Medical School Blues

Medical School Blues Opinion: Majid Ahmed

noreply@blogger.com (Unknown) — Sat, 05 Jul 2008 10:22:00 +0000

There has been recent widespread UK press coverage about the case of medical school applicant Majid Ahmed.

By all accounts Ahmed appears to have a glowing academic record and many personal traits that reinforce his suitability to practice medicine. His university application initially made a very positive impression, securing him interviews at several UK medical schools. One of the medical schools, that of Imperial College, made Ahmed an offer following his dazzling performances both on paper and in person.

But then it all fell apart. Imperial retracted their offer when it became known that Ahmed was a convicted burglar. He had received a conviction for burglary only two years earlier, yet considered it so insignificant that he failed to declare it openly as he should have done. It was only at the eleventh hour that Imperial discovered his previous misdemeanour. That left them little option but to reassess Ahmed's application after an offer was in place.

There is widespread sympathy with Ahmed's plight. Most in support cite the fact that Imperial College is discriminating against someone who has already paid their dues to society. He has been convicted by the courts so why punish him a second time by shattering his university dreams? The conviction relates to an offence committed when he was a naive 15-year-old, who simply got in with the wrong crowd in his hometown of Bradford. Lots of people make mistakes when they're a teenager, don't they?

Entangled in their sympathy for the apparent underdog most people have failed to grasp the most pivotal issue of the case - Ahmed is a burglar who failed to declare his criminal status transparently from the outset. That's an indisputable fact.

UCAS ask people to declare relevant convictions when they complete their application form. Sadly the word 'relevant' is open to interpretation because it only applies to offences considered 'unspent' under the auspices of the Rehabilitation of Offenders Act 1974. It appears Ahmed, perhaps acting on duff information, had used this interpretation to withhold information about his conviction of 2-years earlier. That was a mistake.

A little elementary investigation would have told Ahmed that medical careers are exempt from that legislation. This means they are never truly spent because future employers (or universities) can consider them during the recruitment process. Serious medical school applicants know these rules inside out.

Medical school admission is a cut throat business. Every year tens of thousands of applicants chase only a few thousand places. Every year thousands of exceptionally well qualified applicants face heartbreaking rejection, but accept their defeat graciously and with maturity. Contrast this with Ahmed's behaviour - a convicted criminal in a position of entirely his own making, yet he's still trying to get one up on the universities.

The universities have to separate the wheat from the chaff and, with the spiralling number of grade As being awarded at A-level, it's getting increasingly difficult to do that on a purely academic basis. This means that the universities are paying closer attention to factors like the applicants' interview performance, work experience and personal qualities.

This being the case why shouldn't Imperial College favour an honest applicant with glowing qualifications over a convicted burglar with comparable qualifications? Criminal actions have consequences.

Thinking a 2-year-old conviction for an inherently dishonest offence is too irrelevant to mention shows a severe lack of judgement and integrity on the part of Ahmed. Vulnerable people deserve to be treated by honest medical staff of unblemished character.

I also find Higher Education Minister Bill Rammell's intervention quite worrying. He is in no position whatsoever to dictate admissions policy to any UK institution. No doubt he has chosen to speak out in a hapless attempt to win the maligned Government some urgently needed brownie points.

Mr Rammell: Just because your profession and Government is morally void in every sense doesn't mean we should dilute the standards required of our medical practitioners.

Medical School Immunisations

noreply@blogger.com (Unknown) — Wed, 13 Feb 2008 14:10:00 +0000

The UK's Department of Health has strict guidelines on the immunisation of Health Care Professionals. Since most medical degree programmes now involve early clinical contact it's advantageous to get the necessary injections before turning up at the start of the course.

