Thoughts on Medical Degree Apprenticeship

They should erase the debts of all current medical students while they're at it

I really don't know what that is meant to mean.

You said patients would echo that only clinical ability matters but I know so many patients who would disagree. The people skills and communication skills do matter as well.

In case I’m allowed to post link, the article from the patient’s Mom is here:

https://www.theguardian.com/lifeandstyle/2022/sep/03/13-year-old-daughter-dead-in-five-weeks-hospital-mistakes

That was an incredibly hard read. That poor family, I can't imagine how hard it is for the family knowing that their child should have survived. It does go to show how an arrogant and dismissive attitude in medicine can kill. I can relate to some of that unfortunately. I trusted the doctor's misdiagnosis, I didn't want to bother the NHS any further after being told it was nothing. Most patients don't know how to take it further, or that they should take it further.

I have an incredible team of consultant doctors and a couple of amazing junior doctors now. They have demonstrated you can be warm and friendly, compassionate, AND excellent clinicians. Not only do they make it a more pleasant experience, but they changed my outcome by making me feel very comfortable so I can express my concerns, validating those concerns and listening to and acting on my opinions and suggestions. This has resulted in a VERY positive outcome. If only those doctors in that article had listened to the Mum's concerns and worked to rule them out sooner. So I will never agree that being a good doctor requires clinical competence only.

I can't imagine those particularly difficult doctors make it a nice environment to work in either, which sounds like something you have witnessed at your workplace. I met a nurse at one hospital who said a surgeon screamed at all the staff regularly and made them cry, how is that in any way helpful?

I didn't realise the number of working class people going into medicine was quite that low, although that doesn't surprise me actually. I have dropped an eye-watering amount of money on exams and study materials trying to get in. I can't even consider the GAMSAT because of that price-tag which limits my options. And if you don't spend the money to get all the practice materials it is hard to be competitive enough in the entrance exams. It is definitely hard for the poor folk.

In case I’m allowed to post link, the article from the patient’s Mom is here:

https://www.theguardian.com/lifeandstyle/2022/sep/03/13-year-old-daughter-dead-in-five-weeks-hospital-mistakes

You might not. Others do. And also I think people really do underestimate the benefits of being able to relate to your patients on a personal level. Lives experience can really determine a clinician’s ability to relate to a patient, how they frame advice, what problems they anticipate and how they account for these in their management plans. I think it’s often framed in terms of the benefits to patient choice but it’s not really about that. It’s about the workforce being alert and sensitive to the needs of the population they serve based on lived experience, not just their academic or clinical knowledge. And yes, this can be gained in all kinds of ways and I don’t feel it’s necessary for every doctor to be a rags to riches success story in order to have an effective medical workforce. But diversity is still important and you need to be ever diversifying your workforce and to find ways of enabling that diversification. Whether an apprenticeship is the right route, who’s to say at this stage? Lowering the entry threshold to medicine has its problems and I think the entry requirements for this route appear to be hopelessly vague. If you are going to lower the entry requirements for an apprenticeship you’re actually likely to disadvantage the very people you’re trying to attract because those people often need a large package of additional support that only a university environment can really provide.
I have a feeling that the apprenticeship route is likely to evolve into a conversion route for nurses and AHPs as these are the only people with an appropriate baseline of clinical skills and knowledge to be able to take advantage of this sort of opportunity. This is a route that’s badly needed.

What a load of bs. When your operating on the aorta and it splits, and you only have 30 seconds to stop the bleed. who gives a **** how much you relate to the patient?

You don't need to have gone on an apprenticeship to know how to communicate with patients. Medicine should be academically focused - not some fantasy world where any random person can provide services on the basis that it widens participation.

i think the apprenticeship will be a good thing as it will create a nice class divide or tier system, where those with the real degree can move abroad or get private jobs, whereas those with the apprenticeship wont have that option as they wont be wanted by other countries or private companies and will therefore be the main type of dr in the nhs, so that way it solves the issue of nhs losing drs to overseas, as there will be loads who literally wont be able to get a job overseas, and the drs with the real degree dont have to be the workhorse for the nhs and go elsewhere

Couldn’t agree more

I dispair at the world we are currently in

An extreme left agenda pushed by the schools / unis and media.

I have patients of all backgrounds coming to see me because I’m one of the best in the county at what I do. Often they have previously been seen by a surgeon of similar background to theirs and yet have sought me out by reputation for competence / success to do their operation. Not unreasonably.

My primary concern in clinicians treating me is Ability.
Any patient choosing their clinicians based on background should have their sanity questioned but also be sent for diversity education!

