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Medical school places: what will be the effect of lifting the cap?

BMJ 2020; 370 doi: (Published 27 August 2020) Cite this as: BMJ 2020;370:m3358

Linked Opinion

The A levels fiasco is part of a wider picture of inequality in medical school recruitment

Linked News

Cap is lifted on medical school places in England

Rapid Response:

Re: Medical school places: what will be the effect of lifting the cap?

Dear Editor,

It is with mixed emotions that I welcomed the news that medical school places will remain uncapped for the 2020 entry period. As the medical community has fought the COVID-19 pandemic, most hospitals have revamped their medical rotas to increase the number of doctors directly involved in patient care. This has provided a glimpse of how things could be. Wards have been well-staffed with juniors, the workload has been of a different kind of intensity but manageable, and colleagues have been close at hand to debrief and support one another. This announcement is by no means a direct response to COVID-19, but it is a result of it and the main benefit to be gained is a much-needed increase in our medical workforce.

However, this is a proverbial double-edged sword. More students mean more doctors in 5 to 6 years time rather than in the immediate future. The BMJ has already published this month how the number of full-time equivalent GPs has decreased over the last 12 months, so this does very little to solve the problems of understaffing we face at the present moment.

Equally, there is a question of quality over quantity. Doctors in the making need hands-on experience to hone their skills and develop the mindset of the future clinicians they will become. Yet, the landscape of medical education has changed dramatically due to COVID19. Bedside teaching, once a staple of medical student life, has been absent for some time now and is only just beginning to resurface in the curriculum. There can be no substitute for physical interaction with our patients but student safety is also a priority. Therefore, we have to acknowledge whether increasing student numbers without the means or opportunities to develop them as doctors are ultimately doing them a disservice.

An issue which is not highlighted in the article but also compounds this issue is the challenges that hospitals face even before COVID-19 in providing undergraduate medical education. Students often rotate through several different hospitals in order to observe the breadth of medical presentations needed to become a competent doctor. Increasing the number of students will only exacerbate an already stretched education budget and as hospitals centralise many specialist services such as stroke, students sent to smaller DGHs may not see key presentations that they will encounter in their future careers.

Finally, I wish to contest a statement made in the article that A level examinations are the best predictor of success in medical schools. Certainly for this reader, who took 3 attempts to get into medical school, this could not be farther from the truth. Our patients deserve well-rounded doctors who are both clinically adept but fundamentally human in equal measure. We need to attract candidates from varied backgrounds if we are to achieve this and examination results alone do not dictate the quality of doctor we are.

There is a fine balance to be achieved between quality, clinical need and supporting our students. Whilst increasing numbers may seem like a good idea, peel back the surface and there are a myriad number of issues that need to be addressed if we are to succeed in nurturing the next generation of doctors.

Competing interests: No competing interests

06 September 2020
Joshua L Davies
Senior House Officer
West Midlands