Three Bs, please
BMJ 2006; 333 doi: https://doi.org/10.1136/bmj.333.7565.453-a (Published 24 August 2006) Cite this as: BMJ 2006;333:453All rapid responses
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Difficult to get an A these days by merely being gifted.
High school students who do well have usually worked hard and its a little unfair to denigrate their efforts as a gift. Why not, after all, select those who can work hard?
Alternatively, a colleague suggested a lottery on the grounds that he would rather have a lucky doctor than an unlucky one.
Competing interests:
None declared
Competing interests: No competing interests
Dear all,
I don't think when potential doctors, nurses, physios are being selected
etc you can rely solely on grades or personlity traits - surely we need a
mix of both? whilst someone with the gift of the gab - but a weaker
academic performance - may make a great FY1 etc due to excellent
communication skills what happens when they progress past that? or someone
with 4+As at Alevel who can learn and repeat on demand all the causes of
this, that, and the other but has no personal skills and can't take a
history or reassure a worried patient?
Dr Spence raises some interesting points but I can't agree that grades
should be lowered based on your post primary school! I went to a non
private grammar school - I have better grades than some friends who went
to private schools but worse grades than some who went to comprehensive
state schools - school status doesn't always correlate with what you'll
get at Alevel! we should have the same targets to aim for - if you want to
work towards them you will! I wouldn't regard myself as being 'gifted' -
I simply worked and studied hard!! a trait that seems to be helping in
medical school!!!(but I may have the gift of the gab having kissed the
Blarney stone in my teens and who knows this may have helped?)
bronagh patterson (AAAB at at A level)
p.s David the A level grade I was proudest of was my B in chemistry
because I'd struggled with it - people who will make good doctors will not
always find the traditional school environment the best to learn in
Competing interests:
Im proud of my B!!
Competing interests: No competing interests
The topic Dr. Spence has brought out is a perennial problem in
medical education. Selection of “suitable” students to study medicine can
be a daunting task for any medical school and can be challenged, as many
researchers are trying to find best evidence to design good models for
student selections. However, the more they research more difficult it
gets as evident from recently published data. Goho J & Blackman A. The
effectiveness of academic admission interviews: an exploratory meta-
analysis. Medical Teacher, Vol. 28, No. 4, 2006, pp 335-340. I feel
selecting a mixed cohort of students with high academic qualifications and
acceptable attitudes and others with acceptable academic qualifications
with excellent attitudes may be the right way. The percentages of these
two groups should be determined by the medical school, based on their
expected graduate outcomes or the mission statement.
Competing interests:
None declared
Competing interests: No competing interests
Re; 'Three B's, please';
Choosing medical students is more difficult than it might seem at
first glance (Soundings, Des Spence, 26 August 2006). Whilst not having
the glamour of being formulated drunk, this letter at least has the virtue
of being composed sober.
Lowering entrance requirements for medical school is not the answer -
medical school (and subsequent medical practice) requires intellect and
application. An under-qualified profession will soon be devalued and will
not serve its patients well.
Equally, favouring mature students with a first degree or
qualification in time may lead to a situation where a pre-med
qualification becomes an advantage, and may discriminate against young
applicants just out of school.
Perhaps the fairest way to level the playing field between state and
private schools is to introduce a standardised national medical school
entry qualification, in addition to A level results. In that way, problem-
solving skills, knowledge and emotional intelligence could all be
assessed, without fear of bias towards one group.
In the meantime, it is not helpful to make excuses for the failure of
the state school system to achieve good A level grades, by suggesting that
the private schools are 'puffed up'. Rather, ask the question,'Why do
state schools achieve such low results, even with recent huge increases in
funding?' One may observe that private schools can be academically
selective, tend to have smaller classes, be better disciplined, and have
more motivated pupils and parents - but why attack a system which appears
to be doing the job better? In any case if an A grade at the private
school is equivalent to a B grade at the comprehensive, surely the
individual with the private, 'puffed up' result will regress to the mean
after leaving the hothouse and settle down to 'glorified social work',
just like her state counterpart.
It may be socially rewarding for Des Spence to identify with what he
sees as the underdog, but with such an important issue as this, perhaps it
is time for all of us to put aside our out-dated social prejudices and
just try to get the best result.
Finally, I would argue that attention to detail is exactly what is
required in diagnosis and treatment for the individual patient. Of course
it is desirable that we can formulate the patient's problems in
biopsychosocial termas and avoid over-medicalisation. However, in my
experience, doctors who 'see the bigger picture' tend towards being
dramatic, and somewhat socially psychopathic individuals, prefer to play
politics and attend meetings, and seem to care little for the core
attributes required for good medical practice.
