There are more places for medical students, but concern about fees remain, writes Áine Kerr.
The announcement of an expert group to oversee the first phase of reforming medical education represents an important development for the sector, but concerns about the fees structure and the absence of an implementation body remain.
Once up and running, the new system is expected to clear the way for training hundreds of new medical students to try to relieve the severe shortage of medical professionals.
An increase in medical places and the establishment of a graduate medicine programme was promised last February. Now the expert group appointed last week must make recommendations on a suitable common selection process.
But the absence of a representative from the third-level medical sector or the medical profession on the committee group, which is charged with introducing aptitude tests for school-leavers and graduates, has caused concern.
Dr Eamonn Shanahan, chairman of the Council of the Irish College of General Practitioners, notes that four members of the working group are from educational backgrounds, while one member represents the Department of Health.
"Having a small executive group which must report back by August probably isn't a bad idea when it is necessary to set the goal posts quickly before the first students enter the new system.
"But they should consult the postgraduate colleges and medical schools to gather people's opinions," says Shanahan.
Separate from the work of the committee, fears that the new graduate entry-level system could create a "potentially socially divisive" system abound, according to Shanahan.
In one instance, students of a new graduate-entry programme in the Royal College of Surgeons in Ireland will be expected to pay €40,000 per year for the first two years of their course from September.
Shanahan says providing for "social equity" as opposed to interest-free student loans should be prioritised.
Dr Mick Molloy, chairman of the Irish Medical Organisation (IMO), echoes similar concerns stating that students will incur exorbitant debts over the course of their undergraduate programme and graduate medical course.
He says that medicine at graduate level is now unique in that fees of €20,000 upwards will be required. Prior to the introduction of a graduate-entry programme, only non-EU students in UCD, for example, were required to pay about €23,500 a year in fees for their medical degree.
"Students could be left with debts up to €150,000 after college. How are they going to pay that? High fees have had devastating consequences in the US where the areas of general practitioner and emergency medicine are not as attractive because they aren't well paid. It may create the same problem here," he says.
Shanahan contends that as GPs attempt in future to pay off debts which could amount to €250,000, the consumer will suffer. GPs' patient fees may have to reflect the expense of their education and the extent of their debts.
Aside from the concerns that the new system could become the preserve of the elite, the IMO contends that a new medical education system based on individual and problem-solving learning will require a larger cohort of lecturers and increased space. These requirements, however, have yet to be assessed.
Prior to the changes and development of nursing at third level, significant investment was directed towards introducing new resources and providing increased teaching spaces according to Molloy.
To date, similar measures in advance of changes to medical education have not been proposed, he says.
"We have a small pool of academic medicine teachers, probably one of the smallest in the world," says Molloy.
"I taught a class of 200 myself and I found that number very difficult. I think it would be increasingly difficult if you were to now have 300 in a hall if the numbers go up. It's unfair to students and is somewhat realistic. We need smaller lectures and not didactic lectures because medicine is about hands on experience."
Added to the strain on university structures and resources, Molloy says the hospital facilities for educating medicine students are "pitiful" and receive a "pittance" for graduate education.
In the absence of necessary decision-making, universities remain unclear as to how to prepare submissions in the competition for increased medical students.
For example, many medical schools believe they should have a clear outline of what type of student will be entering the graduate-entry level programmes so they can draft curriculum proposals.
If, for instance, a student has a science background, they can proceed without a foundation course, but if a student comes from a humanities background, a one-year long foundation course as part of the four-year degree will be essential.
Prof Michael Murphy, head of the College of Medicine and Health, says that if Ireland is to achieve a world-class, high-quality medical system, then knowledge of the "desired outcome" is crucial. Having a network of medical schools, each of which are of sufficient size and offering the international norms of 200 graduates must be considered, he says.
Prof Paul Finucane, director of the medical school development at University of Limerick (UL), says universities are still waiting on a four-step tendering process to commence. This would provide for the launch of a tendering process, the submission and evaluation of tenders, followed by a Government decision.
"In Limerick, we would have liked a 12-month lead-in for a start-up in September 2007. But there is unlikely to be a decision now before September," he says.
As both UCD and the Royal College of Surgeons in Ireland (RCSI) begin a graduate entry programme (GEP) in September of this year, medical schools countrywide will treat their operations as a template for operations in 2007.
In RCSI, the 50 places are open to EU and non-EU graduates of all disciplines who have obtained a minimum 2.2 honours degree from a recognised institution and meet the selection criteria.
For graduates presenting with non-science degrees, a demonstration of scientific knowledge will be required.
GEP students starting this September must pay €40,000 per annum for the first two years, after which the remaining two years will be subject to a non-EU fee structure currently in place for the five-year RCSI medical programme.
John Hayden, head of the new expert group , says the small working group will build upon the work of the Fottrell report and seek proposals from stakeholders as it prepares an interim report for publication in August.
He says a full report on how Leaving Certificate points, degree results and aptitude tests can be used in the selection process will conclude before the end of the calendar year.