With higher points needed to study medicine, reforms of the system will be welcomed, writes Eithne Donnellan, Health Correspondent
Dean Huggard wishes he had been born two years earlier or two years later. Had the 17-year-old school-leaver been born two years earlier he would have had enough points to study medicine. Had he been born two years later he would be able to avail of a new system for entry to medical school that should be up and running soon.
Huggard, who lives in Sandyford, Co Dublin, always wanted to be a doctor. He was optimistic about his chances of getting a place at medical school when he clocked up 555 points in his Leaving Certificate this month. That was the number of points required last year to study medicine at University College Dublin, NUI Galway and the Royal College of Surgeons in Ireland.
This year, however, the points jumped by 15 in some colleges, bringing the minimum requirement for entry to 570 in four of the State's five medical schools and leaving more than 1,500 school-leavers who had it as their first college choice bitterly disappointed.
And not all students with 570 points - the equivalent of three A1s and three A2s - got places at Trinity College, UCD, NUI Galway or the Royal College of Surgeons in this year's first-round CAO offers. The minimum requirement at University College Cork in this year's first round was 565 points.
As the rise in points to study medicine provoked debate on the appropriateness of having straight As as the sole selection criterion to be a doctor, Noel Dempsey, the Minister for Education and Science, stepped in and announced plans to reform the system under which doctors are trained. From 2005 all Leaving Cert students wishing to study medicine will do an undergraduate degree first, then apply to study postgraduate medicine for four years.
The Minister immediately appointed a task force to devise ways to implement the changes, the finer details of which still have to be worked out. A syllabus will have to be devised and postgraduate selection criteria agreed.
Prof Michael Murphy, dean of medicine and health at UCC, says he and his colleagues have long been concerned about the appropriateness of the current selection criteria for entry to medical school and the "rather unsatisfactory" organisation and resourcing of medical education.
"Many of us would have shared the view that academic performance is not necessarily a good predictor of the attitudes and skills needed by a good doctor," he says. "I'd also have concerns that it's not necessarily in the interests of the Irish economy that the vast majority of its brightest people go into the health sector. While health is an important predictor of economic success, we must bear in mind that wealth creation through innovation in business is at least as important in achieving economic and social success."
Although Dempsey has said the changes will mean students can follow an undergraduate programme of their choice - even in the arts or humanities - before going on to study medicine under the new system, this is an issue the task force will look at, according to Prof Murphy, a member of the group.
It will also look at the resourcing of medical education. Prof Murphy describes the current infrastructure as totally unsatisfactory. "We have been operating on a wing and a prayer for several decades. The only reason we have brought in non-EU students is because we would have to shut our doors without their fees. They heavily subsidise Irish students.
"We also have to examine in some detail why people choose medicine so avidly at the age of 17 and 18 . . . . A major driver is financial success."
Overall he favours the proposed postgraduate entry system, believing students will by then have made more mature judgments about their careers.
A similar entry system is proposed for physiotherapy, occupational therapy, speech and language therapy, dentistry, veterinary medicine, pharmacy and radiography, but any developments will be piloted in medicine.
The Irish Patients Association welcomes the proposed changes. Its chairman, Stephen McMahon, says he believes it will lead to "more rounded doctors".
A postgraduate entry system is commonplace for medicine in the US and operates in a number of Australian universities. Harvard Medical School selects students on the basis of high honours in their undergraduate courses, and it does not prefer them to have majored in the sciences. It considers, for example, extra-curricular activities, research and community work. The college looks for integrity, maturity, leadership potential and an appetite for working with people. As a result, 21 per cent of its intake in 2001 was from "under-represented social groups".
Linda Shields, professor of nursing at the University of Limerick, has experience of the Australian postgraduate entry system. She says that when students begin to study medicine at a later stage they come out better able to empathise with patients, as better communicators and in general as better doctors. "I think this is a very good idea," she says. "One of the big problems with direct entry from school is that students may be going in just because they get high marks."
Dr Jerry Cowley, the Mayo GP and independent TD, points out that points requirements have soared not because of the popularity of television dramas such as ER but because medical faculties take in so few Irish school-leavers.
"The real issue is the fact that there are so few places in medicine. I'm a rural doctor, and it's a major problem trying to get locums. We only train 305 EU doctors every year here, and the figure had remained unchanged for many years even though the population has increased. This needs to be addressed."
He points out that up to half the places in Irish medical schools go to non-EU students, who pay about €25,000 a year towards tuition, subsidising the education of Irish medical students. "The Government is just not prepared to fund Irish students."
It is inequitable, he says, that a student with 555 points could not get into medical school here when a student with a lesser academic record from outside the EU can get a place in return for the substantial fees. The Institute of Guidance Counsellors has already called on medical schools to cut the number of non-EU students on their rolls.
If medicine becomes a solely postgraduate discipline, then the State must continue to pay students' fees, according to Dr Cowley. The Government effectively pays the fees of all Irish undergraduates, but it meets those for postgraduates only after means-testing.
Another doctor says he feels it is extremely important that the undergraduate degrees from which medical students are selected are not confined to the sciences."The vast majority of doctors will become GPs and non-specialists. And so a humanities degree is as important a preparation for medicine as a technology-based education. When patients are ill it's often the doctor's ability to communicate well and sympathetically which matters most," he says.
Karl Hilton, a pharmacist in Bray, Co Wicklow, believes that the same system for pharmacy would only delay entry to the profession. He concedes that change is needed, to reduce pressure on students, but feels the Minister is going about it the wrong way. "The CAO system should just be reformed to have a mix of points and interview to assess suitability for a course."
Dean Huggard, who now has the option of accepting his fifth choice of radiography, repeating his Leaving Cert or taking a year out and applying for medicine in the UK, supports the new system even if it comes too late for him.
"I think it's a good idea," he says. "It will also be a good incentive to get more people to study science who may then opt to go into other areas they hadn't thought of before."