Robin Ireland
Consultant psychiatrist
Competing interests:
privately (and competitively) educated
Competing interests: No competing interests
I welcome Des Spence's soundings. As a tutor the first thing I look
for when trying to find good students is a desire to actually study, the
second is an ability to do it. A Levels serve as a useful guide for the
second criteria, but not the first and I treat the first as most important
on most occasions. If one is looking for a future research associate I'll
take the A's please. However for a teacher of philosophy, people skills
and a love of the subject are of a higher priority to me. People tend to
learn best from those who love their subject, and although this love is
nothing without the ability to understand it, there is a balance to be
struck. I guess example this might extend to medicine.
Competing interests:
I work in Academia but amnot speaker on behalf of my University,
Competing interests: No competing interests
Dear David
To my shame, I have a confession – I got 3A and 2 Bs in my Scottish
Highers many moons ago. Obviously, we need students who are academic but
there is a balance needed that’s, all. There is much more to medicine than
mere knowledge which we all come to appreciate over time.
On lighter note- I would be delighted to come to dinner. I hope you
lot can cook and haven’t spent most of short lives swotting and preparing
for University challenge. And anyway, why do you lot get about twenty
thousand teams and we northerners only get one? And Jeremy Paxman is
clearly biased towards Oxbridge !
As I am in the mood to proffer advice - enjoy being students – get a
stupid hair cut at least once- perhaps even a eyebrow piercing - you must
go out at the very least twice a week – dodge a few lectures – don’t
bother with distinctions or merits they will seem pointless in twenty
years – avoid the seriously dull.
Competing interests:
I have some A's
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Since this is a personal view, I will not get too excited.However,
being an accomplished writer and an experienced doctor,Des Spence himself
would know the suggestion that 3Bs rather than 3As indicate a better
doctor prospectively,not only lacks objectivity but also sound
evidence.Let's not tar everyone with the same brush.If Spence's cynical
logic is to be followed,arguably 2Bs and a C with ability to drink 6 pints
a few times a week in the company of strangers (and return home safely)
might also be an indicator of a good future doctor; after all, glorified
social workers need to acquire such skills.
Competing interests:
None declared
Competing interests: No competing interests
Editor–I was interested to read ‘Soundings - Three Bs,
please.
I well recall Derek Wylie when dean of St Thomas’s
Hospital Medical School in the in the late 1970s making
exactly these points. The problem he said were the
academics on the selection panel.
Competing interests:
None declared
Competing interests: No competing interests
Dr Spence's article highlights a growing divide in the perception of
who the doctors of tomorrow should be.
On the one hand we hear the cry for more students with lower grades
who have who have "the gift of the gab, blarney, patter or a silver
tongue" (although it seems dubious as to whether there is any evidence
base on which to support an association between these attributes and low
grades- we have moved beyond anecdotal evidence haven't we?).
At the same time it seems to me that medicine needs those of an
academic bent more than ever. We need doctors who are at home in the world
of primary reasearch, who aspire to further the limits of our knowledge,
who have a scientific approach to their profession as well as the ability
to "accept uncertainty and the ability to reassure".
When As make up 24.1% of all A levels now awarded, surely to lower
the requirements even further would remove an important and useful hurdle
for admissions panels: are you motivated enough to achieve the necessary
grades.
I would argue that interviews are the appropriate point at which to
assess a students personality rather than when surveying their grades. To
label all those students who want to go into medicine and were willing to
work to achieve the necessary grades "neurotics" or "no-social-skills
types" is too absurd to be offensive.
Should Dr Spence wish to verify the accuracy of that statement he had
open invitation to dinner with the students in my house (who have not a B
grade between us!).
With best wishes to all those with new places in Medical School and
an entreaty for them to excel academically, regardless of being labelled
"neurotics"!
David McKean
Competing interests:
More than three Bs at Alevel
Competing interests: No competing interests
For the silent minority
It is a myth that high A-level grades are required to successfully
complete a medicine degree. I held two university places as a school
leaver which I was unable to take up due to "poor" A-level performance.
following an undergrad degree i was admitted to one of the Courses
for which I originally held a place. My experience thus far (I passed my
finals first go) is that being bright helps but working hard helps more.
In fact looking around my peers it would seem that apart froma few months
prior to finals even that is questionable.
More needs to be made of interviews and other skills which my
university has inexplicably spent great time and effort "teaching" me.
Comm skills anyone?
Competing interests:
BBC at A-level
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