Final Report > Chapter 25: Competent Healthcare Professionals > The systems for assuring competence > The selection of future healthcare professionals

The selection of future healthcare professionals

32 If the future healthcare professional, to be adjudged competent, must, in addition to technical and clinical skills, be able to display appropriate attitudes and competence in such areas as communication, the question inevitably arises as to the criteria for selecting those who are to become healthcare professionals. Are the criteria sufficiently broad to take account of the need for the full range of qualities and attributes which patients are entitled to expect? Is there a system for ensuring that the criteria are applied? Of course, much can be done in shaping the future healthcare professional by improving the undergraduate curricula. But this alone will not be sufficient. The task begins at an earlier stage: the attributes, attitudes and skills which form the criteria for initial selection also need to be appropriately broadly based. We concentrate on entry to medical school. But the points we make apply to aspiring entrants to all healthcare professions.

33 We heard during Phase Two of the Inquiry that selection for medical school has been criticised for its superficiality. It is generally based on the information contained in a university application form and on an interview which, where it takes place, in some cases lasts no more than 15 minutes. Heavy reliance is placed on high academic achievement, in particular on achieving top A level grades in scientific subjects. We heard that, in the past, medical schools have also been accused of elitism, a lack of fairness and transparency in the process of selection, and of not selecting from a diverse range of social and ethnic backgrounds. Moreover, and remarkably since the NHS both contributes a substantial amount of the funding of the education and employs most graduates, the selection process is conducted with very little input from the wider NHS or from the public.

34 There is some evidence that the GMC's guidance to medical schools `Tomorrow's Doctors', published in 1993, has begun to influence selection. Medical schools are beginning to take account of the applicants' personal qualities, interests, communication skills and relevant work experience in an attempt to select those who have the potential to be versatile, flexible and sensitive professionals. This is only a beginning. And, to the extent that many medical schools would say that they have done this for years, a somewhat greater commitment may be called for. We note that the GMC is in the process of revising `Tomorrow's Doctors' so that it incorporates the GMC's thinking about the qualities of a good doctor, as set down in `Good Medical Practice'. `Good Medical Practice' is a sensitive account of the duties and qualities of a doctor and crucially espouses a patient-centred approach to healthcare. Thus to match the attributes of a `good doctor' with those of young people seeking admission to medical school is a significant development - in the past, to the extent there has been any such match, it has been coincidental.

35 There is also evidence, at the margins, of diversification of routes into medical education. There is at least one successful `access' course for nurses and other healthcare professionals to prepare for entry to medical school. A small number of medical schools, including two which have recently been established, encourage, or intend to encourage, applications from those currently working in other healthcare professions. Some medical schools, such as that at Newcastle University, are seeking to widen access to medical education by reintroducing a pre-medical programme for those who do not possess a predominantly scientific background. Others, such as Guy's, King's and St Thomas's School of Medicine in London, have developed a scheme to target and give special access to students from local schools who would not normally either consider applying, or be considered qualified to apply, to medical school. [15]

36 We regard this diversification as important. We need to guard against future generations of doctors and other healthcare professionals being drawn from too narrow an academic and socio-economic base. Patients want doctors to be clinically competent, and thus doctors must be able to understand scientific method and principles. But, as we have said, this is not all that being a doctor entails. An understanding of science may be a necessary condition for entry to medical school, but it cannot be sufficient. The future doctor must also have demonstrated other qualities, not least a capacity to be open-minded, comfortable with uncertainty, free of preconceived views and capable of recognising and responding to ethical issues.

37 We heard arguments during our Seminars that it would be desirable to make medical education an entirely postgraduate course of study. Postgraduate entry, it was suggested, would ensure that the student would be more mature, more widely educated, and more likely to have chosen to study medicine after careful reflection, something that may not be true of applicants who are still in their teens. Leaving aside the financial implications of such a change (on which we heard no evidence and thus make no comment), we are not persuaded that a wholesale move to a graduate-only entry is justified. What is important is not the age at which the student begins, but what the student has previously studied and been exposed to, the criteria guiding selection, and the way in which the curriculum is thereafter organised and delivered. [16]

38 We referred earlier to the GMC's publication `Tomorrow's Doctors'. Although the GMC has a statutory responsibility for the standards of undergraduate medical education, entry to medical school is governed by the regulations of the particular university, which is an autonomous body. The GMC states that it seeks to influence the criteria for selection through the Council of Heads of UK Medical Schools. The Council for its part has indicated that the attributes they seek in applicants to medical school are similar to those set out in `Tomorrow's Doctors'. But we have not seen evidence to convince us that such indications are systematically being translated into practice. The current state of affairs is far from satisfactory. There is no formal means whereby medical schools can be required to follow the GMC's or any other body's advice. We take the view that the criteria for the selection of entrants to medical school are a matter for discussion and agreement in a community wider than the individual university's medical school and the GMC. At the very least the public and the NHS should be involved.

39 The selection of those who wish to become nurses has equally been subject to re-examination recently. Nurses are selected for pre-registration programmes by reference to the UKCC's baseline entry criteria. The institutions of higher education which provide these programmes may impose their own criteria, but these can only be more, not less, demanding than those required by the UKCC. The Royal College of Nursing told us that it supports the philosophy of widening access to nursing education programmes. It advocates an openness towards older applicants and an acknowledgement of `existing life skills' when considering applications. There is also support for a process of interview and selection which is not only transparent, but also includes representatives from the universities and from the prospective employers, the NHS trusts. The logic behind this approach is one of `joint ownership' of student nurses, paving the way for support for students throughout the three-year pre-registration programme and into employment as qualified nurses. [17] We add our support to this approach and point out that it is compatible with, indeed it can be dovetailed into, the approach to multidisciplinary education to which we referred earlier.

Footnotes

[15] See `Performance Indicators in higher education. Higher Education Funding Council'. HEFC 00/40. 1998/99. www.hefce.ac.uk For example, whereas 25% of all young full-time first degree entrants in 1998/99 came from Social Class III, IV or V, the equivalent figures for the group including medical students was only 12%

[16] We note that a number of medical schools have introduced courses that admit graduates in non-medical subjects to a course which enables them to qualify as doctors in four years instead of five

[17] Seminar 5. The Royal College of Nursing. Position Paper