The medical schools will advise potential students of which immunisations they will require before coming into contact with patients. The usual requirements are as follows:

Proof of immunity against Hepatitis B or, if the immunisation process is unsatisfactory, proof of non-infectivity. The immunisation process involves three doses of vaccine over a period of about 6 months. A blood test will be required shortly after the final dose to determine whether immunisation has been successful. The test will either need to show the presence of Hepatitis B surface antibody or, if insufficient antibody is produced, that you are negative for Hepatitis B surface antigen and Hepatitis B e antigen.
Proof of immunity against diptheria, polio and tetanus. This is achieved by a combined vaccine usually administered every 10 years.
Proof of immunity against measles, mumps and rubella. Again, this is achieved by a combined vaccine usually given in childhood.
Proof of immunity against tuberculosis. This is achieved by the BCG vaccine, usually given in early adolescence.
Proof of immunity against chicken pox. If you've had it in childhood, as most people have, then you're immune. If you haven't had chicken pox you should have the varicella vaccine.

It saves a lot of hassle if you have completed these courses of treatment before turning up at medical school, although it is usually possible to catch up once you're there if need be. Remember to take any evidence you have relating to your immunisations.

Medical School Interviews

noreply@blogger.com (Unknown) — Fri, 18 Jan 2008 14:45:00 +0000

After reading my previous posts you'll be under no illusion that getting a place at medical school is no mean feat. Another hurdle that most people have to cross is the admissions interview.

There are still a few medical schools, Southampton for example, that make offers based purely on the information provided on the applicant's UCAS form. That being the case it is possible to dodge interview if you find the prospect too overwhelming, but in reality you would be foolish to limit your opportunity of getting a place by applying to only non-interviewing institutions. If you are an overseas applicant you are unlikely to be called for interview. If you are a graduate or mature student it makes it all but certain that you will be called for interview before any decision is made.

The interview is perhaps the most important part of the application process. By getting this far you have already proved your academic suitability, performed well in any admissions test and given the appearance of someone who could succeed at medical school on paper. Most applicants have not made it this far. Interview is the final opportunity you have to convince the selectors of your aptitude for medicine.

You only get one chance to make a first impression so make sure you are of clean, smart and practical appearance. Also remember to speak clearly and look at the interviewers when you are engaged in conversation.

Most interviews are conducted by at least two, possibly three interviewers. It is quite common for at least one of these to be a clinician and another a lay person - a non-clinician usually employed elsewhere in the university. Some medical schools invite a senior medical student to act as an interviewer. They will usually have read your UCAS form in detail beforehand and are likely to question you about your qualifications, personal statement (especially) and reference. I can not emphasise enough that you must know your UCAS form word for word and be prepared to answer questions on it. Most interviews begin with a few pleasantries like introductions, shaking of hands and asking about your journey etc.

The questions in the interview are likely to revolve around the following issues:

Your previous experiences, which you must be able to reflect on, and how these better equip you for a career in medicine.
Your understanding of the National Health Service (NHS): What it is, the general structure and how it works.
Ethical questions: What would you do in the situation put to you by the interviewers?
NHS awareness: Read some current stories on the NHS and be prepared to recite them and comment on them.
Why you want to become a doctor: Almost a cliche and few medical schools bother to ask it anymore. Best to have an answer ready just in case.
Why you want to study at [University name]: Know a little bit about the structure of the course and what makes it different from other medical degrees.

When answering the questions remember that there are some key qualities that are expected of all medical students:

Honesty
Integrity
Trustworthiness
Empathy
Compassion
Academic excellence
Perseverance
Teamwork
Reflection

Probably many more which I will add to the list as I think of them.

At the end of the interview there is usually an opportunity for you to ask any questions you have about the course. If you have no questions then don't feel obliged to ask something silly - just explain that you have looked at the course brochure and have already found most of the answers.

The interview usually lasts around half an hour. Once the interview is over it is over - there's no point dwelling on it and torturing yourself with a detailed post mortem.

All being well you should hear their decision within a few weeks.

