Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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Broadening access to undergraduate medical education
- Katie Emmitt (29 November 2000)
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Broadening Access to Undergraduate Medical Education
- Mary Ann Lumsden (1 December 2000)
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Ageism
- Sharon Hadley (2 March 2001)
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Katie Emmitt
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Editor - In their paper, Angel and Johnson describe the University of Sheffield Medical School's Compact and Early Outreach Schemes which aim to widen access to higher education by attracting undergraduates who are underrepresented in the medical profession 1. Financial difficulties among students from lower socioeconomic backgrounds have frequently been discussed in many arenas. With the exception of commenting that financial advice and planning is a component of the Early Outreach Scheme and that it is vital that financial circumstances that prevented students from displaying their full academic potential in school or college cease when they begin their medical studies, this major issue appears to have been largely ignored in the paper. On average, medical students are known to amass larger debts than other students. The cost of higher education has soared over the last few years. 'Freezing' of maintenance grants was followed by their replacement with loans and the introduction of a means tested student contribution towards tuition fees (for the first four years in the case of medical training). Access funds (usually a grant) and hardship loans are also available for students in financial difficulty. Colleges decide which students will receive these payments and how much each payment will be. The BMA have recently stated that eighty percent of medical students come from professional families. The number of medical students coming from under-privileged communities is decreasing and if the current trend continues, it could shrink to almost zero in three or four years time. Twenty percent have debts of more than £15000 at graduation 2. Since tuition fees have been phased in and maintenance grants phased out, the latter only being abolished in the 1999/2000 academic year, the full impact of these changes have not yet been seen. It seems unlikely that prospective students from low income families would view a career in medicine as a realistic option unless they receive some of the extra money which is being made available to institutions to recruit them. This appears to be acknowledged by the Higher Education Funding Council for England who suggest that policies designed to widen access need to incorporate the financial means to support some groups through their studies3. If extra funding is not provided, surely the above schemes can only be of limited effect. Katie Emmitt References: 1. Angel C and Johnson A. Broadening access to undergraduate medical education. BMJ 2000;321:1136-1138.(4 November) 2. Career focus briefing. BMJ 2000;321:S3-7262. (16 September) 3. Higher Education Funding Council for England. The particitation of non-traditional students in higher education. Bristol: HEFCE, 1997. (Report M9/97.) |
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Mary Ann Lumsden
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EDITOR - Sheffield is not alone in making plans for the development of schemes to widen access to Higher Education (HE)as discussed by Angel and Johnson 1. The City of Glasgow incorporates as much as 60% of the areas of greatest deprivation in the UK. The number of school leavers from the West of Scotland who enter higher education is about half the national average (28.3 vs 48% for higher education and 16 vs 29.5% for university admission) and in extreme cases, participation rates in HE are as low as 4% 2,3. In addition, whilst the proportion of young people in Scotland participating in HE rose to 48%, that from under-represented socio- economic groups was only 15%. The GOALS (Greater Opportunity of Access and Learning with Schools) project aims to widen access to HE in the West of Scotland. It provides a spectrum of opportunity for school pupils, from age 10 to 18, to learn about and become familiar with HE and is targeted at schools with low rates of progression. Through a range of mechanisms, spanning all school years from Primary 6, Higher Education Institutions in the West of Scotland make and maintain contact with school pupils to encourage them towards HE. The project includes a range of activities to motivate school pupils including school visits by student mentors, supported study, visits to university campuses and advice for pupils, parents and teachers. The Faculty of Medicine is also taking part in the "Saturday University" sessions aimed at giving the schoolchildren a "taster" of what Medicine might be like as a career, sessions facilitated by staff and undergraduate medical students. In 1999 0.43% (5) of the applications received by the Faculty of Medicine in Glasgow were from those living in areas covered by the GOALS scheme. Two were successful in obtaining places, the other three failed to reach the required academic standard. There is no positive discrimination in Glasgow although when the applicants attend for interview, the interviewers are aware that the applicant is from a school in a deprived area. The University is uneasy with the idea of positive discrimination because it could lead to the accusation of unfairness. Instead, we are keen to develop strategies to identify suitable doctors of the future at an early stage when they can undergo appropriate training that will enable them to reach the required standard by the time of application. This system is being used successfully in the U.S.A. since there has been a move away from positive discrimination as a result of successful legal challenge.4 We support Sheffield's aim in allowing flexibility but feel objective criteria are essential so that there is no opportunity for bias in a highly competitive Admissions Procedure that should be transparent. References 1. Angel C and Johnson A. Broardening Access to Undergraduate Medical Education. BMJ 321: 1136 - 1138, November 4th 2000. 2. Scottish Office, (1997) Leaver Destinations from Scottish Secondary Schools 1994 - 1996, Edinburgh: HM Inspector of Schools Audit Unit Report. 3. Scottish Office, 1998: Revising the Scottish Area Deprivation Index, Edinburgh: SOEID. 4. Carlin JD, Hunt DD, Patterson DG, Garcia C, 1999. Participation in enrichment programs and its effect on interview scores of applicants to the University of Washington School of Medicine. Academic Medicine 74: 360 -362. Dr M.A. Lumsden, Mrs Fiona Andrews, Ms Ruth Stewart Address for correspondence
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Sharon Hadley, VTS Course Organiser / Nurse Practitioner Southend on Sea Gp Surgery and Community and Hospital
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While I agree there are moves being made to improve access to medical education for people with the potential skills to become Doctors but lacking in the traditional backgrounds to be admitted. I feel we are missing a whole group of people who are these types of people that have grown up. Many have affiliated madical careers. Highly developed consultation and problem solving skills. They are a group of people who have proven staying power in the medical arena often with few rewards so are developing for a real passion for the subject area. Should they wish to pursue their development to a medical career, the entry gates are organised to still exclude them. I feel this is a shortsighted view. They may not have traditional Physics and Chemisty A levels and are thus excluded from traditional entry. Those with degrees are exposed to entry examinations that actively discriminate against people that do not have these basic qualifications. I appreciate that should they have the ability they can aquire these qualifications and compete anyway. Older entrants will only be a year older and no more able to undertake the course by this course of action. They have learnt many of the principals required but only as relevant to medicine. This means they actually have not wasted their time learning things that do not facillitate further learning. They are also capable as adult learners to learn basic things in tandem with other areas of learning. We should take stock of this group that has so much potential and skill to offer as they could be trained in a shorter period of time and come out at a far higher level of initial competance than traditional medical students. They may have fewer qualified years to offer but all of them are likely to be productive for all of them, making their training very cost effective. We need Doctors, we need them yesterday - 30% of our local GP's retire within the next 5 years. We cannot afford to keep snubbing people with the required skills as they do not fit our current mould of entry. |
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