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Should there be other (non- uni) routes into Medicine/ becoming a doctor? Watch

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    (Original post by Ambitious1999)
    Opinions please?
    This is a bad idea, and not one someone with experience of healthcare would make.

    (Original post by Ambitious1999)
    With very high tuition fees and cost of living as a student, 5-6 years at medical school can seem daunting. There are a shortage of doctors in Britain and getting into Medical School is so hard that few even consider applying.
    Still way more than there are places though. There is no shortage of idealistic 18 year olds wanting to 'save lives'. The problem with training atm in the UK is with training costs, and with retention of people already trained when they actually realise what the job is like.

    My idea is that people who want to become doctors could take a more vocational route by becoming nurses, health care assistants or physicians assistants.
    Whilst the work HCAs do is of course very valuable; changing sheets, helping old people toilet and doing 000's of sets of obs isn't exactly doctor's training. The same is true of most of nursing - they are different roles. PAs have more overlap but that's because they have more academic training and are working under doctors anyway, which bring me to the next more important point:

    Here they would gain invaluable clinical experience working in hospitals with modules they can take that would work towards an eventual medical degree. They would learn all the things a medical student learns such as anatomy and physiology, pathology etc but some of it would be learnt on the job and they would get a regular income. They would get the same assessments university medical students get and the same standards to pass would be required.

    You could say it's a bit like an apprenticeship in medicine.
    An apprenticeship is precisely the opposite of what you want your medical training to be like.

    Medicine is a science. Treatments are based on evidence. All the movement in medical education for 50+ years is towards Evidence Based Medicine i.e. that we do things not just because our seniors did, but because there is evidence that we should. Reverting to an apprenticeship model is the exact opposite of putting evidence first - its literally saying that you should just do what your senior does, even if they are bad at their job. Its saying that we don't need to ever try to progress beyond where we are already or ever aspire to improve.

    In reality we do not have evidence covering every situation so you do need a bit of practical experience. It shouldn't be your entire education though.

    (Original post by friyaa23)
    The problem we have is the BMA. They have a lot of power and they restrict and cap the no. of students allowed to become doctors every year and unis that want to become medical schools face tough standards to meet. Medical school isn't that hard to get into in terms of grades (A*AA-AAA - There are plenty of students that can easily achieve this) and many capable students get knocked out due to the competition.
    The BMA has no power over medical school places, nor do they have power over medical school standards. The BMA is a trade union, not a government body.

    Even grad school medicine is hard to get into.
    It is, in fact, much harder, with competition ratios about double that of undergrad.
    (Original post by ForestCat)
    Oh and the AAA+ requirements are in large part due to competition. Go back 15 +years ago and people got in with Cs and Ds.
    15 years ago was 2002 - most unis were at AAA or AAB standard then, with a few ABB. Oxbridge also had lower standards. You'd have to go back a lot further i.e. to a time when the numbers of people getting As at A-level was very low indeed, for there to be doctor with multiple Ds.

    Nor can we conclude that having AAA candidates now isn't a good thing! In fact, we are still seeing entry requirements go up and up, with multiple unis now requiring at least one A*. Generally unis do want the highest academic standard they can get, with a few caveats.
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    Well, maybe if the tories increase wages for NHS staff, there'd be a higher incentive to work for the NHS? But we all know that isn't going to happen.

    We can all blame clueless tory voters for that one. "muh corbyn is a cowurd cuz he wanna spend more on nhs and less on ta army"
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    (Original post by paul514)
    I don’t disagree like I said they need all the training for those none standard appointments.....
    Out of interest - are you a medical student/doctor?
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    Absolutely not - never in a million years should it become an "apprenticeship" model. Medicine requires knowledge of several different disciplines (Anatomy, Physiology, Biochemistry, Microbiology, Pathology, specialties etc) before you even step onto a ward for practical tasks. The only way students will get the academic and practical experience concurrently is through a degree.
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    (Original post by *pitseleh*)
    Out of interest - are you a medical student/doctor?
    Nope
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    It's not all stuff you can learn on the go, really.
    (Original post by GEM2018)
    Is there anything that wasn't easier for baby boomers!
    Being gay? :dontknow:
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    (Original post by paul514)
    Nope
    Then what are you basing the below on?