Medical School Finance

noreply@blogger.com (Unknown) — Sun, 30 Dec 2007 22:19:00 +0000

You need to carefully consider the following sources of income and expenditure before you start your journey through UK medical school. You will have to carefully balance the following:

Income:

Student loans.
Parental/family contributions.
Employment.
Savings.

Expenditure:

Tuition fees.
Living expenses.

The student support you are entitled to depends on a number of factors: where you live, whether you have previously been supported in higher education, whether you have any dependents and the duration of your course. Home students are those who are normally resident in the UK/EU or Switzerland. Overseas students are those from elsewhere.

1. Home students on the standard 5-year course who have NOT previously attended a higher education course:

In each of the first four years of the course these students are entitled to full support from the Student Loans Company. This support is in the form of a loan covering both living expenses and tuition fees.
In the final year these students are entitled to a non-repayable NHS bursary and a reduced loan from the Student Loans Company to cover their living expenses. The NHS will also pay their tuition fees.

2. Home students on the accelerated 4-year graduate entry course:

In the first year these students are entitled to partial support from the Student Loans Company. They are entitled to the living expenses component only and will have to fund their own tuition fees.
In each of the remaining three years these students are entitled to a non-repayable NHS bursary and a reduced loan from the Student Loans Company to cover their living expenses. The NHS will also pay their tuition fees.

3. Home students on the standard 5-year course who HAVE previously attended a higher education course:

In each of the first four years of the course these students are entitled to partial support from the Student Loans Company. They are entitled to the living expenses component only and will have to fund their own tuition fees.
In the final year these students are entitled to a non-repayable NHS bursary and a reduced loan from the Student Loans Company to cover their living expenses. The NHS will also pay their tuition fees.

4. Overseas students on the standard 5-year course:

These students are liable to pay their own tuition fees and living expenses.

5. Overseas students on the accelerated 4-year graduate entry course:

At the moment overseas students are ineligible for the graduate entry course.

The new system of Government student loans (from the Student Loans Company) provide enough support for most home students to survive comfortably. The interest on these loans is linked to the rate of inflation, meaning graduates pay back only what they've borrowed in real terms. Further information can be found on the Student Loans Company website.

Medical School Entrance Exams

noreply@blogger.com (Unknown) — Thu, 15 Nov 2007 11:07:00 +0000

With ever increasing A-level results getting a place at medical school is more competitive than it has ever been. Another way of sorting the wheat from the chaff are the medical school entrance exams, which came into existence at the start of the decade. Medical schools usually use the exams as an additional filter of applicants before the interview stage - if you don't do well in the exam you don't invited for interview.

There are three main exams:

UKCAT: The UK Clinical Aptitude Test - an exam required by everyone applying to a 5-year undergraduate medical degree programme.
GAMSAT: The Graduate (Australian) Medical School Admission Test - an exam required for entry to some 4-year graduate entry courses and some 5-year courses. As the name suggests a variety of this exam is also used for entry to Australian medical schools.
BMAT: The BioMedical Admissions Test - an exam required for entry to some 4-year graduate entry courses.

Applicants should check carefully which institutions require which exam because it is quite often necessary to register for these exams before the UCAS application deadline (15th October each year).

It is sad that, because of the watering down of the A-level gold standard, medical schools have had to resort to these additional exams. It's also quite an unfair system for three reasons:

The cost: These exams can cost hundreds of pounds EACH. If the exam venue is far from your home you will also need to cover your own travel expenses and one, possibly two, night's accommodation.
The time frame: Some exams, GAMSAT for example, have only one sitting during the year. If you can't attend you can't sit the exam at another time.
The geography: Some exams are held at 'centralised' locations. If you live in a remote part of the UK then getting to these places could be a problem.

The disproportionate cost, particularly of GAMSAT, is my main gripe - I honestly believe the massive expense is a deterrent to many very capable medical school applicants.

In my case GAMSAT costs nearly £200 to register, plus I have to travel more than 100 miles to Sheffield (about £40 return rail fare), spend 2 nights in a hotel (about £100). Combined with other expenses (like food and drink) this means it costs me nearly £400 in total to sit GAMSAT. That is a lot of money - most people's monthly mortgage or rent bill.

