SECOND OPINION:HEA seeks 'new direction' for medical education, writes SHAUN McCANN
I ONCE asked the Secretary of Comhairle na nOspidéal how many of its 50 reports had been enacted in full. The answer was simple: none. I was therefore surprised when the Higher Education Authority (HEA) decided to enact the report Medical education in Ireland: a new direction, known as the Fottrell report.
As professor of Academic Medicine in the School of Medicine in Trinity College, I – with members of the Irish Universities and Medical Schools Consortium, which represents TCD, UCD, UCC and UCG – was asked to oversee the implementation of the report.
We were charged with developing a “national” view of medical education. The Fottrell report’s many recommendations included increasing student numbers, instituting curriculum reform, a graduate entry programme, and increasing the number of academic appointments in hospitals and universities.
Let me make one thing clear: the number of medical students in public medical schools is strictly controlled by the HEA. The number is not “capped” by the medical profession or kept artificially low by a cabal of doctors, as many people – including some ex-government ministers – think.
In my experience, heads of medical schools have lobbied for an increase in student numbers. The number of students from European Union countries (mostly Irish) was about 300 in the four medical schools in 2004. Fottrell wanted this number increased to 700-740 in 2010/2011. This meant almost doubling the number of EU students from 60 to about 120 annually in TCD. As there are 530 intern positions in Ireland, then clearly there will be more Irish/EU graduates than intern places in the future.
Curriculum reform was introduced in medical schools in 2007/2008 with financial support from the HEA. The medical school curriculum was reduced from six to five years in TCD, and some medical schools, namely UCD and UCC, introduced a graduate entry programme. Graduate entry students who had a second class honours primary degree (minimum 2H1) could undertake a four-year medical course. The second prerequisite was a satisfactory mark in the Gamsat (Graduate Medical School Admission Test) exam. This mark could vary between universities and yearly, depending on the number of applicants. In 2008 the University of Limerick opened a medical school with a graduate entry programme. The cost of graduate entry programmes is about €25,000 per year, of which €13,000 is payable by the student.
The number of students entering TCD School of Medicine in 2011 was 173 (128 Irish/EU). Even though medical schools have increased their numbers and there are three graduate entry programmes, we now have a shortage of non-consultant doctors. Why should this be? Reasons for leaving Ireland include inadequate training and remuneration and lack of career prospects. Non-consultant doctors had their €3,000 educational grant removed by the HSE and their salary markedly reduced because of the implementation of the European Working Time Directive which limits the number of hours a doctor can work in one week. I have not met a doctor in any country who thinks leaving a sick patient to their incoming colleague is not harmful to patient care.
The HSE undertook an electronic survey of all interns in June 2011 to ascertain the reasons for leaving Ireland. In spite of a number of requests I have been unable to obtain the results but presumably this survey will provide definitive answers.
I can speak with confidence that the Irish taxpayer does not want to subsidise hundreds of medical students’ education only to see them leave the country, perhaps never to return, while the health service is propped up by doctors who receive their education outside the European Union. Let us hope that the work we did in trying to implement the Fottrell report will not have been in vain and that we can give our new medical graduates a proper training with adequate remuneration and good career prospects.
The opinions expressed are those of Prof McCann. Shaun McCann was professor of academic medicine in the School of Medicine in TCD from 2005 to 2011. He is chairman of the European Hematology Training Online Unit