The debate about whether school leaver entry or graduate entry is better for medicine will continue for a long time because there are winners and losers in either scenario (Inside Story, 24/11/2006; Letters, 8/12). The graduate entry pathway has the following disadvantages:
1. Many highly able students who would otherwise have become excellent doctors will be lost to other professions, because they may be reluctant to obtain another degree after graduation.
2. Graduate medical programs reduce the productive working life of a doctor.
3. The longer duration of study is likely to result in increased cost of services to patients on graduation and higher costs to tax payers to subsidise their study.
4. A significant proportion of school leavers are mature enough to make career choices. Our evidence is that over 99% of Year 12 students prefer to go straight into Medicine rather than do an irrelevant degree. Forcing them to do a degree in which they have no interest in, and see it only as a means to an end, will result in frustration and lead to increased unethical conduct during assignments/exams, such as copying and plagiarism.
5. Graduate Medical programs make medical education backtrack 50 years. Back then, students in medical schools spent the first three years learning basic medical sciences with no patient contact, and only afterwards spent time in hospitals seeing the relevance of what they previously learnt. This is effectively what a Graduate Medical program involves. The current worldwide trend of Problem Based Learning in undergraduate medical entry avoids this problem, with students learning biomedicial sciences 'just-in-time', which makes the learning process relevant, interesting and memorable.
6. If a student completes a biomed/science degree with the intention of pursuing medicine and is later unsuccessful in obtaining a place in medicine, what career options are available? Students are lured into a science degree by universities keen to bolster their flagging enrollments in science faculties, with disregard for the career aspirations of students.
While school leaver entry is better for everyone, a small proportion of medical places (say 10%) may be set aside for graduate entry. Graduate medical places can be an option for those who are uncertain about their career choice, unprepared for tertiary study or were unable to obtain a place after year 12.
However, there is a problem with the entry test for graduates. If practicing doctors in Australia were to sit the tests without preparation, at least 70% would pass the UCAT (test for school leavers), whereas only about 1% would pass the GAMSAT (test for graduates). This is not because GAMSAT is harder than UCAT: it is because while UCAT tests generic skills, GAMSAT tests knowledge, much of which is irrelevant to the practice of medicine.