381
Medical Education
IF I WERE A DEAN
CHARLES CLAOUÉ* SUPPOSE we look at the current-edition medical student. In the eyes of his fellow (non-medical) students he is usually "somehow different" or even "a bit strange". Could it be that medical students are selected on different criteria from those applied to other would-be students ? The non-medicals will usually grudgingly admit that medical students, despite their reputation for high alcohol intake and peculiar jokes, do work hard. Perhaps this is because selection committees choose the students who most resemble themselves. And what opinion do medical students have of themselves? Usually too high, but I think this helps them to survive. Often there is a feeling of great doubt about embarking on a medical career. A tutor told me that about 20% of his medical students saw him during their first term with a view to changing course. In fact, very few do change, and by the start of the second term there is a feeling that "this is the right thing for me to be doing." The actual selection of medical students is a complex interaction between applicant, medical school, and U.C.C.A. The applicant has to play a dangerous game. His U.C.C.A. application form must make him appear interesting but industrious. He must have a reasonable but not excessive number of pastimes, and they should not include such enthusiasms as punk-rock or large motor-cycles. The order of medical schools is all-important, for some schools can easily make their choice from the applicants who list them as first preference. The next step may be the interview. In my own case, I feel that I eventually got into a medical school because it chose not to interview me. (A certain monarchal London medical school was so horrified by my interview performance that I arrived home to discover that they had already rejected me by telephone.) The interviewers have the applicant absolutely at their mercy. What are they, or the unseen selectors, looking for? Presumably an ability to complete a five or six year medical course without too many problems during or after the course,
*Preclinical medical student, Churchill
6. Sibert, R. Br. med. J. 1975, iii, 87. 7. Brown, G. W., Ni Bhrolcháin, M., 8. Brown, G. W., Harris, T. O. Social
College, Cambridge CB3
ODS
Sociology, 1975, 9, 225. of Depression: A Study of Psychiatric Disorder in Women. 1978. London (in the press). 9. Cooper, J., Copeland, J., Brown, G. W., Harris, T. O. Psychol. Med. 1977, Harris,
T. O.
Origins
7, 517.
10. Wing, J. K., Nixon, J. M., Mann, S. A., Leff, J. P. ibid. p. 505. 11. Brown, G. W., Davidson, S., Harris, T. O., Maclean, U., Pollock, S., Prudo, R. Soc. Sci. Med. 1977, 11, 367. 12. Douglas, J. W. B., Blomfield, J. M. Children Under Five. London, 1958. 13. Rutter, M. Children of Sick Patients—An Environmental and Psychiatric
Study. London, 1966. M., Paykel, E. S. The Depressed Woman: A Study Relationships. Chicago, 1976. 15. Manheimer, D. I., Mellinger, G. D. Child Dev. 1967, 38, 491. 14. Weissman, M.
16. Mitchell, R. G. Devl Med. Child Neurol.
1967, 9, 767.
of Social
for either the student or the medical school. One problem at once arises: not all medical graduates will enter clinical practice in the U.K. Some will go into administration, or laboratory research, or emigrate. The heterogeneity of medical students allows them to go off in many directions at the end of their course, and I feel that this heterogeneity is such a good thing that I would be tempted to reserve one place on the course for the least-likely candidate applying each year. Possibly a few should be chosen because they might become good deans. There is no way of judging how good a doctor will eventually be when he is only seventeen. Perhaps the best way to choose is intuitively. How can one judge whether or not that specific individual, whose entire future is in the balance, will be able to maintain the interest and put in the long hard hours required? How many applicants are asked if they are prepared to work a seven-day week? Surely a good applicant should have some idea of suffering and dying as well as the more successful aspects of medicine? There is something romantic and glorious about rushing around curing patients which appeals to young men denied swashbuckling days chasing adventure with a sword at their side; but there is less appeal in holding the hand of an old lady whilst she breathes her last. The candidate who shows no interest, at interview, in the care of the dying will be the same person when qualified. He can be trained, but does this really change his fundamental outlook? When I asked a friend what was the most important attribute to look for in a candidate for medical school, she narrowed her eyes and purred "Supreme self-confidence". Besides this, an ability to pass exams seems to be a good criterion. Much like i.Q. tests, they sort people out according to how good they are under unnatural, precisely defined conditions. The curricula are ludicrous. (What are the metabolic products of pipecolate? Can you name the seventeen or more branches of the internal-maxillary artery? Give a brief account of the hormone tuftsin.) Schools do their share of the damage. Students who arrive at medical school with A-levels in maths, physics, and chemistry are at a grave disadvantage, yet those arriving with biology, chemistry, and physics are very nearly a minority. It is perhaps desirable that medical students should be slightly more numerate, and I would like to see medical schools offering more places to people with biology, chemistry, and the new A-level subject physics-with-mathematics. At present only a perverted 1% of students are prepared to do a third-year course in medical statistics; and, at the other extreme, I have known some to faint at the sight of log tables. Quite often, bright school-students studying biology as one of their A-level subjects are encouraged to apply to read medicine almost as a logical next step. This I suspect has very little effect; people don’t apply for five-year courses unless motivated from within. But what motivation should medical schools be looking for? A wish to cure people? Better become a faith healer. Want to be rich? Try organised crime. Daddy-is-a-doctor? Professional phenotypes are the result of environmental effects on the products of multiple genetic loci, not directly inherited. So why did I want to be a doctor? I think the answer that I would look for as dean is: "Please sir, I really don’t know."
