they are not up to a certain level they will simply not be able to cope with the course."

Under the spotlight

It costs around pound;250,000 to put a student through medical school.

There are 4,652 medical students in Scotland.

63 per cent of applicants to medical school are students.

On average medical students accumulate pound;21,755 in debt by their final year at university.

On average there are 1,000 applicants for 140 places at St Andrews University each year.

Medical courses have higher than average costs, such as expensive reference books, appropriate clothing for ward rounds and stethoscopes.

GPs earn about pound;90,000; consultants pound;70,822-pound;95,831

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