Tuition fees for medical school: what is the effect on students?BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k890 (Published 01 March 2018) Cite this as: BMJ 2018;360:k890
All rapid responses
I would like to respond to Mr Samuel Chun's rapid response in which he asked:
"An English student, a Welsh student, a Scottish student and an overseas student sit next to each other waiting for their lecture. They pay £9250, £3000, £0 and £30,000 per year respectively. The lecture is cancelled because the clinician got called away to a clinic (something we have all experienced multiple times) - how much money has that hour cost them?"
It is with some irony that the most obvious candidate for the biggest loser of this situation was never even considered: the clinician
I cannot be certain the exact contractual detail of this particular imaginary doctor would have been but it would be safe to assume that although the NHS contact would have mentioned providing education and supervision to students of health professions, there is little if any specifics on how much, how involved or how far the provision of this ancillary function would have been in consideration with core function of providing clinical services.
In the land down under, there are many doctors who are attracted by these academic titles of "clinical professors" and "clinical lecturers" conferred by various medical schools keen to recruit educators for their expanding clinical program but very few schools actually provide secretarial, infrastructural, equipment or financial support full-time university teaching staff usually have access to.
Hence, these clinicians often have to organise teaching venues and time, spend time preparing for the lecture topic plus reading around the materials (typically time spent on preparation is usually 3 times the expected presentation duration), organise replacement cover for clinical duties or cancel any service obligation in order for the clinician to be able to attend the lecture program.
Sometimes clinical lecturers do not even know what is the content (and extent) of the medical curriculum or what year/level the intended audience is meant to be. In the current culture of basic-science-starvation-diet prevalent in many (self-proclaimed) "progressive" medical schools, this information is vital for the lecture content to make any sense to the students.
Couple this with the failure of students to appreciate their responsibility to prepare for a teaching session as part of the adult learning principles expected of a tertiary student in a University, and you find a gap of knowledge between expected core foundation of knowledge according to the lecturer, and the reality of the students' abilities.
God forbid if the clinician dares to field probing questions to students to assess their depth of understanding, where the doctor could be accused of teaching by humiliation instead of raising awareness of the need of students to proactively bridge their gap in knowledge and what is expected of them.
Many students can only see academic learning as their goals but rarely appreciate opportunities in learning to manage workflow and prioritisation as well as professional etiquette from their clinical attachment to hospital department.
Is it then any wonder many of us are now working in clinical environments where important basic principles are mistakenly trivialised while other minor discrepancies get blown up into major contentious issues in which there was never a real solution to but nevertheless HAD to be discussed and the self-righteous agitators pacified?
But I digress.
Sufficed for me to declare that the clinician who cannot attend the 1 hour lecture she/he spent 3 hours to prepare for the biggest loser in this scenario, which almost as common as when only half (or less) of the intended audience actually turned up of a lecture
Competing interests: I had at times been asked to give tutorial and lectures to medical students
We read with great interest the recent feature by Anne Gulland on ‘Tuition fees for medical school’ (1).
An English student, a Welsh student, a Scottish student and an overseas student sit next to each other waiting for their lecture. They pay £9250, £3000, £0 and £30,000 per year respectively. The lecture is cancelled because the clinician got called away to a clinic (something we have all experienced multiple times) - how much money has that hour cost them? We appreciate this sounds like a joke, but there’s no punchline - this is a regular occurence. In reality, as paying medical students, we are all aware of the financial value of our learning time. So a missed lecture, or a cancelled day all adds up. Many of us are desperately counting pennies just to afford the basic necessities such as rent, even taking extra jobs or loans to be able to bridge the rather large gap between maintenance loans and actual living costs. We live in London and pay £9000 a year for rent alone, however our maintenance loan is only £5500. It is often quoted that ‘time is money; money is time’ and as such we are acutely aware of the cost of time, a one hour lecture has a value to all of us. The meaningless remarks of “it happened to all of us” fall on deaf ears, and surely it is about time that something is done about this disparity.
When we were applying to study Medicine, we were often told, “your loan won’t be seen as a black mark on your record”, but what is never discussed is how this loan will always have to be factored in to our future finances until it is paid or written off. Our teachers, and school advisors all told us not to worry about the loan, but just to take what we can and get the degree. That’s all well and good during the degree, however it offers little support when we are catapulted into reality. Some of our peers that have graduated are dependent on hefty loans just to afford rent, let alone transport and food costs.
From our experience, Medicine is a subject that can be and should be open to people from all backgrounds. However, from conversations, those students who are more concerned about finances and any changes to student loans tend to be students from poorer backgrounds. It seems that we are some way from creating an accessible platform where all students regardless of financial status are able to fully enjoy their medical school experience without the additional worry of the inevitable tens of thousands of pounds of debt.
After reading countless news reports and media coverage about the current state of affairs in England regarding the junior doctor reforms, Scotland and Wales seem to carry high incentives for both jobs and education. Maybe it is a blessing in disguise that FPAS allows us to apply anywhere in the country regardless of where we call home. Perhaps, we should cherish the last of our medical school days, as receiving our prized GMC numbers and graduating is only the start of the doom and gloom.
1. Gulland A. Tuition fees for medical school: what is the effect on students? BMJ. 2018;360:k890.
Competing interests: No competing interests
The high university fees inevitably distort potential students decision-making about university. Those from less privileged backgrounds - and perhaps those who are more timid or otherwise anxious about the large debts they will acquire - are bound to be discouraged from applying to and attending university, thereby depriving us all of the benefits their greater contribution (as graduates) to society.
But the justification for charging high fees for university quoted by ministers is that the tuition costs money, and that graduates can afford to pay back their student loans because they will be earning more than non-graduates.
If this is true, then there is a far more straightforward solution, which would not cause (or exacerbate) these inequalities of access: funding university through general taxation. As they did when I graduated in the 1980s.
If, as they claim, graduates earn more, they will pay more in tax.
We all benefit from the work graduates do - from their contribution to society, through their use of the skills they acquire, and the additional taxes they pay. So an increase in taxation - paid by all taxpayers, but bearing in mind that graduates pay more in taxes because they earn more - would benefit all of us.
Competing interests: Impoverished after supporting three offspring through university courses!