Anoraks and public school boys not wanted

Medical schools are looking to recruit a new generation of doctors who accurately reflect the communities that their patients will come from.

Wanted: medical students who like people, enjoy solving problems and don't necessarily have science A-levels, let alone two or three A grades. Graduates and Afro-Caribbeans and other ethnic minorities particularly welcome. Anoraks need not apply...

Medical training has come a long way in the last 20 years. That spoof advertisement sums up the feeling of many in charge of medical education.

The curriculum has undergone extensive change. It now emphasises learning by doing rather than by sitting through lectures, and new efforts are being made to ensure that doctors represent the population at large. At present the overwhelming majority of recruits are from comfortable, not to say affluent, backgrounds, and a large proportion of entrants are from independent rather than state schools, because of the pressure on places and the need to recruit the best as defined by A-level results.

But the shortage of doctors has led to a once-in-a-generation opportunity to innovate more boldly than ever. The Government has approved a plan to create 1,000 new training places, and so far 20 universities have submitted bids for those places (decisions are expected by early June). And a look at the bids shows how far the face of medical training - and of the doctors who treat us - could change.

One of the most innovative plans is from St George's Medical School in Tooting, south London. It proposes four years of fast-track training for graduates of any discipline who fancy wearing a white coat. Initially, its plan was for a three-year course, but that fell foul of the General Medical Council. The new scheme, approved by the GMC, is similar to the Australian model. Entrants would take the Graduate Australian Medicine Admission Test.

"Our scheme is based on experience in other countries where short courses for graduates - substantially shorter than the course we're proposing - have worked successfully for many years," says Professor Robert Boyd, the principal of St George's.

St George's believes that graduate entrants from a range of academic backgrounds should enrich the medical profession. "We've been too monolithic," says Boyd. "Increasingly, it's unsatisfactory that children choose to do medicine at a young age. Young doctors quite often feel they have made the wrong choice. It belongs to an old system of stability and making a choice for life which no longer applies."

The English education system forces pupils to choose between arts and sciences. Many gifted children opt for arts subjects because they find they can play an active, critical part. In science, by contrast, it is hard for them to be creative until a solid body of knowledge has been learnt, so students who may be suited to medicine are lost to the profession. The St George's scheme would change that.

Imaginative thinking also comes from Guy's, King's and St Thomas' in London; the biggest medical school in the UK, which is hoping to recruit local pupils without the grades but with the potential to succeed as doctors. "We have been very concerned by the ratcheting up of the entry requirements at A-level for our students," says the dean, Professor Adrian Eddleston. "The bid for new student numbers offers a new access route for local children - particularly, though not entirely, from ethnic minorities - who may have difficulty in making the grades."

Thus Guy's, King's and St Thomas' is working with local schools in areas such as Camberwell and Brixton to identify children who aspire to do medicine but don't have a hope of two As and a B at A-level. Suitably committed pupils, who will be expected to take biology A-level, will be interviewed and, if successful, offered a place on a clinically oriented degree in biomedical science. Mentors will help them to hone their academic skills during that three-year degree. At the end of it they will move on to the last three years of conventional medical training. Altogether they will qualify within six years rather than the traditional five.

In a further initiative Guy's, King's and St Thomas' is joining forces with Kent University to give medical students real responsibility for looking after patients in their final year before becoming fully fledged doctors. The way to do that, it believes, is by working in district general hospitals, community placements and general practice.

As well as an overall shortage of doctors caused by an ageing population and demand for more and improved health care, the country suffers from serious regional shortages of doctors - particularly in the West Midlands and the South-west. Some of the bids are setting out to counter these regional shortages. The argument is that doctors tend to stay in the area where they trained because they have friends and professional relationships locally.

Such thinking lies behind the plan by Leicester and Warwick universities for an extra 128 students to enter a joint medical school. Recruitment of doctors is particularly problematic in Coventry. "It's very, very important that we produce more doctors, and as quickly as possible," says Professor Stewart Petersen, head of medical education at Leicester University. "The shortage is already producing problems, which are going to get worse. We also need to produce a range of doctors who reflect the population they're serving."

The idea is that students with first degrees in biological sciences will enter a new four-year graduate entry course at Warwick/Leicester. They will spend 18 months on the Warwick campus taking some of the Leicester curriculum and will then join regular students at the Leicester campus.

More collaboration is taking place further north, at Keele - also because of a shortage of doctors in the area. It is bidding for 80 new places with Manchester University. The students would join Manchester's conventional five-year course, sitting the same exams as other students. They would have two years in Manchester; then 50 of them would move, to spend three clinical years in Keele and north Staffordshire. "We have enormous capacity for expansion," says Dr Susan Dilly, dean of the faculty of health at Keele.

"Although the current round of bids is only for the extra 1,000 students, there are a lot of senior people who believe that with the European directives on the number of hours that doctors can work and so on, it's inevitable they will require a further expansion in four or five years time. That's why we're linking Manchester and Keele in this proposal. The plan is that, if there were the opportunity to bid for further students in four or five years' time, we would then put in a bid that would have us doing the first two years as well at Keele. We would then bid for many more students - probably 100 to 150 a year, and those students would spend all five years in Keele. So, we're incorporating the future into our plans."

The expansion in medical student numbers could see the creation of the first new medical school in the country in 30 years. One of these bids is from Hull University, which is planning a four-year accelerated programme for 100 mature students a year. It would initially be open to science graduates; graduates of other disciplines would have to take foundation courses first.

The emphasis is on taking mature students, says Professor Tony Horsman, dean of Hull's faculty of health. "In some of the medical schools the drop-out rate is quite high. I think the average national figure is around 10 per cent, so we have to find ways of offering and designing programmes that reduce the wastage rate. Recruiting mature students who are making a more considered choice of career path is one obvious way of doing that."

Another bid is for a new school in the South-west, to be called the Peninsular Medical School. This is a collaboration between the OU and the Universities of Exeter and Plymouth (there is no doctors' training west of Bristol) and involves taking graduates once they have done a distance-learning foundation course in medicine with the OU. This would replace the first two years of traditional medical school. At first, only science graduates will be accepted on to the foundation course. Once students have completed those two years, they will move on to placements in the South-west.

The OU also has a partnership with Leeds University to take graduates, put them through their foundation course and send them on to Leeds Medical School for the third year of medical training. The hope is to attract recruits from the Muslim community in Leeds.

Doubtless the anoraks will not disappear. However, bold decisions taken now about medical education in Britain could offer a rare chance to make the medical profession look less like a clique and more like the community it serves.