Now for a little more about each exam. Please be sure to check the details on the official websites:

UKCAT

When:

UKCAT must be registered in August/September/October of the year before you intend to enter medical school. The last date to sit the exam is the middle of October in the year before you enter medical school (eg. before the UCAS application deadline of 15th Oct). Candidates can choose which day they take the test, but it can only be taken once and must be before the published deadline. Be sure to check the website for precise dates.

Where:

UKCAT is sat at your local Pearson Vue test center. These are the same people who do the driving theory test.

What's involved:

UKCAT is a computer based test with 5 sections:

Section 1, "Verbal Reasoning", in which candidates have to respond to onscreen evidence. Examples might include responding to a piece of poetry, a newspaper article or a chart. All questions have a choice of 4 possible answers and have an equal weighting.
Section 2, "Quantitative Reasoning", in which candidates have to perform onscreen maths problems. Quite often this involves responding to the evidence provided. All questions have a choice of 4 possible answers and have an equal weighting.
Section 3, "Abstract Reasoning", in which candidates have to recognise and respond to patterns of shapes. All questions have a choice of 4 possible answers and have an equal weighting.
Section 4, "Decision Analysis", in which candidates use the evidence provided onscreen to decipher some codes. All questions have a choice of 4 possible answers and have an equal weighting.
Section 5, "Non-Cognitive Analysis", in which candidates answer a series of profiling questions. This new test was introduced in 2007 and is being trialled. It didn't count towards the final UKCAT score in 2007, but may do in future.

How is it scored:

Each section is scored between 300 and 900, with scores between 500 and 700 being the norm. An overall score is obtained from the mean of all sections.

When are results published:

As UKCAT is computer based results are available immediately on completion of the test.

Other points:

You will be provided with a calculator and an erasable board for working out.

UKCAT is a 'busy' test with lots to do in a short space of time. Incorrect answers are not penalised so it's important to maintain a sense of urgency and complete all questions. Although you may be permitted to take a break the clock will not be stopped if you choose to do so.
UKCAT scores are available for only one year.
Unfortunately I can't remember the time limit for each section because I was a bit rushed!
A good revision resource is the book called "Passing the UK Clinical Aptitude Test and BMAT" by Felicity Walker-Buckton, Rosalie Hutton and Glenn Hutton.

GAMSAT

When:

GAMSAT must be registered in the June/July of the year before you intend to enter medical school. The exam is sat in September of the year before you enter medical school (eg. before the UCAS application deadline of 15th Oct).

Where:

GAMSAT is held at the following test centres around the UK: Birmingham, Bristol, Swansea, London, Nottingham, Sheffield. It is also available at Melbourne, Australia.

What's involved:

GAMSAT has 3 sections:

Section 1, "Reasoning in Humanities and Social Sciences", has 75 multiple choice questions. Candidates are allowed 10 minutes reading time and then 100 minutes to complete the section. All questions have a choice of 4 possible answers and have an equal weighting.
Section 2, "Written Communication", has 2 essay questions. Candidates are allowed 5 minutes reading time and then 60 minutes to complete the section. Both questions have an equal weighting.
Section 3, "Reasoning in Biological and Physical Sciences", has 110 multiple choice questions. Candidates are allowed 10 minutes reading time and then 170 minutes to complete the section. All questions have an equal weighting.

How is it scored:

ACER, the people who administer the test, have a complicated algorithm for marking the tests. A useful approximation is as follows: Overall score = [(1 x Section 1) + (1 x Section 2) + (2 x Section 3)] / 4.
The medical schools set a different overall pass score each year, but for entry to Nottingham and St. George's candidates must score the following: at least 55 in either section 1 or section 3, at least 55% in section 2, at least 50% in the remaining section, an overall score equal to or higher than that published.

