Should medical students be older?

Medical students should be at least 23 and have studied English, argues one academic. Prisca Middlemiss reports.

Imagine you want to study medicine, but the minimum entry age is 23; a humanities A-level is essential and A-level English literature is desirable; and you must have worked for a year in healthcare or a voluntary organisation.

Would you, like Jonathan Searle, 19, who has just completed his first year as a medical student at King's College, London, have 'run to the hills' rather than suffer five gap years before medical school?

Or would you, as envisaged by Dr Christopher Cowley, lecturer in ethics at the University of East Anglia's medical school, have felt your medical vocation tested and strengthened by such an enforced postponement?

Clinical aptitude

According to Dr Cowley: 'The 18-year-old pure science pupil is no longer suitable for medicine.' He admitted that his ideas were 'based on scant evidence', but said he wanted to stimulate others to perform the necessary research.

Professor John Tooke, dean of Peninsula Medical School in Devon and Cornwall and chairman of the Council of Heads of Medical Schools, agreed that current selection criteria were unreliable.

'It is regrettable that we do not have a better evidence base for selecting students using tests with strong predictive validity,' he said.

This summer, the first batch of AS-level students hoping to choose medicine have just taken the new 90-minute UK Clinical Aptitude Test.

'The test, which has no specific science content and for which students cannot revise, explores cognitive powers and professional behaviours that are deemed appropriate for aspiring doctors,' Professor Tooke explained.

Requisite maturity

By raising the admission age to 23, Dr Cowley hopes to capitalise on a student's maturity.

He argued: 'The onus should be on those younger than 23 to show somehow that they have the necessary maturity. There are certain things about patients that we cannot understand unless we have lived a little.'

By imposing a compulsory year in healthcare or voluntary work, he aims to test for applicants' medical vocations.

By requiring a humanities A-level with extra points for English literature, he aims to attract students with a more refined understanding of human nature.

'Students with a humanities background are better able to make sense of what it means to be a doctor,' he said.

English literature, in particular, refines the student's 'imaginative understanding of the suffering of individual patients', Dr Cowley said.

Professor Tooke said Dr Cowley's idea was too prescriptive. He thought that excellence in the arts or music did not require an A-level, and a full year in the workplace was not required.

Interview importance

Maturity and characteristics such as empathy can all be revealed in interview.

Jonathan Searle was more vehement: 'When you get to university, A-levels are redundant. The last thing the average med school applicant needs is the pressure of a completely unrelated extra exam, in a subject of little use in the future.

'An increase in health-related work experience, and compulsory lessons in medical sociology would be of benefit, both in sorting the most committed students from the rest and in improving those elusive communication skills before the crash course you begin in your first year,' he said.

'If more work is to be given to a student, at least make it related to the subject they are passionate about.'

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