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Studying-Medicine-Fair-Process-For Studying Medicine – A Fair Process for Graduate/ Mature Applicants in the UK: Reflecting back on National Health Service (NHS) Principles * M Mr Shahid Muhammad B.Sc. (Hons) BMS Tox, LIBMS Biomedical Scientist Practitioner and Chief in Research for the Renal Patient Support Group (RPSG) Address 15 Stoke Hill Stoke Bishop Bristol BS9 1JN England UK Email [email protected] * C Corresponding Author 1 Studying Medicine – Fair Process for Graduate/ Mature Applicants in the UK; Reflecting back on National Health Service (NHS) Principles Abstract Background: Medicine is a popular choice of study in Higher Education. Evidence suggests that there are more applicants applying to study than institutions can accept. In the UK, the application process for medical school is disorganised and perplexing as a result of there being a single admissions gateway, the University and College Admissions Service (UCAS) for graduate and undergraduate applicants. Aim: It is proposed that there should be a separate selection and admission process for graduate applicants to Medicine Introduction: Since its launch in 1948, the NHS has grown to become the world’s largest publicly funded health service. The National Health Service (NHS) stands for patients their needs. Future medics need to have empathy and a strong background of experience in a variety of health and social practices. Discussion: Medical school applicants should understand how the NHS functions and the admissions process should recognise this imperative in all types of applicants. It is apparent that the current process favours school-leaver applicants. Conclusion: Two application processes are required which justify entry criteria separately and with integrity. This paper proposes that there should be a separate application process for the mature applicant reflecting back on NHS core principles. Keywords: Medicine, Medical Programmes, Application, Entry, University and College Admission Service (UCAS), Widening Access, National Health Service (NHS) 2 Introduction Of foremost importance is the observation that the study of Medicine is in great demand, and this has increased competition across all types of applicant. Evidence suggests that there are more applicants applying to study Medicine than institutions can accept, despite the introduction of ‘extra’ requirements such as aptitude tests (Parry et al. 2006). A study has been conducted to inform the process used by English schools for candidate applications (Parry, Mathers, Stevens, Parsons, Lilford, Spurgeon, & Thomas 2006). Of particular importance, especially when reflecting back on patient care is the following: “Different approaches to admissions should be developed and tested” (Parry, Mathers, Stevens, Parsons, Lilford, Spurgeon, & Thomas 2006) Some medical schools select a proportion of applicants via interview, remaining applicants being identified on a chance-weighted process for assessing academic attainment (Bore et al. 2005; Lumsden et al. 2005). The present application and admission process would be more accurate if it were geared around selecting which school-leaver applicants would make better doctors. Use of the same entry criteria for graduate/mature as for school leavers leads to discrimination. The current single application scheme (the University and College Admission Service or UCAS), exacerbates the problem. Graduate/ mature applicants though they meet the traditional entry criteria and have excellent potential are frequently disappointed (Bore, Lyall, Dempsey, & Powis 2005;Lumsden, Bore, Millar, Jack, & Powis 2005). The objective for medical admissions is to select applicants who will achieve and comprise of good doctors regardless of their academic or career background (Lumsden, Bore, Millar, Jack, & Powis 2005). Entry to study Medicine in the UK is based on academic endeavor, the process often being less than transparent (Lumsden, Bore, Millar, Jack, & Powis 2005). Despite changes in the stringency of candidate selection criteria, numbers of applications to study Medicine remain overwhelming. Ultimately the admissions and selection process should exclude all applicants who will devalue the profession. It is interesting to note the following statement: “High academic achievement in school-leaving examinations has been shown to predict success in empathy” 3 (Lumsden, Bore, Millar, Jack, & Powis 2005) Graduate applicants may demonstrate a variety of relevant attributes which are not tested by examination (Lumsden, Bore, Millar, Jack, & Powis 2005). Prejudice may be introduced into applicant selection because within the present system institutions could ‘comparing’ two cohorts of applicants solely on their GCE A-level grades. A graduate/ mature candidate may therefore productively have advanced his/her career in relevant areas to find this is not recognized as a valid medical admissions criterion. Aim: It is proposed that there should be a separate selection and admission process for graduate applicants to Medicine The National Health Service (NHS) Behind this proposal is the recognition of the core values and mission of the UK National Health Service (NHS) and the consequential requirements of today's clinical practices and the doctors which serve them. Since its launch in 1948, the NHS has grown to become the world’s largest publicly funded health service. It is also one of the most efficient, egalitarian and comprehensive. The NHS was born out of a long-held ideal that good healthcare should be available to all, regardless of personal wealth and circumstances. NHS care offers everything from screening and routine treatments to transplantation surgery, accident and emergency treatment and end-of-life care (NHS - http://www.nhs.uk). NHS Core Principles Launched by the then minister of health, Aneurin Bevan in 1948, the NHS was founded on three core principles: 1. That it meet the needs of everyone 2. That it be free at the point of delivery 3. That it be based on clinical need 4 The NHS mission is two-fold: 1/ ‘We believe that the patients' needs and experiences are the first and uppermost consideration and the best outcomes result when patients, their carers and relatives and staff are active in decision taking’. (The NHS - http://www.nhs.uk) 2/ ‘We believe in the continuous improvement in everything we do and that staff's dealing with patients, their families and each other should be conducted with courtesy, professionalism, integrity, openness and respect’. (The NHS - http://www.nhs.uk) In March 2011, the Department of Health published the first NHS Constitution, which covers the principles of the NHS and the rights of its patients. Patient rights embrace how to access health services, the quality care patients receive, the information, treatments and programmes available to them, patient confidentiality, and the right to complain. The NHS Constitution is written in consultation with health professionals and patients. This should be apparent to all medical applicants who should be expected to have a working understanding of what patient care really means. At the same time, quintessentially, medical schools' admissions officers need to reflect on these principles in maintaining standards. Studying Medicine Frameworks & Guidelines Medicine is an intensive career pathway and clinicians now need to be able introduce an understanding of basic science into practice and appreciate patient involvement in research (Thompson and Evans 2009). The Tooke Report (2008) outlines proposals for the governance of medical training. The Medical Schools Council (MSC) which governs medical education (MSC - http://www.medschools.ac.uk/) embraces its recommendations. The Royal College of Physicians (RCPH - http://www.rcplondon.ac.uk/) expects future doctors to demonstrate increased professional responsibility. This can be assessed neither in graduate/mature nor school -leaver applicants for Medicine as a 'paper exercise'. The full range of roles and attributes a doctor require better 5 comprehension by school-leaver applicants whose understanding of collaboration and research are unlikely to be well-developed. Research experiences gained through internships are just as important as academic standing. Clinical and scientific research and collaboration are important criteria since they are continuously measured and should a graduate candidate for example possess such capabilities, these should highlight their competency and integrity to study Medicine. What does the present application process involve and how should this relate to the NHS? All candidates for places to read Medicine apply through one system via UCAS and this is the British admission service for students applying to university and college generally, including post-16 education (UCAS - http://www.ucas.ac.uk/). The UCAS process is used by both school-leavers and graduate/ mature applicants. Applicants who want to apply to study Medicine have to demonstrate good discipline, rigor, perseverance, motivation and determination, together with the potential for patience, compassion and empathy towards patients and a variety of supplementary personal quality indicators. Applicants must also demonstrate that they understand the various medical career pathways and that they also require respectively (Anderson et al. 2011;Arnold et al. 1987). (See also (McHarg et al. 2007;Searle and McHarg 2003). The current policy applies a range of general criteria including academic achievements (i.e. cognitive measures) coupled with experience through internships or voluntary work.
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