Access to medical school – a middle class pursuit?

A recent study carried out by the Higher Education Authority found that the typical Irish medical student is female and middle class. Students are most likely to be from wealthier socioeconomic backgrounds, with only 14 per cent of students surveyed in receipt of grants. Although unsurprising to most, these findings raise significant questions about the diversity of medical students and accessibility of medical school to broader sections of society.

The biggest change in medical school admissions in recent years, the Health Professions Admission Test (HPAT), was introduced in 2009 as a rather blunt instrument to ameliorate the endless race for high Leaving Cert points and change the gender balance of a field that was becoming unsustainably female dominated. However, not only has it somewhat failed in that respect (with 58 per cent of current medical students being female), it could also be argued that it has only served to make access to medicine even more unequal than it was before.

It is now seen as a matter of course that more affluent students will spend hundreds of euro doing HPAT grinds courses; these simply are not an option for students from poorer areas of society. Entry into medical school is now increasingly only for those who can pay for it.

Aside from this, its unsuitability as a test to assess future doctors seems obvious – how could being able to match random shapes possibly ensure that someone will be a good neurosurgeon or a good GP or a good oncologist? What possible test could assess for the various aptitudes and personalities that the huge variety of specialties in medicine requires? In particular, its heavy assessment of non-verbal skills seems bizarre for a career where, no matter what specialty you go into, effective communication with your patients, families and colleagues is the cornerstone upon which everything else stands.

I argue that we need a wider approach in assessing admissions to medical school. We should look to our neighbours in the UK and US where, yes, high grades and aptitude tests are used as discriminators, but in combination with other methods such as personal statements and interviews.

We’ve all looked at certain classmates and colleagues and wondered what on earth possessed them to do medicine, people who may be vastly intelligent but you still wouldn’t let them anywhere near your granny. Perhaps having people really think about their motivation to do medicine as well as assessing their interpersonal skills may act in some way to ensure that people are entering medicine for the right reasons.

Of course no method is perfect; along with the rather trite argument that Ireland is too small for medical school interviews (as if people aren’t interviewed for jobs and training schemes in medicine every day of the week), an entire industry of interview prep courses and hospital work experience programmes has emerged in the UK that, again, are only affordable for the most affluent students. There is no doubt that a similar cottage industry would spring up in Ireland, given the chance.

Efforts must be made by the medical schools themselves to get a wider variety of people from society into medicine rather than just teenagers with high points and good HPAT scores from the same small number of private and grinds schools. The introduction of graduate-entry medicine courses has gone some way to change this, but again, they are only accessible to those who can afford the astronomical fees and four further years of living expenses or have family who are able to guarantee the vast loans required to finance it.

As well as aptitude tests and other methods to assess applications, medical school admission programmes need to actively target those they are missing; students from deprived areas, students from disadvantaged schools where there is no culture of students progressing to any form of third level education, much less medical school.

Some universities, particularly Trinity, run very successful access programmes, but all of the medical schools need to be more proactive on this. It needs to start early on in secondary schools; bright and interested prospective students need to be exposed to careers in medicine and given the support that students in more affluent schools are offered as a matter of course. Mentorship programmes should be established that offer role models and support to students who have no family members in medicine or in university at all.

If medicine is to truly be representative of Irish society, students need to arise from more than the large dynasties of Irish medical families. We must ensure that background and financial status are not barriers to entering medical school and that the people who study medicine are as varied as the people that they will one day treat.

<strong><em>Neasa is a graduand of UCD Medicine and is due to start her internship in July</em></strong>