Moving the entry posts

Postgraduate medical degrees were a good idea, but they are failing to fulfil their purpose, writes Alex Thomas

Seven years ago, St George's hospital medical school in London (SGHMS) introduced a new method for admitting students to the medical profession.

Following the model of education in the US and Australia, SGHMS designed a new graduate entry programme (GEP) medical degree that could be taken only by graduates and could be completed in just four years instead of the usual five or six. Since then a further 13 universities have followed suit, introducing four-year medical degrees of varying design and quality.

It was recognised that many qualities were required to make a good doctor and the traditional access point of four A grades at A-level and a scorching medical school interview was precluding many intelligent, compassionate and committed people from following this career path.

The introduction of the GEP aimed to widen access to the medical profession to include people who had not necessarily achieved the highest marks in science at school or who had perhaps not enjoyed all the traditional advantages of life that would have enabled them to commit at 18 to the longer, more intensive and more expensive period of study that medicine demands.

This move was supported by generous funding arrangements - the individual would pay fees in the first year and would be eligible to apply for an index-linked student loan. Thereafter, fees and maintenance costs would be paid for by the Department of Health and NHS bursaries.

This was in direct contrast to those taking the five-year medical degree who were entirely self-funding for four of the five years.

However in 2006, seven years on from the original vision, the reality of educated, committed individuals with a wealth of life experience and education moving into the medical profession may be drawing to a close.

Applicant numbers have soared to the point where there may be between 20 and 60 applicants for each place. As a result, admissions tutors are resorting to traditional means of selection, with heavy emphasis on degree subject and high grades, to determine which applicants will get the coveted interviews and places.

Of 14 GEP courses in the UK, seven demand a science degree, 12 demand a 2:1 or higher - with a clear preference for a first - and six place emphasis on excellent A-level results as well.

Furthermore, rumblings from the graduate medical community hint that the public face of these requirements is not all it seems. At least one major redbrick university is only seriously entertaining applications from those already in possession of a first-class degree in a strong and relevant scientific subject; a fact not publicised on its website.

Far from widening access these additional requirements represent a move towards previously unprecedented levels of elitism, with medical schools bestowing medical student status on exactly the same type of applicants as before, except that instead of being 18, they are three or four years older.

There are also concerns within the medical academic profession that some degree subjects such as biomedical science and other life science degrees are becoming simply playpens for the graduate medics of the future.

Another worry is that within a year or two, graduate medical degrees will only be accessible to those with first-class degrees and AAA at A-level, which is of course the kind of academic elitism that the GEP programmes were set up to counter.

Ironically, many graduate applicants find these academic hurdles insurmountable, so they apply alongside school leavers for a place on the five-year courses, where entrance requirements are more lenient.

However, with the government planning to make graduates pay their £3,000 top-up fees in advance without the safety net of an index-linked student loan, even this path to a medical career may become beyond all but the most privileged.

Entrance exams have been lauded as the fairest way of levelling the playing field. The pioneering one used in this country is the Graduate Australian Medical Admissions Test (Gamsat) currently used by SGHMS, Nottingham, and Swansea.

These universities have the most egalitarian entry requirements in the country with the minimum academic requirements set at a 2:2 degree in any subject from a British university.

However, Gamsat is an expensive business; the exam fee for this year was £176 and past papers are £17 each. In terms of preparation for the exam, Gamsat requires at least first year degree level biology and chemistry.

So despite the intention that the GEP degree can be accessed with any degree-level background, clearly those without a science degree are at a distinct disadvantage. This is a shortfall that many overcome with the help of Gradmed - an intensive preparation course that costs upwards of £3,000.

Though no university endorses any preparatory course, a first-year student on the GEP programme at SGHMS revealed that a sizeable proportion of those who were successful did take this route. The advantages to the already wealthy and well-educated are clear.

There is no question that doctors, however educated, must be equipped to face rigorous intellectual challenges. But the ever-decreasing academic parameters of entry to the GEP programmes, combined with the enormously increased financial burdens, means that the medical profession is set to face an eroded representation of those with a breadth of life experience and educational background arguably needed to sustain medicine as compassionate, intelligent, human and reflective of the population it treats and serves