Debate rages on the details announced last week on increasing the number of Irish and EU medical graduates. Áine Kerr examines what it will mean for universities and the future of medicine
Increased medical places and the establishment of a graduate medicine programme will herald significant changes for universities in terms of their funding, teaching methods and student selection processes.
With aptitude testing now proposed for both graduates and undergraduates, and interviewing potential medicine students still a possibility, the profile of students entering medical schools may now change.
The overhaul of medical education and training announced by Minister for Health Mary Harney and Minister for Education Mary Hanafin last week steers medical school authorities into a period in which they must wait for further instruction from an implementation committee.
The focus of third-level heads has now turned to the proposed future funding of medical schools; which until now have been heavily reliant on the fees of non-EU students to subsidise their costs.
At UCD, for example, non-EU students pay about €23,500 a year in fees. With the number of places for Irish and EU students now increased, medical schools will be seeking compensation for the loss of fees from potential non-EU students.
Fears that the new graduate entry structure could result in the introduction of exorbitant fees and consequently mitigate against the participation of many students have been echoed by both the Union of Students (USI) and Dr Mick Molloy, chairman of the Irish Medical Organisation (IMO).
"There have been rumours as to how significant these fees could be. What concerns us is that such high fees could restrict the number of people coming forward who have always had an inclination to do medicine," says Molloy.
Should fees restrict certain students from accessing the graduate entry-level system, the programme could become the preserve of the elite.
"It could also pigeon-hole medicine graduates into certain careers, where they can earn more money and pay their fees debt."
Molloy reasoned that if, for example, a graduate was required to pay €20,000 per year for four years, and tops this up with rent and living costs, they would incur a debt of €100,000-€120,000 when leaving medical school.
In UCD, where the first of the graduate programmes will start this September as a form of pilot project, 15 graduates will pay €15,000-€25,000 in fees per annum according to the dean of the faculty, Prof Bill Powderly.
Of equal concern among medical school authorities is any proposed introduction of an interview into the student selection process. This possibility is one which currently divides medical schools because of the potential bias involved and concern that there would be an impractical number of candidates to interview.
Last year, just 4 per cent of the 12,000 students who applied for medicine, dentistry, pharmacy and veterinary secured places. Points for medicine reached an incredible 590 in Trinity College, which was the equivalent of almost six A1s in the Leaving Cert, a level achieved by just 145 Leaving Cert students this year.
Many education observers have since argued that some students choosing medicine do so because of the high points associated with it, and not because they perceive it as their vocation in life. Hence, many have questioned if the medical system is producing the correct calibre of doctors.
However, Dr Eamonn Shanahan, chairman of the Council of the Irish College of General Practitioners, defended students of medicine as sincere and committed future carers. He conceded, however, that an aptitude test would address some concerns.
"Whatever is introduced needs to be transparent and fair. As it is, the Leaving Certificate is transparently clear and everyone knows exactly where they stand with it," says Shanahan.
But as debate rages on the merits of using an interview to assess candidates, international practice shows that most medical schools are now employing both an aptitude test and an interview, according to Prof Paul Finucane, director of the medical school development at University of Limerick (UL).
"Internationally, it is common to use interviews to assess the personal attributes of an applicant. I know from talking to people in Ireland though that they are greatly concerned that because our country is so small there would be an element of bias, nepotism and unfairness," says Finucane.
Under UL's proposed graduate programme, which could start receiving upwards of 120 graduates as early as September 2007, students of the proposed four-year medical course will be primarily from Ireland and the EU. Only 10 per cent of places will be reserved for non-EU students.
If the model of financing medical schools is changed, and medical schools no longer have to rely on non-EU student fees to subsidise, UL proposes having the same fees for both EU and non-EU students. What figure this will be has not been disclosed.
Finucane expects that based on international comparisons, half the students applying to the graduate courses when the programme starts will have a science background and will be in their 30s.
The remaining cohort will come from non-science backgrounds and may have just completed their first degree.
Leaving Certificate points will not be taken into consideration when people apply for the graduate course in UL. Therefore, the pressure of producing evidence of 570 points has been eradicated. Instead, prospective candidates for the course will be required to display a 2.1 grade or better in their first degree.
After receipt of application, applicants will be required to sit "some form of paper test" which is internationally recognised and will gauge both their knowledge of the sciences and their ability to problem solve.
Likewise, University College Cork has prepared its curriculum for the proposed graduate entry-level programme and submitted it for consideration with the Irish Medical Council.
However, Prof Michael Murphy, dean of the Faculty of Medicine, is strongly opposed to the introduction of an interview.
If the process goes as expected, he estimates that in September 2007, the university will enrol 200 medicine students, 50 of whom will be graduates. Of these 50 graduates, 30 will be Irish/EU and 20 will be non-EU students.
However, before these figures can be realised, Murphy says that the Government would have to give significant consideration to the fact that operating a graduate programme is much more resource intensive than that of an under-graduate programme.
Having witnessed graduate programmes in practice in the University of Chicago, Murphy says that providing teaching instruction for 49 weeks of the year will have implications for staffing arrangements.
Longer teaching hours, shorter holidays and the need to condense a five-year undergraduate programme into a four-year graduate programme will have to be addressed by the implementation committee to be set up by the Higher Education Authority.
Before the announcement last week, both the Royal College of Surgeons and UCD had stated that they were developing a graduate programme.
The aptitude test for both RCSI and UCD is likely to be based on the Australian model - the Graduate Australian Medical Schools Admission Test.
Assessing what extra accommodation, lecturers and resources are required to realise the ambitious new medicine education programme is now critically important, according to Finbarr Fitzpatrick, secretary general of the Irish Hospital Consultants Association.
Exchequer funding for medical students (currently in the region of €6,500 per student per annum) is perceived as insufficient and needs to be increased. But Fitzpatrick cautions that despite the proposed increases in medicine places which are to be welcomed, it will take 10 years for that to change on the ground for GPs and 17-20 years for consultants.
Unfortunately, for future Leaving Certificate students, the increased numberof medicine places is unlikely to lead to significantly lower CAO points, levels for medicine. In the event that points decrease, it would be by a mere five or 10 points.
Ultimately, while the race for medicine points continues until at least 2008, the debate as to what fees should be charged, how third-level colleges will be funded and whether an interview should be used to source suitable doctors, will rage on.