Graduate Entry Medicine – Life before, during and
after.
Michael Crisp
FY2 Doctor – General
Practice
Background
My first experience of higher education came
in the late 1990’s when studying for a degree in biology.
During my time at university one of the favourite discussions, sure
to inspire heated emotions over a pint in the students union bar
was the traditional “who’s course is the hardest” debate.
There were of course many reasonable contenders, some more
convincing than others, however, consistently, one of the strongest
contenders for the top spot was always medicine.
With medical students facing at least two
extra years worth of study, long hours, regular exams, clinical
placements often far from home; medics never had any problems
convincing their peers that their course was indeed highly
demanding. Even then, once the resilient medic had made it
trough the trials of medical school they were rewarded with even
longer hours, regular on-calls, night shifts and yet more exams for
many more years to come. So armed with this insight one would
reasonably assume that I would never even consider becoming a
medical student, let along a doctor. However, you would be
wrong; in 2002, 4 years after graduating for the first time, I
began medical training on the four year Graduate Entry medicine
course at St Georges Hospital Medical School.
A change of career
After I completed my first degree I went to
work for a large hotel company in sales and marketing, eventually
working as a Marketing Analyst. I enjoyed my time, had fun
working and socialising in central London, learnt a lot about
business and above all, grew up a lot. However, after three
years changes took place in the company which forced me to make a
decision about my long term career and I began to look to
opportunities outside of the commercial world.
Around the same time, partly in a response to
a chronic shortage of doctors in the UK, four year graduate entry
medical courses were slowly beginning to take shape. This
radical departure from traditional training was very much in its
infancy and it would be another two years before any doctors
trained in this way would hit the wards. After much research,
shadowing of doctors and months of deliberation I took the decision
to apply to St Georges for their Graduate Entry Course. Some
6 months, two application forms, an 8 hour exam and an interview
later I was lucky enough to get a place and began my medical
studies.
Making a change of career is never an easy
decision and is certainly not one to be taken lightly.
However making the decision to start a career which will first
require four years at university is even harder and far
riskier. Four years out of a job in industry is a long time,
if having completed my time at medical school I decided that
medicine was not for me it would have been almost impossible to
slot back into my old role, certainly not at the same level.
There were also huge financial implications; a salary would have to
be swapped for grants and student loans. In spite of all the
potential pitfalls I took the decision that it was a risk worth
taking and left my cosy office behind for the slightly more
uncertain life as a medical student. A decision, which I am
pleased to say I have never regretted.
The Graduate Entry Course
At the time of starting my medical studies,
Graduate Entry medicine was s new concept in the UK and as such had
been attracting significant attention from the media and not always
in a positive way. One of the principle criticisms levied,
mainly in the lay press, was that a four year course heralded the
“dumbing down” of medicine. How could medical schools
possibly guarantee the same standard in doctors who have missed one
fifth of their medical training? Abridged anatomy classes
were often cited as one of the principle areas where a graduate
entry student was likely to be significantly disadvantaged compared
to their five year counterparts. Thankfully, however, such
fears have proven misplaced. The first graduate entry
students qualified four years ago and have shown they are more than
able to hold their own along side doctors trained for five
years.
In order to condense medical training into
four years there are of course some subjects that are covered in
less detail, however the reality is that such areas are few and far
between. While the graduate entry course is only four years
long, holiday time is much shorter than on the five year course,
meaning that the real difference in time spent in the classroom can
be counted in months. Graduate Entry Students sit exactly the
same final examinations as the five year students, proof in itself
that although the route may be different, the end result is the
same.
Graduate Entry Course
Structure
The graduate course at St Georges and I
believe at several other medical schools, is centred on so called
problem based learning. For the first two years students are
taught in small groups, spending each week working their way
through a clinical case. Learning is entirely self-directed,
through discussion; students generate their own learning points,
hopefully stimulated by the case. During these problem based
learning (PBL) sessions students feed back their learning to each
other, there is a facilitator present, however their role is simply
to ensure the continuity of discussion they do not provide any
educational input. There are lectures, and practical
sessions, however it is the PBL sessions where the majority of
learning takes place.
Initially the PBL style of learning can be
hard to adjust to and I will admit to being slightly sceptical to
whether or not the process would work at all! Thankfully,
things soon slot into place and while PBL is not necessarily and
educational approach that would suite everyone, I personally found
it to be excellent.
The real innovation brought by graduate entry
medical courses was far more subtle that simply shaving a year off
medical education, gradate entry courses represented the first
truly integrated, multidisciplinary, approach to medical
training. We experienced significant patient contact from day
one. In addition, far more emphasis was placed on
communication skills, professional development and ethics than had
previously been the case. All of which have proven far more
useful in my career to date than a detailed knowledge of anatomical
minutiae.
In common with any educational course,
regardless of subject matter, there were and more than likely still
are some problems with the graduate entry approach. However,
overall my experience was a positive one and I feel that the course
left me well equipped to deal with life as a junior doctor and
beyond.
Life beyond Graduate Entry
Medicine
Well over a year has now passed since I
qualified and I am currently working as an F2 doctor in general
practice. When I first stated at medical school I had an idea
that I might like to follow a career in general practice and in
spite of exploring various other options along the way, this is
still very much the case.
There was an entirely false and very much
unsubstantiated urban myth that circulated when I was medical
school that the Graduate Entry Course was designed specifically
with general practice in mind, particularly as at the time there
seemed to be a surplus of vacancies in general practice.
Firstly, there is no suggestion at all that graduate entry medicine
is designed to “fast track” doctors into general practice.
Secondly, the perceived shortfall of GP’s at that time now no
longer exists, with general practice being a highly competitive
career choice. However, that said, I do feel that the way in
which I was educated at medical school has been extremely
beneficial to my aspirations to be a GP. The huge emphasis
that is placed on communication skills certainly puts one at an
advantage. During a recent GP teaching session for F2
doctors, I was struck by how much the communication models we were
taught as graduate entry students mirrors those assessed by the
MRCGP.
Life as a junior doctor is not always an easy
one and at low points, generally approaching the end of a night
shift or a hectic 12 hour on call, I have on occasion looked back
to my old life as a Marketing Analyst wistfully. However,
such moments are short lived and for the vast majority of the time
I love my new career as a doctor. At the time, it was
certainly one of the most major decisions that I had ever had to
make, thankfully it is not one that I have lived to
regret.
My advise to anyone considering a similar
career, or perhaps more accurately, life change, would be to spend
a long time thinking, weighing up the pros and cons.
Definitely spend some time with real doctors in hospitals so that
you really understand what they do. It is also a good idea to
spend time with either an experienced GP or consultant, as
ultimately theses are the jobs that you will be doing long
term. If at the end of all that you are still keen: go for
it! You will not regret it!