    I dare say being a gp in the training manner you suggest would be fine for 90% of the people who see them as it’s repetitive cases which an educated eye could sort out.

    The other 10% though are more complex and require all that special knowledge as does all the hospital doctors.
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    Honestly it seems to me that in saying 'doctors can be trained to be doctors by working as HCAs' you demonstrate a complete and utter lack of understanding of the role of a doctor within healthcare and no insight whatsoever in the profession...
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    (Original post by *pitseleh*)
    Then what are you basing the below on?
    Daily Mail comments section.
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    Patient comes in with congestive cardiac failure, on Furosemide 80mg BD and all sorts of other wonderful medications. He also has CKD with a Creatinine of 146 at baseline. Now his Creatinine has jumped to 402 and his urine output has dropped. There are a few non-specific bibasal crackles, his JVP is 6cm and he has oedema up to his abdomen.

    A doctor without a rigorous academic base (or just slept through medical school)-
    Identifies the patient as fluid overloaded, prescribes Furosemide 80mg BD IV and applies a fluid restriction of 1l.
    Result: renal function goes way off. patient dies.

    A doctor with some understanding of how the body works-
    Identifies the patient as fluid overloaded, but can see the patient is not in acute heart failure. Reduces the Furosemide dose to 40mg BD IV and places a fluid restriction of 1.5l, but encourages the patient to drink up to this
    Result: patient alternates between renal and cardiac failure until either ATN or pulmonary oedema set in. Patient dies on ward 4 weeks later from a HAP.

    A doctor with a rigorous understanding of medicine-
    Identifies the patient as fluid overloaded, but is fluid depleted intravascularly. Recognises this as cardiorenal syndrome, which is pre-renal. Can see the patient does not have pulmonary oedema. Reduces the Furosemide dose to 40mg OD IV and starts slow IV fluids.
    Result: patient's renal function improves, urine output picks up, the reduced dose of Furosemide is now more effective because the kidney's are actually filtering it into the tubules, the patient fluid offloads naturally. The patient goes home.

    A doctor with too much medical knowledge (or a bowtie)-
    Identifies cardiorenal syndrome. Asks his medical students to explain this syndrome then gives them a condescending look when they're unable to answer. The SHOs are secretly praying they don't get asked next, because they don't have a clue either. He gives Furosemide 160mg BD IV because he knows that Furosemide will reduce in efficacy in renal failure as less of it is filtered into the tubule. At the same time, he starts a dopamine infusion to ensure that renal perfusion is maintained in the face of the rapidly worsening hypovolemia that the resulting diuresis will certainly cause. He knows that dopamine infusions have no evidence that they improve morbidity in these kinds of patients, but that's not the point.
    Result: The patient's cardiac and renal function improve. Until the dopamine infusion stops. Then the patient dies. The case is presented at grand round but nobody pays attention because the lasagna is ****ing banging.
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    (Original post by infairverona)
    Honestly it seems to me that in saying 'doctors can be trained to be doctors by working as HCAs' you demonstrate a complete and utter lack of understanding of the role of a doctor within healthcare and no insight whatsoever in the profession...
    Yeah I'd say as a HCA on the majority of shifts I never interacted with a doctor anyway, and if you did it was just them walking by. HCAs are completely isolated from doctors as they are ward based. Even in ICU which is stuffed with doctors the HCA is focussed on cleaning, turning patients etc and has no real interaction with a doctor.
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    (Original post by Chief Wiggum)