When are results published:

About 6 weeks after the exam date. ACER will email you prior to the results being published.

Other points:

The exam takes a full day and usually begins at around 10 am and finishes around 6 pm. Sections 1 and 2 are completed in the morning, then there's a 1 hour lunch break, then section 3 is completed in the afternoon. There is a short refreshment break between sections 1 and 2.
Candidates are allowed a bilingual dictionary for sections 1 and 2. Use of a calculator is permitted in section 3.
GAMSAT scores are valid for 2 years.
There are some good GAMSAT preparation courses, but these are expensive. It is also worthwhile buying the sample questions. Questions tend to be very similar each year.

BMAT

When:

BMAT must be registered in August/September/early October of the year before you intend to enter medical school (eg. before the UCAS application deadline of 15th Oct). The exam is sat at the end of October in the year before you enter medical school.

Where:

BMAT can be sat at a suitably registered Cambridge Assessment test centre, normally quite local to where the candidate lives. More details on the website.

What's involved:

BMAT has 3 sections:

Section 1, "Aptitude and Skills", has 35 multiple choice questions to be completed in 60 minutes.
Section 2, "Scientific Knowledge and Applications", has 27 multiple choice questions to be completed in 30 minutes.
Section 3, "Writing Task", has a choice of 3 essays questions, one of which is to be completed in 30 minutes.

How is it scored:

Each section is scored between 1 (low) and 9 (high). Most candidates should expect to get around 5 in each section, only the most able score 6 or higher. Scores are reported to one decimal point.

When are results published:

Results are available a few days after the exam. For more details see the website.

Other points:

Candidates are not allowed a calculator or bilingual dictionary.
BMAT scores are valid for only one year.
A good revision resource is the book called "Passing the UK Clinical Aptitude Test and BMAT" by Felicity Walker-Buckton, Rosalie Hutton and Glenn Hutton.

Remember that most of these tests require the candidate to respond to the sources of evidence provided. If you do have to do these tests be sure to get it right first time - it's too expensive not to! Good luck.

University Application Process

noreply@blogger.com (Unknown) — Sat, 10 Mar 2007 10:50:00 +0000

Since I've told you about Medical Education in the UK it's only fair I tell you about the application process involved. All UK/EU home students apply to undergraduate degree courses via the University and College Admissions Service (UCAS). This applies equally to school leavers, mature students and those graduates who wish to pursue a second undergraduate degree. In days gone by, when I was a young lad applying for my first chemistry degree, this used to be done using a paper form but now it's all done electronically using the 'Apply' system. This has the big advantage of allowing you to fill in your details online, save them on the UCAS server and then return to adjust them later on - there's negligible chance of losing your data since it's stored at their end.

The online application form, just like the previous paper version, has three sections:
1. Personal Details
2. Personal Statement
3. Reference

The personal details section asks for you name, date of birth, address and that sort of thing. It also asks for you to provide details of all your academic qualifications (type, date, awarding body) and employment history. The personal statement is an opportunity for the applicant to write a few paragraphs of prose in an attempt to 'sell them self' to their university choices. Here you would include your reasons for applying, details of any relevant work experience, alternative qualifications and personal skills. The reference section is an 'academic type' reference provided by your school, college, employer or someone else neutral, preferably of some standing, who knows you well.

There are several books that offer solid advice to budding medical students about how to tackle the application process. Those published by BMJ Press (British Medical Journal) are obviously quite informative.

One of the downsides of the application system is that the same details go to each of your university choices. You're allowed up to 4 medical school choices and obviously if you tailor your application form to the requirements of institution X, you might not satisfy those of institution Y. In medicine you've got to take any offers you get, so best not to offend any of your choices. That's something you need to be careful of. You are also allowed 2 non-medical choices on the application, so you've got 6 choices in total. You don't need to use all 6 if you don't want to - don't apply to somewhere you're not interested in just because you need to fill a space on the form!

