Choosing tomorrow's doctorsBMJ 1996; 313 doi: https://doi.org/10.1136/bmj.313.7065.1149a (Published 02 November 1996) Cite this as: BMJ 1996;313:1149
Students' knowledge of the realities of the profession is important
- Caron Grainger,
- Eleanor Harries
- Consultant in public health medicine Research fellow Institute of Public and Environmental Health, University of Birmingham, Birmingham B15 2TT
EDITOR,—Sandra Goldbeck-Wood questions the adequacy of academic achievement alone as a selection criterion for entrants to medical school, focusing on the need to produce doctors who are good for patients.1 We believe that there is another issue for debate—namely, choosing doctors who can survive the system in order to be good for patients. We therefore offer a complementary approach to use alongside academic criteria.
Our work is based on a postal survey conducted in 1994 to determine morale among preregistration house officers who had been trained in Britain and were working in four health authority regions in England. The response rate was 59% (433/735). Two hundred and forty one of the respondents reported some degree of regret about studying medicine, the main reasons being interference with the rest of their life, long hours, and poor pay. High degrees of regret have implications for a person's wellbeing and morale, which, if that person is a doctor, may lead to detrimental effects on patients' care. Indeed, those respondents who reported regret were significantly more likely to suffer important psychological disturbances than those who did not report regret.
Questions to ask prospective medical students
How old were you when you decided to become a doctor?
Have you ever considered studying for a career other than medicine?
What is the average number of hours that a preregistration house officer works?
How long will it take to get to consultant level?
How strong is your desire to study medicine?
What would your do if your grades at A level did not match the requirements for entry to medical school?
Several factors, which could be ascertained at selection, were associated with less regret later. These included knowledge of the length of the working hours of preregistration house officers, knowledge of the length of postgraduate training, and always having wanted to study medicine and no other career. Additionally, the strength of the desire to study medicine was significantly associated with regret, with those expressing a strong desire to study medicine experiencing less regret. Those who had decided on a career in medicine by the age of 15 had a significantly stronger desire to study medicine.
The association between knowledge of the realities of the medical profession before entry to medical school and the degree of regret at choosing a medical career suggests that students who can assimilate information and relate long term consequences to current decision making are better prepared for a medical career. The selection of undergraduates might therefore be improved by asking questions such as those in the box, although a prospective study would be required to confirm this. While people who are proactive in seeking information are to be welcomed in the profession, using this as the sole criterion for selection for medical school may result in people with a caring or empathic nature being rejected; this criterion should therefore be used as only part of the selection process.