More medical students for England

In late March this year the UK government announced funding for 1033 more medical students in England. The places were allocated across 14 medical schools. Two further new medical schools are being created as a result of successful collaborations between Hull and York universities and between Brighton and Sussex. Last year, new medical schools were announced at Plymouth and Exeter (the Peninsula Medical School) and at the University of East Anglia. These new schools are designed to meet regional shortages and some of the additional allocations reflect the establishment of new centres or alliances. This brings the number of medical schools in England to 21, aiming to provide better distribution of medical education across all parts of the country with consequent major effects for medical care. By 2005, the annual intake to medical schools will be 5894 compared with 3749 in October 1997. Table 1 shows the numbers of students allocated to medical schools in this round of bids. A joint implementation group allocated places after consideration of bids from medical schools. The implementation group represents the Higher Education Funding Council for England (HEFCE), the Department of Health and the General Medical Council. The group used several decision-making criteria, reflecting the desire to secure high quality, cost-effective medical education; to broaden the range of social and ethnic backgrounds amongst medical students; to widen opportunities for graduates of other subjects and for other health care professionals to become doctors; to encourage innovative collaboration between universities and the NHS; to meet regional needs, and lastly, to encourage multiprofessionalism in medical training aiming to ensure health care professionals work more effectively together. Many of the universities gaining extra student numbers are aiming to widen the social mix of students, whilst retaining recruitment on merit. In 1999 more students from socioeconomic group 1 were accepted into medicine than the combined total number from groups 3, 4 and 5, and twice as many were accepted from professional family backgrounds than from unskilled ones. Examples of proposed schemes include The Durham/Newcastle Universities Medical School at the Stockton Campus (UDSC), where the course has been specifically designed to support students from all sectors of secondary education in an area where low levels of students enter higher education. UDSC has a specific mission to bring educational quality to one of England’s most deprived Regions in terms of deprivation, poverty, and crime. Collaboration between the Universities of Bradford and Leeds seeks to recruit students from a broader range of social and ethnic backgrounds and the University of Birmingham aims to attract increasing numbers of students from local, socially deprived areas. A compact scheme with local high schools has recently been reported by the University of Sheffield and is being taken up by other universities. Graduate entry is also growing in popularity, with places awarded in 1999 to St George’s Medical School, London, and jointly at the Universities of Leicester and Warwick. Such courses offer opportunities for widening access to medical training and represent almost 40% of the total new numbers awarded in 2001. New graduate entry courses will be offered by the Universities of Birmingham, Bristol, Newcastle, Nottingham, Queen Mary (University of London), and Southampton. The establishment of new medical schools and increasing numbers of students are positive moves in a National Health Service which is a net importer of medical staff and which is under increasing pressure from planned expansions in specialist numbers. Growth brings opportunities for invention and new ways are needed to prepare doctors for the modern world of clinical practice. The new programmes offer opportunities to critically evaluate the effects of multiprofessional learning activities, of graduate entry, and of liberal curriculum models. Intriguing questions remain unresolved, however. Will more students place added pressure on a system already over-stretched by the demands of institutional performance measures for research and teaching quality? Where will the new medical schools find their teachers? How will the expansion in student numbers be supported in the community where contractual unrest amongst general practitioners has reached unprecedented peaks in recent weeks? With one of the aims of expansion being to achieve more cost-effective medical education, more work is needed on the relative costs of differing models of curriculum.