Dr Martin Newell's submission to the Points Commission on medical education caused at bit of a stir at last week's launch. Newell, the secretary of the CAO, suggests there should be no direct entry by school-leavers into the professional healthcare courses, and the commission has taken this on board. Instead, anyone hoping to train as a doctor, vet, dentist, pharmacist, physiotherapist or radiographer would first spend at least two years on a life-sciences course in either a university or an IT, Newell suggests. His submission has won the support of the HEA, which sees "significant benefits for second-level education and for students if some or all of the courses which drive the competitiveness of the points system were not open to entry by school-leavers".
Views in the medical profession, however, are divided. "It's totally contrary to the current thinking on curriculum development," says Professor David Jenkins, dean of UCC's medical school. "In medical schools, students do a two-year life sciences course, followed by the clinical years. "If you did a two-year course outside medicine and then came into a four-year clinical programme, you would be at a disadvantage, because you'd have lost out on the vertical integration of life and clinical science," Jenkins explains. "The whole point of recent innovation in medical education is integration." Newell's proposal "would put us back", the professor says.
Many medics believe that the proposal would simply move the entry bottleneck from Leaving Cert to a stage two years down the road. Newell argues, however, that after a couple of years in health science, students would be more mature and in a better position to make informed choices about their careers. Dr Tom O'Dowd, TCD's professor of general practice, is also concerned about the postponing of the bottleneck. But he says: "I'd prefer to see people coming into medicine with a more diverse science background. If they went into a specific life-sciences programme, they would be more likely to continue to be focused on medicine and would lack a broader experience. "I do feel that people who come in to medicine at 17 or 18 are too young.
We do need to introduce an element of choice so that students are not coming in from school with their parents' vocations." Professor Gerard Bury, president of the Medical Council (the statutory organisation set up to oversee the medical profession in the Republic) welcomes debate on medical education. He favours the introduction of some postgraduate entry. "Personally," he says, "I think that diversity is healthy. I would not seek to be prescriptive about how medical schools should achieve their ends."
However, he adds, "it would not be advantageous to switch from one uniform model of entry to another".
Postgraduate medical education is the norm in the US. According to the RCSI's registrar, Professor Kevin O'Malley, competition for entry to US medical school is equally fierce. "I'm not sure how attractive a two-year certificate would be (as a means of entry to medical school)," he says. "I would prefer a science degree, which would give students more flexibility." At the launch of the Points Commission's report, the Minister for Education and Science, Micheal Martin, indicated that he would immediately begin a consultation process on healthcare education. If it emerges that more medical-school places are necessary, he will approve them. A recent survey of pharmacy has highlighted a need for a substantial annual increase in the number of pharmacy graduates. At the launch, Department officials were casting doubts on the need for more places.
"The Department of Health isn't telling us about any shortages," one source commented. Medics, however, take a different view. They say there is need for more doctors, for a number of reasons. The Medical Council is anxious to reorganise the intern (preregistration) year to include a greater educational content. At present, only 375 intern posts are available in the Republic. The new structure will require an increase in the number of posts to 500.
The EU's stipulation that the hours worked by hospital doctors be significantly reduced in the next three or four years will mean that more doctors are required. And other EU regulations which will require all overseas doctors to take clinical and language tests before they are allowed to practice here will increase the demand for home-grown doctors, O'Malley notes.