    To be honest, I do think medicine courses could probably be shortened. Perhaps I'm being naive, but I genuinely think the medicine course could be shortened to 4 years.
    doesn't the UK have one of the shortest start -> end turnarounds in the world? Most countries are longer than the 5 year option you have to train. I mean you almost certainly could though - a lot of GEM courses take people with no background in life sciences and graduate them as doctors, pretty sure a good number of school leavers could hack it although I don't really see the point in making it so intense for 18 year olds.
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    (Original post by Hippysnake)
    Patient comes in with congestive cardiac failure, on Furosemide 80mg BD and all sorts of other wonderful medications. He also has CKD with a Creatinine of 146 at baseline. Now his Creatinine has jumped to 402 and his urine output has dropped. There are a few non-specific bibasal crackles, his JVP is 6cm and he has oedema up to his abdomen.

    A doctor without a rigorous academic base (or just slept through medical school)-
    Identifies the patient as fluid overloaded, prescribes Furosemide 80mg BD IV and applies a fluid restriction of 1l.
    Result: renal function goes way off. patient dies.

    A doctor with some understanding of how the body works-
    Identifies the patient as fluid overloaded, but can see the patient is not in acute heart failure. Reduces the Furosemide dose to 40mg BD IV and places a fluid restriction of 1.5l, but encourages the patient to drink up to this
    Result: patient alternates between renal and cardiac failure until either ATN or pulmonary oedema set in. Patient dies on ward 4 weeks later from a HAP.

    A doctor with a rigorous understanding of medicine-
    Identifies the patient as fluid overloaded, but is fluid depleted intravascularly. Recognises this as cardiorenal syndrome, which is pre-renal. Can see the patient does not have pulmonary oedema. Reduces the Furosemide dose to 40mg OD IV and starts slow IV fluids.
    Result: patient's renal function improves, urine output picks up, the reduced dose of Furosemide is now more effective because the kidney's are actually filtering it into the tubules, the patient fluid offloads naturally. The patient goes home.

    A doctor with too much medical knowledge (or a bowtie)-
    Identifies cardiorenal syndrome. Asks his medical students to explain this syndrome then gives them a condescending look when they're unable to answer. The SHOs are secretly praying they don't get asked next, because they don't have a clue either. He gives Furosemide 160mg BD IV because he knows that Furosemide will reduce in efficacy in renal failure as less of it is filtered into the tubule. At the same time, he starts a dopamine infusion to ensure that renal perfusion is maintained in the face of the rapidly worsening hypovolemia that the resulting diuresis will certainly cause. He knows that dopamine infusions have no evidence that they improve morbidity in these kinds of patients, but that's not the point.
    Result: The patient's cardiac and renal function improve. Until the dopamine infusion stops. Then the patient dies. The case is presented at grand round but nobody pays attention because the lasagna is ****ing banging.
    I have a significant problem with this.

    You get ****ing lasagna at your grand rounds?! Da ****.
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    I was literally just going to say. Tesco sandwiches and crisps is all I've seen so far (and not even the premium stuff).
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    (Original post by paul514)
    No,

    I think a lot of gp medicine is something they see repeatedly all day. So be that writing a letter, repeat prescriptions, blood pressure tests checking something is normal and so on.
    You realise there are nurses do that sort of thing too right? Also well done for ignoring my point

    (Original post by ForestCat)
    I assume you mean that nurses would struggle with a top up scheme and not a medical degree, because I will tell you that plenty of nurses are academically capable enough to complete medical degrees.

    I agree that the nursing degree, as it stands, does not give a solid enough basis to allow a simple top up scheme to become a doctor. There simply isn’t enough a&p, pharmacology, history taking etc taught during a nursing degree. Most nurses pick this up after, from experience. I do think however, that there should be more graduate entry schemes (I.e. the full four year course) aimed at all allied health professionals, as the insight and skills they bring is invaluable.

