Graduate Entry Medicine

Rebecca Gray

Studying medicine in the UK

• All students – undergraduate medicine eg MBBS

• 32 Universities: traditional course (5/6 years)

• 16 Universities: graduate entry (4 years)

• GMC (core content) and EU (hrs training)

Academic requirements

• Traditional course: A Levels - ABB. Chemistry, ?Biology + another science

• GEM: Hons: 2:1, ?2:2. Subject stipulations vary

• Aptitude Tests: UKCAT, BMAT, GAMSAT

• Applications: UCAS. 4 Schools

Background GEM

• North America and Ireland: Graduate entry only

• Australia: Since '97 increasing graduate entry only

• Strongest arguments: Increase flexibility re career choice. Increase diversity

• UK: 1st GEP set up in 2000 – meet need for more doctors through widening access

Case Study – St George’s

• Entry requirements: Hons 2:2 or 3rd + Masters. Any degree subject + A-levels “. . . that will influence the end product of the medical school through the broadening of the intake” Peter McCrorie (GEP Course Director)

• No science? GAMSAT exam. Minimum score required

• Work experience, home student, CRB checks

• Multi-Mini Interviews (new): 2.5 candidates per place

Course structure

• Since 2008, revised curriculum to align with five year course

• Four themes and six modules. Problem Based Learning - weekly scenarios (systems)

• 18 months pre-clinical, but exposure from outset

• Regular assessments: written and clinical (OSCEs)

Advantages of GEM

• Broad range of applicants and ages (<45) – motivation, promotes communication skills

• Shorter course length

• NHS Bursary from year 2 onwards

• Greater emphasis self-directed learning: suits older students

Disadvantages of GEM

• Broad range of applicants – non-scientists can feel under-prepared ?emphasis BCS

• Previous careers, older age

• Intensity of course – highly demanding, other responsibilities

• Divisive two tier system? But same final exams

Prognosis

• Graduate courses growing in popularity, but are they making good doctors?

• In US no real comparison to be made

• In UK, Australia, Ireland courses still relatively new

• What form of measurement?

Research to date

• Qualitative: innovation in teaching style (PBL), influences on student experience GEM

• Quantitative: exam performance data – difference between science and non-science graduates, between graduates and school leavers

• Mixed picture in terms of results - ?conclusions

To be a graduate or not?

• “Highly motivated and committed, much more self-directed, challenging, demanding, questioning, and mature than non-graduate medical students . . . mature students are sooner and better able to handle the responsibilities of being a doctor . . . patients would be better served by doctors entering medical school after the age of 22.” Peter McCrorie (St George’s GEP Course Director)

To be a graduate or not?

• “It would be discriminatory to school leavers and to mature non-graduates to limit medical training to people who already have a degree in the absence of any convincing evidence of benefit. It would also cost more to the taxpayer.” Charles George (former Clinical Academic, University of Southampton)

The future

• More research is needed

• Follow up 1st graduate entry cohort from St George’s who left medical school 2004?

References

1. Medical Schools Councilhttp://www.medschools.ac.uk/Students/Courses/Pages/Graduate.aspx2. British Medical Association http://www.bma.org.uk/images/becomingadoctor2011_tcm41-198047.pdf3. NHS Careers http://www.nhscareers.nhs.uk/details/Default.aspx?Id=5564. St George’s Hospital Medical School, UOL http://www.sgul.ac.uk/undergraduate/MBBS%20Graduate

%20Stream5. Hutchinson L, McCrorie P, Hughes P. Graduate entry programmes in medicine. Student BMJ. 2002;

10:45-886. Rushforth B. Life in the fast lane: graduate entry to medicine. Student BMJ. 2004; 12:368-707. Gapper S. Older & Wiser? Student BMJ. 2006. 14 (118-120)8. Hayes K et al. Anxiety in Medical Students: is preparation for full time clinical attachments more

dependent on differences in maturity or on educational programmes for undergraduate and graduate entry students? Med Educ. 2004; 38:1154-63

9. Rapport F et al. What influences student experience of graduate entry medicine? Qualitative findings from Swansea School of Medicine. Med Teacher. 2009; 31:e580-e585

10. Calvert MJ, Ross NM et al. Examination performance of graduate entry medical students compared with mainstream students. J R Soc Med. 2009. 102(10): 425-430

11. McCrorie P. Graduate students are more challenging. BMJ. 2002; 325:67612. George C. Should all medical students be graduates first? NO. BMJ. 2007; 335:1073

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