Wanted: arts graduates with a convincing bedside manner

The United Kingdom is short of doctors. A forthcoming report is expected to call for an extra 1,000 medical students. But how to train them quickly?

Some medical schools are proposing American-style fast-track medical degrees for graduates in other subjects. Others wonder whether three years' training on top of a first degree in history or sociology is enough preparation.

During the Nineties the British Medical Association changed its mind about the number of doctors it thought the country needed. It decided to lift the cap on numbers that had been imposed to keep doctor oversupply down. The United Kingdom had to have more doctors, it asserted, because of increasing pressure on the health service brought about by an ageing population, demand for more and improved health care, and advances in medicine.

Moreover, there is unease about the UK's reliance on overseas doctors. Last year 60 per cent of newly trained medical practitioners came from abroad. The worry is that these are not a reliable source, because they may return home to work, as developing countries build up their own health services.

That is why a committee chaired by Sir Colin Campbell, vice-chancellor of Nottingham University, is investigating the future need for doctors. His report, originally expected this month but now scheduled for the end of the year, is likely to suggest that up to 1,000 more medical students be recruited. It is understood that further drafting was needed, to help officials to advise ministers on implementing the recommendations.

Boosting the number of home-grown doctors takes time and money. That is why some medical schools are proposing radical change in the shape of three- or four-year postgraduate degrees for people who have already been to university and who fancy the idea of wearing a white coat.

"Graduate medical courses are the norm in North America, and are being developed elsewhere in the world," says the 40-page discussion document for an accelerated degree from St George's Hospital medical school in south London. "They allow a greater diversity of previous educational background and ensure a greater level of maturity."

St George's - along with the United Medical and Dental Schools of Guy's and St Thomas's hospitals - is blazing a trail that it hopes will win approval from London University and from the General Medical Council, the body that regulates the profession and ensures standards of qualifications.

Its proposal - which was sent to those two bodies last week - is for a three-year medical degree for graduates on the lines of the well-established model of McMaster University in Canada. It would be in addition to the traditional five-year medical degree; it would run for 37 months; and it might recruit students without science backgrounds, so long as that did not run foul of the European Union. Medical training has to be more than six years, or 5,500 hours, according to an EU directive.

The idea of taking non-scientists and turning them into doctors within three years is not on the table in most other medical schools, though some deans, such as Professor Michael Langman at Birmingham, think it might be feasible to convert science graduates into doctors within that time.

Professor Frank Harris, dean of Leicester's medical school and a member of the GMC's education committee, says: " I am not against graduate entry, but patients want a high-quality, thoughtful and compassionate doctor, who can communicate and has the knowledge, skills and aptitude to look after them. That is not accomplished easily or quickly, otherwise we would have done so."

Nevertheless Leicester University is considering a conversion course for science graduates, lasting three-and-a-half years, as part of its joint bid with Warwick University for a new medical school.

St George's protests that there will be no lowering of standards in its proposed degree. "Students will be rigorously assessed, and take the same examinations as those on the five-year course," says Dr Douglas Maxwell.

The South London medical school is keen to attract arts as well as science graduates to medicine because it thinks they would enrich the student body as well as the profession.

The English educational system forces children to choose between arts and sciences at a young age. Many gifted pupils opt for arts subjects because they find that they can take an active, critical part in humanities lessons, it says in its document. By contrast, it is difficult to be creative in science until much later, when a solid body of knowledge has been learned. "Thus many students who would be highly suited to medicine, with its mix of people skills and science, are lost to the profession at an early age."

Other deans are sympathetic to the desire to recruit from a wider pool of applicants. Professor Stephen Tomlinson, dean of Manchester's medical school and executive secretary of the council of deans of medical schools, says there's a real concern that more than three-quarters (76 per cent) of last year's entrants were from social classes one and two. In other words, their parents are middle or upper middle class, and comfortably off. Getting on for half (45 per cent) of the entrants to Manchester last March were from independent schools.

Whether or not the reform being proposed by St George's would attract students from a broader range of social backgrounds, is debatable.

"I'm enthusiastic about exploring options, because I think attracting graduates is something we would be very keen to do," says Professor Tomlinson.

At the same time, he is wary of an accelerated medical degree. His university takes graduates from St Andrews with a three-year degree in medical sciences, who come to top up with the final years of doctor's training at Manchester. That works because these people have a grounding in science. Professor Tomlinson is not sure whether it would work for non-scientists.

"What everybody is anxious about," he explains, "is the quality of the education that individuals are going to get in shortened courses."

One reason for the caution is that the curriculum for medical students has undergone radical change in the past year. The content has been slimmed down, and information is passed on through problem-solving exercises rather than big lectures. Some experts say that makes it even more difficult to condense training into three years and to bring non-scientists up to speed quickly.

"If it proves to be possible to get people up to the standard in less time, then the whole country will be interested," says Professor Brian Jewell, dean of Leeds medical school. "That is all to be tested. I strongly welcome the experiment. It could lead the way for major changes in medical education."

Professor Peter Rubin, dean at Nottingham, is also interested. He is au fait with the American system of recruiting doctors on to postgraduate degrees, having worked at Stanford University in California for two years. "It produces a far wider spectrum of people with a wealth of different interests," he says. "My personal view is that has to be beneficial to medical education."

At present, most graduates who want to enter medicine have to take the standard undergraduate medical degree, lasting five years. Many have to fund themselves. Despite that, they do better on average than the traditional fresh-faced 18-year-old recruit, because they are highly motivated and have sorted out what they want to do. By contrast, A-level recruits may be excessively influenced by their parents, and ignorant of the full range of careers open to them.

An analysis of mature students at St George's shows their failure rate in first- and second-year exams to be about half that of all students. However, they do no better or worse than younger recruits when it comes to dropping out of the course. But the older students have to contend with much less financial support and more outside commitments. Thus the medical school has concluded that mature students do better.

It reckons that the McMaster model of highly motivated groups of students determining the pace of their own learning would work here, and proposes that students study in groups of seven, assisted by a tutor and with access to a computer network of learning materials.

Dr Colin Smith, who teaches at Southampton medical school and is chairman of the BMA's medical staffs committee, is an admirer of the McMaster system too, but wonders whether St George's has the infrastructure to cope with it. The system requires highly qualified staff to be on tap to help students with questions. "What we don't have here are McMaster's resources," he says. Moreover, St George's has not produced either a risk assessment or a cost benefit analysis.

Other methods the Government may consider to increase the number of doctors include setting up Open University style training; expanding existing medical training; and opening a new medical school. Dr Smith hopes the authorities will give fair consideration to the St George's idea. He says: "We do need to have some quite serious ateral thinking in medical education."