    Oh and the AAA+ requirements are in large part due to competition. Go back 15 +years ago and people got in with Cs and Ds. And their are plenty of graduate with less than stellar a levels that excel in medical exams. I don’t think A levels are that good a prediction of future performance at all.
    Nurses don't even need certain grades to do a nursing course they just need certain number of UCAS points. Sure, some may be capable but that doesn't matter, they'll need to prove that they have the calibre by getting into med school. Also the med rejects are easily more capable than nurses since they do highly academic degrees anyway.

    Again that may be the case but they'll need to prove that by passing tests. Realistically speaking they wouldn't be able to though. Yeah there should be more grad schemes but again its up to the BMA to let that. There'll probably be more of a chance of more undergrad entry into medicine that grad entry.

    The point is however that we'd want the best people to become doctors. If we open the floodgates and let anyone become a doctor who may be capable it'll be a disaster. There'll be higher drop out rates, wage depression, doctors will become unemployed for the first etc etc. Im sorry but its simply wrong to say that a nurse will be able to perform well in the medical exams. It's simply not true.
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    (Original post by friyaa23)
    You realise there are nurses do that sort of thing too right? Also well done for ignoring my point



    Nurses don't even need certain grades to do a nursing course they just need certain number of UCAS points. Sure, some may be capable but that doesn't matter, they'll need to prove that they have the calibre by getting into med school. Also the med rejects are easily more capable than nurses since they do highly academic degrees anyway.

    Again that may be the case but they'll need to prove that by passing tests. Realistically speaking they wouldn't be able to though. Yeah there should be more grad schemes but again its up to the BMA to let that. There'll probably be more of a chance of more undergrad entry into medicine that grad entry.

    The point is however that we'd want the best people to become doctors. If we open the floodgates and let anyone become a doctor who may be capable it'll be a disaster. There'll be higher drop out rates, wage depression, doctors will become unemployed for the first etc etc. Im sorry but its simply wrong to say that a nurse will be able to perform well in the medical exams. It's simply not true.
    Wow, just wow.

    Thanks for telling me that I won't be able to perform well in medical exams. I guess the straight distinctions in OSCEs and finishing in top 20% for cumulative marks over the past few years is a fluke.

    Oh and what do you class as "best". You can't judge on pure academics alone. You need common sense, compassion, communication skills. The ability to think on your feet. I could go on. And I'm sorry, but rote learning an exam syllabus to get that A* does not prove you have any of those.

    Oh and its the GMC that influences training standards and places (though this is more a funding issue influenced by government). The BMA is a union.
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    (Original post by friyaa23)
    Im not really sure why you're taking this personally.

    No one said pure academics. There's a reason why you have exams like the UKCAT or BMAT, they test that sort of thing. And medicine schools have the facilities to teach that sort of thing too. 90% of being a doctor is about having the intelligence and the knowledge. Wrapping bandages isn't going to teach you that.

    You've also missed my point. We simply cannot open the floodgate and let anyone train to be a doctor. It will be a disaster. Hence why we choose the best. You can be as caring, compassionate and practical as you like, if you don't have the intelligence then you can't be a doctor and pass the medical test.
    And you're missing mine. You cannot just make a blanket statement about who should be a doctor. Yes you need to be able to cope with learning a lot of theory and being able to apply it (a lot of it is patern recognition), but you don't actually need to be that academically gifted.

    You have the UKCAT and BMAT to help medical schools cope with applicant numbers. It is one way of putting limits on who can apply, but it doesn't say anything about future performance.

    Wrapping bandages actually taught me a lot. It taught me about wound healing, what works, what doesn't. How to spot when a wound is deteriorating and when it is improving. How to manage a patient's pain and discomfort whilst I do so. And no, in my future career, I probably won't need to continue to know when honey is best, or when it should be silver. But those assessment and communication skills are highly valuable and transferable.

