Intercalation helps to develop doctors with a more holistic approach to medicineBMJ 2023; 380 doi: https://doi.org/10.1136/bmj.p577 (Published 13 March 2023) Cite this as: BMJ 2023;380:p577
- 1Edinburgh Medical School, University of Edinburgh
- 2The Medical School, Faculty of Medicine, Dentistry and Health, University of Sheffield
Intercalation gives UK medical students the chance to take a year out of their medical programme to obtain another degree in a discipline of interest. These degrees can range from medicine adjacent subjects like anatomy or pharmacology to those outside the scope of the usual medical curriculum, such as a humanities subject. Intercalation is often considered a valuable experience by students, and until recently it could assist them in securing their desired foundation training posts. The rules have now changed, however, and students entering the UK foundation programme in 2023 are the first cohort to no longer be awarded points for having these additional degrees.1
If intercalation no longer counts towards applications, is it still worthwhile? Yes. Medicine is a lengthy and demanding career, which begins with five or six years of medical school. It can be difficult to remember that there is no rush to get through this—medicine is a marathon, not a sprint. Intercalation allows medical students to take a break from the rigours of clinical medicine, reducing stress and potentially preventing burnout.
One of the many reasons to intercalate is the opportunity to take some time away from medicine to appreciate other disciplines. Doing so will encourage students to approach medicine with a wider perspective when they return. After all, society does not revolve around medicine, but rather a complex mix of humanities, sciences, and the arts. Intercalating allows students to develop a more holistic set of ideas and approaches.
In non-collegiate UK universities, medics often form close knit cliques owing to the intense nature of the course. Intercalating allows medical students to expand their social circle to include those who study a range of subjects. In clinical practice, we can become desensitised to aspects of medicine that the public might find unpleasant. If we rarely interact with people outside our course, how can we truly understand what other people think about medicine and factor this into our practice so that we provide the best standard of care?
Intercalation provides lots of opportunities to learn skills that are transferable to clinical practice. Students can explore specific areas of medicine in detail, such as cutting edge cardiovascular treatments. Research oriented students might be able to familiarise themselves with the bench-to-bedside process, while also critically appraising research and interpreting statistics. Other students will focus on different areas. Students studying psychology, for example, might learn more about the emotional, social, and cognitive elements that shape patients’ behaviour and experiences, whereas those studying medical anthropology could obtain a greater understanding of different societal attitudes towards medicine, enabling them to practise in a culturally informed way. Overall, an intercalated degree can develop and sharpen our understanding of the world, as well as our clinical acumen.
Intercalating can also confer benefits outside of clinical practice. Work produced from the intercalated degree can develop into publications and conference presentations. Intercalation allows students to form a good professional network early on, paving the way for future career advancement.
Given the many advantages of intercalating, the removal of additional degrees as part of the education performance measure of UK foundation programme applications in 2020 caused controversy. It was later announced that, from 2023, undergraduate degrees, including intercalated degrees, would no longer count towards the application scoring matrix for internal medicine training.2 No alterations have yet been made to the point scoring system for the specialised foundation programme.3
Some have argued that these changes are for the better—one reason the UK Foundation Programme Office cited for their decision is that additional degrees are no longer helpful in differentiating between candidates.4 And with many candidates not able to afford these additional qualifications, there is a question of equity here.
The financial opportunity costs of starting work later, coupled with the anxiety of resuming your medical degree with a cohort of strangers, might make some students reluctant to intercalate. More financial support should be provided to widen access so that the benefits of intercalating are attainable for everyone.
Over the years, medicine has increasingly become a “checklist” exercise for medical students, as we tick boxes in our portfolios to progress. Many of us may have forgotten our initial drive to build up our skills and learn more about the world around us. Keeping in sight the idea of constant learning in a medical career, we should take up the opportunity to intercalate, which broadens our horizons and enables us to develop holistically not only as clinicians, but as people.
Competing interests: Both authors are medical students. They have no competing interests and are unpaid.
Provenance and peer review: Not commissioned; not externally peer reviewed.