Letters

Hepatitis B and medical student admission

Richards and Harries are at pains to underline the concept of responsibility. The point here is that the Committee of Vice-Chancellors and Principals has a massive responsibility. It has a responsibility to the medical student who is now halfway through his or her course, having been accepted and been held in limbo for the two years which the committee has taken to debate the matter. This student's future has now been significantly affected by the guidelines, and whereas a modified clinical course was in prospect, he or she is now being pressured to leave or change course.

The responsibility of the committee pertains particularly to medical schools, some of which are continuing their policy of screening after admission. The fear is that, in view of the justifiably high regard in which the committee is held, some schools will, against their own better judgment, exclude or dismiss outstanding students on the sole grounds that to admit them would be to go against one of the committee's pronouncements.

Admission to medical schools should be on the basis of merit and suitability to become a doctor, not on grounds of infinitesimal risk factors which are preventable. The concept of accepting an applicant who is less suited for medicine on grounds of intellect, attitude, and personality rather than someone who is more suited but is positive for hepatitis B antigen - possibly temporarily - is not in the best interests of the profession or the public, whereas constructive use of able individuals and creation of an appropriate training programme for them is. I believe the debate should continue and the Committee of Vice- Chancellors and Principals should re-evaluate its position in the light of responsible opinion, such as that provided by the BMA medical students committee.

A M L Lever

Department of Medicine, University of Cambridge School of Medicine, Addenbrooke's Hospital, Cambridge CB2 2QQ

1. Lever AML. Hepatitis B and medical student admission. BMJ 1994;308:870-1. (2 April.) [Free Full Text]
2. Richards P, Harries F. Hepatitis B and admission to medical school. BMJ 1994;308:1161. (30 April.) [Free Full Text]
3. Gauntlett R, Bailey M. Hepatitis B and admission to medical school. BMJ 1994;308:1161. (30 April.)
4. Elder AG. Hepatitis B and admission to medical school. BMJ 1994;308:1161. (30 April.)

Guidelines apply to dental students too

EDITOR, - A M Lever highlights the problems of implementation of the recently issues guidelines for universities regarding medical students.¹ These guidelines also apply to dental student admission. The aim of courses for dental students is to produce a graduate with academic and clinical knowledge and skills, ready for independent practice as a dental physician and surgeon. Therefore as part of these courses all students are required to carry out a wide range of treatment procedures. By the Department of Health's guidelines virtually all dental procedures are "exposure prone" in that the operation takes place within a body cavity. On qualification virtually all graduates will continue to perform clinical work as there are few jobs in dentistry which do not include clinical work.

It is appropriate to screen dental students and start hepatitis B vaccination during the first term of training as they are unlikely to perform exposure prone procedures then. Dental schools can avoid pre-admission screening. Lever suggested that one in 5000 medical school applicants could be infectious, which would suggest that one carrier of e antigen might be accepted to dental studentship every six years - surely a surmountable problem. The cost of the vaccination programme to dental schools or students is considerable - vaccination by the student's own general practitioner necessitates travel and time costs. This is accepted as necessary to protect the patients and the dentist.

We considered the problem of the HIV positive dental student at a European Community Working Party² since employment opportunities in dentistry would be very limited for such students. On admission to dental school, students should be informed of the occupational risk and consequences for employment of becoming HIV positive.³ positive. There is one reported case of a dental undergraduate who was found to be HIV positive.³ Testing should remain on a voluntary basis but once a student is identified as positive a sympathetic approach by the dental school, university, and General Dental Council should allow a clinical student to complete the course and be examined while avoiding exposure prone procedures. The graduate could then seek research or administrative work or obtain graduate entry to a non-dental course.

A recent report indicated that "over 70% of hospital ward doctors had been accidentally jabbed by `sharps' during a two year period."⁴ The emphasis in dentistry has, for some years, been to prevent injury and possible contraction of HIV. Risk assessment⁵ has led to modification of techniques and so reduced the danger to the operator and assistant. Anecdotal evidence points to a reduction in injuries, but only time will tell how effective these changes in techniques have been in preventing dentists from contracting HIV infection.

P L Erridge 

Special Needs Unit, Guy's Dental Hospital, London SE1 9RT.

1. Lever AML. Hepatitis B and medical student admission. BMJ 1994;308:870-1. (2 April.)
2. Smith CJ. HIV infection and AIDS: educational and ethical aspects in relation to dentistry. Br Dent J 1993;175:75-7. [Medline]
3. Comer RW, Myers DR, Steadman CD. Management considerations for an HIV dental student. J Dent Educ 1991;55:187-91. [Abstract]
4. Zinn C. Australian doctors fight over HIV testing. BMJ 1994;308:1058. (23 April.) [Free Full Text]
5. Health and Safety Commission. Management of Health and Safety at Work Regulations 1992. London: HMSO, 1992.

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Related Article

Hepatitis B and medical student admission

A M L Lever
BMJ 1994 308: 870-871. [Extract] [Full Text]