    And I take it personally as you are insuinating that nurses can't be intelligent. Couldn't possibly make the transition. And actually that they are inferior. I don't know if you're a medical applicant, or just stumbled on to this thread. But pro tip if you ever do start to study medicine, don't speak to nurses this way. It won't go well.
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    (Original post by GEM2018)
    Yeah I'd say as a HCA on the majority of shifts I never interacted with a doctor anyway, and if you did it was just them walking by. HCAs are completely isolated from doctors as they are ward based. Even in ICU which is stuffed with doctors the HCA is focussed on cleaning, turning patients etc and has no real interaction with a doctor.
    Imo it depends what you make of it. As a HCA I had LOADS of interaction with Doctors, but I went out of my way to do so. A few of them helped me with my UCAS application and gave me advice for interviews, etc. This was both on a traditional ward and in a more acute MAU/SAU environment.

    You have to make the most of your opportunities when chaperoning (catheters, PR exams, etc) to ask questions and to showcase your enthusiasm. I used to even stay on after my shift to shadow the Doctors on occasion if they would let me. As a HCA you have the foot in the door already, just go up and say hello!
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    (Original post by ForestCat)
    And you're missing mine. You cannot just make a blanket statement about who should be a doctor. Yes you need to be able to cope with learning a lot of theory and being able to apply it (a lot of it is patern recognition), but you don't actually need to be that academically gifted.

    You have the UKCAT and BMAT to help medical schools cope with applicant numbers. It is one way of putting limits on who can apply, but it doesn't say anything about future performance.

    Wrapping bandages actually taught me a lot. It taught me about wound healing, what works, what doesn't. How to spot when a wound is deteriorating and when it is improving. How to manage a patient's pain and discomfort whilst I do so. And no, in my future career, I probably won't need to continue to know when honey is best, or when it should be silver. But those assessment and communication skills are highly valuable and transferable.

    And I take it personally as you are insuinating that nurses can't be intelligent. Couldn't possibly make the transition. And actually that they are inferior. I don't know if you're a medical applicant, or just stumbled on to this thread. But pro tip if you ever do start to study medicine, don't speak to nurses this way. It won't go well.
    Well if we let people who aren't so academically gifted we're taking a big risk. If you can't get an A in chemistry a level then there's also a likely correlation with someone failing medical school. And if the floodgates open and everyone becomes a doctor it'll be an even bigger problem. Sorry, but as a patient i'd want my doctor to be able to be intelligent enough and have the aptitude to diagnose me and treat me. I really do not give a crap whether or not they are good with people or not (and most doctors are anyway).

    Well done, you know how to treat a wound, doesn't make you an expert in Haematology now.

    Oh god. The reality is they're not going to be as academically minded as someone with a degree or doing medicine.

    "It wont go well"? Really? I thought a large reason why you feel you can become a doctor is that you're nice and caring! You just sound super entitled. If you were good enough to become a doctor you'd be on a grad scheme programme or you would have done well in A levels, performed in interviews and gotten into medical school. You didn't. Quit whining.
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    (Original post by Marathi)
    Imo it depends what you make of it. As a HCA I had LOADS of interaction with Doctors, but I went out of my way to do so. A few of them helped me with my UCAS application and gave me advice for interviews, etc. This was both on a traditional ward and in a more acute MAU/SAU environment.

    You have to make the most of your opportunities when chaperoning (catheters, PR exams, etc) to ask questions and to showcase your enthusiasm. I used to even stay on after my shift to shadow the Doctors on occasion if they would let me. As a HCA you have the foot in the door already, just go up and say hello!
    Well similarly I spoke to a lot of doctors at work and obtained shadowing this way. But this differs from the actual HCA tasks, this is just networking essentially at work? Basically none of my job was working with doctors in a professional capacity though which is what this thread is talking about - like the scope to learn clinical medicine as a HCA is nil in my experience. If you were trying to study a medical degree via a HCA job it'd be impossible - the bulk of the job was making beds, patient care, obs and supporting nurses in the general chaos of the ward haha. ICU is the most likely due to the frequency of doctors but even then I think it'd be very difficult as it's so time-consuming carrying clinical waste disposal, cleaning, helping nurses turn patients etc
 
 
 
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