Intended for healthcare professionals

Letters Lifting the medical school cap

Medical school places: balancing quality, clinical need, and supporting students

BMJ 2020; 370 doi: (Published 28 September 2020) Cite this as: BMJ 2020;370:m3738
  1. Joshua L Davies, senior house officer
  1. Walsall Manor Hospital, Walsall WS2 9PS, UK
  1. josh.l.davies{at}

I welcomed the news that medical school places will remain uncapped for the 2020 entry period with reticence.1 Almost all hospitals have revamped rotas to increase the number of doctors directly involved in patient care in response to covid-19. This has provided a glimpse of what could be. Wards have been well staffed, and colleagues have been close at hand to support each other. This announcement is by no means a direct response to covid-19 but a result of it, and the main benefit to be gained is a much needed increase in our medical workforce.

But this is a proverbial double edged sword. More students mean more doctors in years to come rather than in the immediate future. The BMJ has already reported that the number of full time equivalent GPs has fallen over the past year,2 so this does little to allay the problems of understaffing we face at present.

Equally, there is a question of quality over quantity. Doctors in training need hands-on experience to hone their skills. Yet, the landscape of medical education has changed dramatically because of covid-19. Bedside teaching has been absent for some time and is only just beginning to resurface. There is no substitute for physical interaction with our patients, but student safety is also a priority. Therefore, we must consider whether increasing student numbers without the means to develop them as doctors is ultimately doing them a disservice.

This is compounded by the existing challenges that hospitals face in providing undergraduate medical education as hospitals centralise their services. There is a fine balance to be achieved between quality, clinical need, and supporting our students. Our patients deserve well rounded doctors who are clinically adept and fundamentally human in equal measure. Increasing numbers might seem the ideal solution, but beneath the surface there are many problems requiring careful consideration if we are to succeed in nurturing the next generation of doctors.