There is also a strict time frame that needs to be kept to for medical school applications. Applications open on 1st September each year and must be received by UCAS by 15th October each year. Since there is such fierce competition to get a place you have zero chance of being considered if you submit your application late. There may also be separate entrance exams that you need to register for and the deadlines for these will vary - check beforehand.

You can follow the progress of your application online using UCAS's 'Track' system. Some universities will interview before making an offer, others will offer without interview and some will reject you solely on the basis of your application form. When all of the universities have made a decision you have to choose which offer to accept. If you are rejected by all of your choices or choose to withdraw you will have the opportunity to enter the UCAS 'Clearing' process. Clearing is a collection of unpopular courses that are under subscribed so desperate to fill their places.

Next time I'll discuss some of the medical school entrance exams in a bit more detail.

UK Medical Education

noreply@blogger.com (Unknown) — Fri, 02 Mar 2007 10:59:00 +0000

I thought I would explain a bit more about the system of medical education for the benefit of those unfamiliar with how doctors are trained in the UK.

All medical practitioners in the UK have to be registered with the General Medical Council. The GMC is the authority responsible for the registration and licensing of all medical practitioners in the UK. Registration is achieved by gaining a primary medical qualification at a medical school listed by the World Health Organisation. The GMC do not treat all medical schools in the WHO directory the same - schools in the UK, EU and Switzerland are, to a certain extent, favoured over those from elsewhere.

There are 3 levels of registration with the GMC - limited, provisional and full. If you are a graduate from a UK/EU/Swiss medical school you are entitled to provisional registration for your first 12 months after graduation and then can upgrade to full registration. If you are a graduate from a medical school elsewhere you are usually entitled to limited registration, which has certain conditions you need to fulfill before you are allowed to become fully registered.

For UK medical schools the primary medical qualifications awarded are the degrees of Bachelor of Medicine and Bachelor of Surgery. These degrees are usually abbreviated to MB ChB, MB BS, BM BS or MB BChir. The University of Southampton award a degree called just Bachelor of Medicine (BM), but this has exactly the same value and meaning as those degrees with the 'double-barrelled' names.

Traditionally, it takes a school leaver 5 years to graduate with a primary medical qualification from a UK university. Within the last decade 'foundation year' and 'graduate entry' courses have been introduced. The courses with a foundation year, aimed at those people with non-science backgrounds or alternative qualifications, last 6 years. The graduate entry courses, open to graduates with a good science degree or who are already healthcare workers, last only 4 years. Whichever route is taken the result at the end is the same - a primary medical qualification that allows registration with the GMC.

My Journey Begins

noreply@blogger.com (Unknown) — Fri, 02 Mar 2007 10:39:00 +0000

Let me introduce you to both myself and this blog. Medical School Blues is an ongoing chronicle of my journey to, hopefully through, medical school in the UK.

I come to medicine from a slightly unorthodox background - not as a school leaver, but as a PhD chemist seeking a change of career. I've wanted to be a medical practitioner ever since I was at school. Back then A-levels were the 'gold-standard' qualification of the compulsory education system. They were much harder, un-modularised and people could start a reasonable career with them. Fewer people were going into higher education and the medical schools had lower admission standards than they do today. The sensible thing, in hindsight, would have been to apply for medical school back then. A combination of things, mainly my wavering confidence, meant I went to chemistry instead. I've done alright at chemistry too - I've studied at a good university and got good qualifications but the endless grind of research, chasing dead ends and low job satisfaction has rekindled my passion for a medical career. In my branch of chemistry, analytical chemistry, you churn out repetitive results in a lonely lab and don't see the significance for several months. Medicine is not like that - in medicine actions today can have a pronounced, worthwhile and noticeable effect tomorrow and in days to come.

I long for the day I can leave the relentlessly churning sausage factory of chemistry and head for my true vocation in life. It will be a long road and many challenges will lie ahead, but I'm sure I'll get there in the end.