2. Graduate Entry Medicine Rebecca Gray

3. Studying medicine in the UK All students – undergraduate medicine eg MBBS 32 Universities: traditional course (5/6 years) 16 Universities: graduate entry (4 years) GMC (core content) and EU (hrs training)

4. Academic requirements Traditional course: A Levels - ABB. Chemistry, ?Biology + another science GEM: Hons: 2:1, ?2:2. Subject stipulations vary Aptitude Tests: UKCAT, BMAT, GAMSAT Applications: UCAS. 4 Schools

5. Background GEM North America and Ireland: Graduate entry only Australia: Since '97 increasing graduate entry only Strongest arguments: Increase flexibility re career choice. Increase diversity UK: 1st GEP set up in 2000 – meet need for more doctors through widening access

6. Case Study – St Georges Entry requirements: Hons 2:2 or 3rd + Masters. Any degree subject + A-levels... that will influence the end product of the medical school through the broadening of the intake Peter McCrorie (GEP Course Director) No science? GAMSAT exam. Minimum score required Work experience, home student, CRB checks Multi-Mini Interviews (new): 2.5 candidates per place

7. Course structure Since 2008, revised curriculum to align with five year course Four themes and six modules. Problem Based Learning - weekly scenarios (systems) 18 months pre-clinical, but exposure from outset Regular assessments: written and clinical (OSCEs)

8. Advantages of GEM Broad range of applicants and ages (<45) – motivation, promotes communication skills Shorter course length NHS Bursary from year 2 onwards Greater emphasis self-directed learning: suits older students

9. Disadvantages of GEM Broad range of applicants – non-scientists can feel under-prepared ?emphasis BCS Previous careers, older age Intensity of course – highly demanding, other responsibilities Divisive two tier system? But same final exams

10. Prognosis Graduate courses growing in popularity, but are they making good doctors? In US no real comparison to be made In UK, Australia, Ireland courses still relatively new What form of measurement?

11. Research to date Qualitative: innovation in teaching style (PBL), influences on student experience GEM Quantitative: exam performance data – difference between science and non-science graduates, between graduates and school leavers Mixed picture in terms of results - ?conclusions

12. To be a graduate or not? Highly motivated and committed, much more self- directed, challenging, demanding, questioning, and mature than non-graduate medical students... mature students are sooner and better able to handle the responsibilities of being a doctor... patients would be better served by doctors entering medical school after the age of 22. Peter McCrorie (St Georges GEP Course Director)

13. To be a graduate or not? It would be discriminatory to school leavers and to mature non-graduates to limit medical training to people who already have a degree in the absence of any convincing evidence of benefit. It would also cost more to the taxpayer. Charles George (former Clinical Academic, University of Southampton)

14. The future More research is needed Follow up 1st graduate entry cohort from St Georges who left medical school 2004?

15. References 1. Medical Schools Councilhttp://www.medschools.ac.uk/Students/Courses/Pages/Graduate.aspxhttp://www.medschools.ac.uk/Students/Courses/Pages/Graduate.aspx 2. British Medical Association http://www.bma.org.uk/images/becomingadoctor2011_tcm41- 198047.pdfhttp://www.bma.org.uk/images/becomingadoctor2011_tcm41- 198047.pdf 3. NHS Careers http://www.nhscareers.nhs.uk/details/Default.aspx?Id=556http://www.nhscareers.nhs.uk/details/Default.aspx?Id=556 4. St Georges Hospital Medical School, UOL http://www.sgul.ac.uk/undergraduate/MBBS%20Graduate%20Stream http://www.sgul.ac.uk/undergraduate/MBBS%20Graduate%20Stream 5. Hutchinson L, McCrorie P, Hughes P. Graduate entry programmes in medicine. Student BMJ. 2002; 10:45-88 6. Rushforth B. Life in the fast lane: graduate entry to medicine. Student BMJ. 2004; 12:368-70 7. Gapper S. Older & Wiser? Student BMJ. 2006. 14 (118-120) 8. Hayes K et al. Anxiety in Medical Students: is preparation for full time clinical attachments more dependent on differences in maturity or on educational programmes for undergraduate and graduate entry students? Med Educ. 2004; 38:1154-63 9. Rapport F et al. What influences student experience of graduate entry medicine? Qualitative findings from Swansea School of Medicine. Med Teacher. 2009; 31:e580-e585 10. Calvert MJ, Ross NM et al. Examination performance of graduate entry medical students compared with mainstream students. J R Soc Med. 2009. 102(10): 425-430 11. McCrorie P. Graduate students are more challenging. BMJ. 2002; 325:676 12. George C. Should all medical students be graduates first? NO. BMJ. 2007; 335:1073

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