Medicine should be a graduate entry degree

23 Aug

I started med school at the age of 18. I was a sheltered child of an adult. Most people I knew at that age were. It’s not their fault it’s more that we are a society capable of producing legally defined adults who aren’t really emotionally/socially/psychologically capable of living as adults.

And while that in itself is interesting and controversial (and arguably completely wrong…) it’s not what i want to talk about here.

I spent 5 years in med school learning as little as possible, playing a lot of footy, doing a lot of travelling and having a great old time.

I never got a mark above average in 5 years, i never attended a full week after the first week of 1st year.

I spent a lot of time nervously propping up walls in wards and slacking off early without learning anything.

No one ever pulled me aside and told me that that wasn’t OK. No one ever gave me a booted kick in the rear end. I kind of think they should have.

I started work as a doctor having only just turned 23. I loved every minute of it and after my first year I started working my butt off to learn all the things I probably should have known by then.

Working with patients and people, in a place that expected something of you, got it across to me that this shit matters. The job matters. What we do is really important (as what most people do with their life is really important in its own way) and I was only about the maturity level by then to notice it.

I also realised that what we do is a lot of fun, interesting, satisfying, rewarding and full of its own form of humour.

So if you’ve waded through the self-referential narcisstic bit above then i’ll get to the title.

I think medicine should be a graduate entry program.

A few reasons from my own anecdotal observations

  • i think graduates make much better doctors (more quickly)
  • they bring with them not only the skills and knowledge from whatever they studied before (from art to philosophy to pharmacy) but also the maturity that comes from having to commit another 4/5 years to training.
  • I work with students every day and can see that the mature students are leagues ahead compared with the “just finished leaving cert” crowd.
  • two of my best mates who I grew up with went back to med-school in their mid-twenties and they’re brilliant already and they’re only getting started…
  • i think 5 years is way too long to be in med school, I think 4 years is fine if you run a tight program and have motivated people.

Of course the north americans have been doing this for a while now (perhaps always I don’t know…) and their med school is 4 years in length and you can be out the door of a residency program from graduation in 5 years flat. It takes 9 or 10 years minimum to be fully trained here.

Some big problems

  • how the *&^% do we pay for this? will we end up with graduates as heavily debted as the americans do?
  • the time commitment, by the time it seems people are mature enough to take this seriously they’re also mature enough to have a real life with real responsibilities and partners and kiddies and all that

This is of course a deeply complicated and nuanced issue and would suffer from so many issues I couldn’t hope to bring out here

Any thoughts? I’m looking at you @lizzyferret, @drphillya, @albinoblackbear, theoffice?

12 Replies to “Medicine should be a graduate entry degree

  1. For what it’s worth I agree. I was in a very similar situation to the one you describe and wish I could have afforded the long route.

    • Cheers for the comment

      Would you have chosen a longer path to medicine when you were 18. Even if money were no object would you have chosen to do some other things before going into medicine?

      I’m not sure I could think of anything better to do when I was 18. It wasn’t born out of passion for medicine, just that I couldn’t think of anything else to do and my mate was doing it

  2. Man. Feelin’ old.*

    * Undergrad and MA in English Literature, started a Phd, left that program, became an EMT, worked at that for a while interviewing for fire jobs, became a medic, fell in love with medicine, six years later, second-year resident.

      • Many. Those were good experiences, good years, I use all that stuff in my work. The only question, playing devil’s advocate for a minute, is whether I would trade that experience for ten year’s experience as an ED attending, which you’ll have when you’re my age. That’s the key comparison.

        So. Good books. I’m a big Jane Austen fan, myself. She’s great on the power of rationalization and other filters we use to hide stuff from ourselves. Also a brilliant observer of the fact that a lot of the people we love and have in our lives are pretty deeply flawed. Alexander Pope — especially Essay on Man and Essay on Criticism. Karl Popper — “The Open Society and Its Enemies.” Chekov’s short stories (got to give a shout out to a fellow practitioner.)

        It may no be literature in the strictest sense, but there’s a lot of great boxing writing out there. I like this quote:

        “You can map out a fight plan or a life plan, but when the action starts, it may not go the way you planned, and you’re down to your reflexes – that means your training. That’s where your roadwork shows. If you cheated on that in the dark of the morning, well, you’re going to get found out now, under the bright lights.”
        — Joe Frazier

  3. Uncanny, in relation to experience of undergraduate med school (apart from the fact that I could take it no longer in 4th year). Totally agree, in relation to the general conclusions you make. Another reason – Ireland needs scientists, and some of those straight-A1 students might stay on in science programmes as post-grads instead of converyor-belting on to become “undergraduate” doctors as they do. But if we’re to be serious about it we need to start campaigning for a change.

  4. In Australia we have both undergraduate and post-grad courses and passionate advocates for each. I did an undergraduate program and I think I had a better grounding in basic medical sciences and more clinical experience that some of my post-grad counterparts. I certainly appreciated the lecture and lab-driven curriculum as opposed to the teach-yourself problem-based-learning model!
    In my intern year, supervisors often commented that they could tell the difference between the traditional undergrad course interns and those who were post-grad (preference for the former).
    I don’t doubt that those who have had to do a degree first and then apply are a little more keen to pay attention in class.
    And as to the diversity offered by post-graduate medicine: most of my post-grad medicine colleagues went straight from degree 1 (usually medical science) to degree 2 so really only one or two years more “life experience”.
    Now I’m 4 years out I think we’ve pretty much equalised and I really don’t think there’s much in it to be honest!

    • Thanks for the comment

      Most of the mature med students i know are going through the 5 year old style schools, though I have known a few who did the 4 year programmes and came out not knowing their arse from their elbow. (i exaggerate of course)

      And you’re right I’m pretty sure we all level out once we’ve grown up a bit. but the fact that the yanks do medicine as a post-grad thing probably helps them get their residencies done in 3 or 4 years as composed to the rest of us doing maybe 7 or 8 years. I’m 7 years out now and am still nowhere training wise (largely my own fault/choice).

  5. guys i am a doctor from mexico, do you know how to study the speciality (postdegree) at ireland? i mean if you know the webpage for the information is there a national test or something?

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