Priorities for Health: Medical students
November 2006
Introduction
In August 2006, BMA Scotland conducted a survey of members to identify their priorities for health. Around 600 doctors from all branches of the profession responded to the survey and their priorities for medical student education are reflected in this policy briefing.
Background
There are currently 4652 medical students in Scotland and each year, approximately 800 new graduates [reference 1]. Following Sir Kenneth Calman's Review of Basic Medical Education in Scotland, this figure is set to rise as St Andrews students, who historically graduated from Manchester, will soon be able to complete the clinical part of their degree in medical schools in Scotland rather than England. This will increase the number of medical students completing their degrees in Scotland by approximately 100 each year. It is hoped that, by allowing more graduates to train in Scotland, it will boost Scotland’s future medical workforce.
Scotland’s medical schools have an unrivalled international reputation for excellence. However, problems of access and concerns of excessive debt deter Scottish students from studying medicine.
Debt
Medical students have a longer and more expensive course than students on most other courses with little or no opportunity to earn extra money while they are studying. They have higher than average costs such as the requirement to purchase expensive reference books, appropriate clothing for ward rounds, stethoscopes and other essential equipment.
Many students rely on student loans during their studies and the shortfall is made up by borrowing from commercial lenders in the form of bank loans, credit cards and overdrafts. A recent survey shows that on average, medical students accumulate around £21,755 in debt by their final year at university [reference 2].
The BMA believes that entry to university should be based on academic ability, not ability to pay. However it is feared that school leavers, particularly those from lower income families, are deterred from applying to study medicine because of the huge debts they face.
Widening access
The BMA supports all attempts to encourage medical school applications from a wider socio-economic base. A BMA report revealed that 59% of applicants to medicine in 2003 came from managerial and professional backgrounds and in recent years applicants from these groups were more than twice as likely to be accepted as those from unskilled backgrounds [reference 3]. If medicine is to truly represent the people that it serves, there must be incentives to attract students from all walks of life.
Graduate-entry programmes attract students from a wider background with qualities such as experience and maturity. Their popularity is evident worldwide and a number of countries have established shorter programmes for graduates. Establishing a fast track graduate entry programme in Scotland would help widen access and bring with it new knowledge and skills which are likely to enrich the medical profession.
In Scotland, 63% of applicants to medical school are female [reference 3] and some concerns have been raised that the growing proportion of female students will result in a future health service that is understaffed due to increased demand for part-time working and career breaks. However, these problems could be reduced by supporting flexible working and training and introducing other improvements in working conditions in the NHS. Indeed, nearly 94% of doctors surveyed believed it important for flexible training opportunities to be widely available across Scotland.
Training
It costs on average £250,000 to put a student through medical school and currently, Scotland educates more students than there are specialist training posts. If graduates from Scotland’s medical school are denied access to training posts in Scotland then they are more likely to leave to continue their training elsewhere.
Although additional medical school places could help address the current recruitment and retention problem of doctors in Scotland, this move would only be successful alongside an increase in the number of training posts in hospitals and general practice coupled with attractive long term career opportunities. 95% of doctors surveyed agreed that all medical school graduates should be guaranteed a foundation training post.
Funding
The BMA welcomed the fact that top up tuition fees have not been introduced in universities in Scotland. However, following their introduction in England, English universities are now able to generate more income from top up fees. In order to maintain equity, universities in Scotland need to be better funded to be able to compete. Otherwise there is a danger that students could be drawn to better-funded English universities which can offer better facilities and attract renowned medical academics, leaving Scotland to fall behind.
Recommendations
In order to improve the situation for medical students in Scotland:
- Every medical school graduate in Scotland should have access to a fully funded foundation training programme in Scotland.
- Financial support should be improved to help those from poorer backgrounds, who tend to be more debt averse, choose to study medicine.
- Initiatives to improve diversity of medical students should be extended. The Pathways to the Profession project was set up in 2001 to widen access to law and medicine courses at the University of Edinburgh. The WHAP project based in Glasgow. The desired outcomes of the projects are to increase applications from the state sector and an increase in under-represented groups accessing the professions.
- Graduate entry degrees should be introduced in Scotland to bring a wealth of knowledge and experience to medical schools.
- Flexible training and working should be introduced along with improvements in working conditions to encourage the increasing number of female medical students to remain in the NHS.
- Attractive training posts for graduates and first-rate career opportunities should be introduced to encourage doctors to remain in, or return to, Scotland.
- Funding for Scottish medical schools should be increased to match the additional amount English medical schools receive from top up fees.
1. Information gathered from individual medical schools. October 2006.
2. British Medical Association. Survey of Medical Students’ Finances 2004/2005. London. November 2006.
3. British Medical Association. Demography of Medical Schools. London. June 2004
For more information contact:
BMA Scotland Public Affairs Office
Tel: 0131 247 3050/3052
Email: press.scotland@bma.org.uk