Medical Education
IF I WERE A DEAN
CHARLES CLAOUÉ* SUPPOSE we look at the current-edition medical student. In the eyes of his fellow (non-medical) students he is usually "somehow different" or even "a bit strange". Could it be that medical students are selected on different criteria from those applied to other would-be students ? The non-medicals will usually grudgingly admit that medical students, despite their reputation for high alcohol intake and peculiar jokes, do work hard. Perhaps this is because selection committees choose the students who most resemble themselves. And what opinion do medical students have of themselves? Usually too high, but I think this helps them to survive. Often there is a feeling of great doubt about embarking on a medical career. A tutor told me that about 20% of his medical students saw him during their first term with a view to changing course. In fact, very few do change, and by the start of the second term there is a feeling that "this is the right thing for me to be doing." The actual selection of medical students is a complex interaction between applicant, medical school, and U.C.C.A. The applicant has to play a dangerous game. His U.C.C.A. application form must make him appear interesting but industrious. He must have a reasonable but not excessive number of pastimes, and they should not include such enthusiasms as punk-rock or large motor-cycles. The order of medical schools is all-important, for some schools can easily make their choice from the applicants who list them as first preference. The next step may be the interview. In my own case, I feel that I eventually got into a medical school because it chose not to interview me. (A certain monarchal London medical school was so horrified by my interview performance that I arrived home to discover that they had already rejected me by telephone.) The interviewers have the applicant absolutely at their mercy. What are they, or the unseen selectors, looking for? Presumably an ability to complete a five or six year medical course without too many problems during or after the course,
*Preclinical medical student, Churchill
6. Sibert, R. Br. med. J. 1975, iii, 87. 7. Brown, G. W., Ni Bhrolcháin, M., 8. Brown, G. W., Harris, T. O. Social
College, Cambridge CB3
ODS
Sociology, 1975, 9, 225. of Depression: A Study of Psychiatric Disorder in Women. 1978. London (in the press). 9. Cooper, J., Copeland, J., Brown, G. W., Harris, T. O. Psychol. Med. 1977, Harris,
T. O.
Origins
7, 517.
10. Wing, J. K., Nixon, J. M., Mann, S. A., Leff, J. P. ibid. p. 505. 11. Brown, G. W., Davidson, S., Harris, T. O., Maclean, U., Pollock, S., Prudo, R. Soc. Sci. Med. 1977, 11, 367. 12. Douglas, J. W. B., Blomfield, J. M. Children Under Five. London, 1958. 13. Rutter, M. Children of Sick Patients—An Environmental and Psychiatric
Study. London, 1966. M., Paykel, E. S. The Depressed Woman: A Study Relationships. Chicago, 1976. 15. Manheimer, D. I., Mellinger, G. D. Child Dev. 1967, 38, 491. 14. Weissman, M.
16. Mitchell, R. G. Devl Med. Child Neurol.
1967, 9, 767.
of Social
for either the student or the medical school. One problem at once arises: not all medical graduates will enter clinical practice in the U.K. Some will go into administration, or laboratory research, or emigrate. The heterogeneity of medical students allows them to go off in many directions at the end of their course, and I feel that this heterogeneity is such a good thing that I would be tempted to reserve one place on the course for the least-likely candidate applying each year. Possibly a few should be chosen because they might become good deans. There is no way of judging how good a doctor will eventually be when he is only seventeen. Perhaps the best way to choose is intuitively. How can one judge whether or not that specific individual, whose entire future is in the balance, will be able to maintain the interest and put in the long hard hours required? How many applicants are asked if they are prepared to work a seven-day week? Surely a good applicant should have some idea of suffering and dying as well as the more successful aspects of medicine? There is something romantic and glorious about rushing around curing patients which appeals to young men denied swashbuckling days chasing adventure with a sword at their side; but there is less appeal in holding the hand of an old lady whilst she breathes her last. The candidate who shows no interest, at interview, in the care of the dying will be the same person when qualified. He can be trained, but does this really change his fundamental outlook? When I asked a friend what was the most important attribute to look for in a candidate for medical school, she narrowed her eyes and purred "Supreme self-confidence". Besides this, an ability to pass exams seems to be a good criterion. Much like i.Q. tests, they sort people out according to how good they are under unnatural, precisely defined conditions. The curricula are ludicrous. (What are the metabolic products of pipecolate? Can you name the seventeen or more branches of the internal-maxillary artery? Give a brief account of the hormone tuftsin.) Schools do their share of the damage. Students who arrive at medical school with A-levels in maths, physics, and chemistry are at a grave disadvantage, yet those arriving with biology, chemistry, and physics are very nearly a minority. It is perhaps desirable that medical students should be slightly more numerate, and I would like to see medical schools offering more places to people with biology, chemistry, and the new A-level subject physics-with-mathematics. At present only a perverted 1% of students are prepared to do a third-year course in medical statistics; and, at the other extreme, I have known some to faint at the sight of log tables. Quite often, bright school-students studying biology as one of their A-level subjects are encouraged to apply to read medicine almost as a logical next step. This I suspect has very little effect; people don’t apply for five-year courses unless motivated from within. But what motivation should medical schools be looking for? A wish to cure people? Better become a faith healer. Want to be rich? Try organised crime. Daddy-is-a-doctor? Professional phenotypes are the result of environmental effects on the products of multiple genetic loci, not directly inherited. So why did I want to be a doctor? I think the answer that I would look for as dean is: "Please sir, I really don’t know."