I think you are looking at this is the wrong way, the programme isn't necessarily designed on the sole focus to increase diversity, but rather increase the chances of the people from backgrounds who are not able to otherwise get into medicine due to financial reasons or their environment they live in to get a better chance of getting in. As a result the programme may end up being more diverse.

I also dont really understand how an apprenticeship aiming to do this is "extreme left agenda". I've always seen this as a way to increase the numbers of doctors that will be trained and working in the NHS overtime. Admittedly there may be other ways to do this that seem to be more efficient, however on the basis of getting more doctors, if it works to the like they are planning for it to be, then overall this doesn't seem too bad. Although I do wish they'd start improving system as a whole sometime soon as well.

I am contemplating pursing this with the Secretary of State for Health and the Secretary of State for Education.

This nonsense needs to end….

The Extreme left agenda is equality of outcome.

Less good people are getting to be med students than their better piers who can’t tick the right post code, background box.

Very few people don’t support equality of opportunity.

But we are way beyond that.
The playing field is now heavily titled in favour of certain groups.
Non selective state school applicants getting lower entry requirements over selective grammar or selective independent schools (Birmingham / Newcastle). Anyone think if you academically select at a school that might have something to do with the better results?

Lower requirements because you are not white (Newcastle Partners can’t believe that’s legal) or because your parents didn’t go to uni.

How about assessing applicants solely on ability…..

I am contemplating pursing this with the Secretary of State for Health and the Secretary of State for Education.

This nonsense needs to end….

the programme is no way however is saying that the selection process to be a part of it is in any way going to be that different from the standard selection process that you would tend to get in a regular medical school. By saying "less good people" are becoming med students are you suggesting those from disadvantaged backgrounds are not as worthy to be a doctor compared to those from other backgrounds? The programme allows students to receive extra considerations like you would in most places anyway, but this time through an apprenticeship route.

With reference to certain programmes like Birmingham the contextualise a very large proportion of students across the UK which effectively standardises the approach, however you do have to understand with these selection processes contextualising usually only plays one part of the entire process, there are interviews, UCAT/BMAT and other things that do get considered. To be fair though i do understand where your coming from with Newcastle thing- it is kinda of a strange approach, however something to remember is Newcastle is very big on things like UCAT, in which you would have to score in top percentiles to get an interview therefore it slightly reduces the effect of this contextualisation.

By saying "less good people" are becoming med students are you suggesting those from disadvantaged backgrounds are not as worthy to be a doctor compared to those from other backgrounds?

Medicine is a profession where you make life and death decisions. Correctly calling these requires a high level of competence. Students should be selected on this basis. Not any other basis. So if indeed those from disadvantaged backgrounds perform worse in examinations used as an appropriate assessor of a student's suitability for the profession, then they should not be going to medical school.

This is not discrimination, because the assessor is exam performance, not the student's background, their race, or their religion.

This doesn't mean we don't care about students from disadvantaged backgrounds. If these environmental factors do truly impact their exam performance, then the solution is not to lower the entrance requirements for students from disadvantaged backgrounds.

The solution is to ensure disadvantaged students can perform better in these admission tests (e.g. with more support, funding for Medify ect.). All students are then tested against the same criteria with academic ability as the main assessor.

Score needed for interview at Birmingham 8.1/10
1.5 points for going to a non selective state school? Does that sound reasonable / fair / equitable? (81% score required if non selective school vs 95% score if selective school)

Tell me how do you know when contextualisation has gone too far? Because obviously like anything it can.

It’s my belief we crossed that threshold a while ago.
Extreme left equality of outcome ideology instead of equality of opportunity.

The issue of access to Medical studies is complex and goes far beyond of the caricature of some posts here who condescendingly frame is as giving away degrees for free. The numbers are there: a report published by the government a few years back shows that only 7% of students have been privately educated, yet they make up 61% of the doctors. If you include doctors from grammar school background, the number jumps to 83%. There certainly is a failing of state secondary education *funding* in addressing the problem, and apprenticeship is one way to help. Whether it will work or not, only time will tell. But don't prejudge.

You keep lambasting the "extreme left" but as a reminder, we have been governed by Conservative governments for the past 13 years. Both the Left and the Right see that there is currently a problem . The numbers I quoted are were published by a *Conservative* government, not a hypothetical "Extreme Left" you ragingly foam about. I should also point out that similar scaremongering came out when the Graduate Entry Medicine route was established, with many older consultant lambasting the programme as "lower quality degree". The GEM route turned out to work very well.

I say it's worth to give a try. If it doesn't work, at least there will be evidence and data to reflect upon, instead of pre-judgmental opinions.