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• Response to Ashwini Oswal
  Christopher Cowley
  Published on: 18 May 2017
• Let’s move towards creating a fairer applications procedure and not just shifting the existing bias
  Ashwini Oswal
  Published on: 18 May 2017
• A Humanities 'A' Level will make for a well rounded medical student.
  Ranjit S Bains
  Published on: 18 May 2017
• Author's response to Simon Lammy
  Christopher Cowley
  Published on: 18 May 2017
• Don't Measure A Students Success Based On Your Own Limitations
  Simon Lammy
  Published on: 18 May 2017

• Published on: 18 May 2017

  Response to Ashwini Oswal

  • Christopher Cowley, Lecturer

  Dear Editor,

  I have been accused of creating "prejudices" and of "force-feeding" others my own viewpoint. This seems a bit strong. Yes, it was a polemic, and so is by definition one-sided, but this should be taken as an invitation to discussion about what I think is an important question: which applicants are most likely to become the best doctors? And that itself depends on the question of what is a good doctor....

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  Dear Editor,

  I have been accused of creating "prejudices" and of "force-feeding" others my own viewpoint. This seems a bit strong. Yes, it was a polemic, and so is by definition one-sided, but this should be taken as an invitation to discussion about what I think is an important question: which applicants are most likely to become the best doctors? And that itself depends on the question of what is a good doctor.

  Oswal says that we should "move towards assessing candidates based upon on their individual merits, in contrast to categorizing them based upon their A-level choices as the author suggests." As such, I assume Oswal is saying that we should be interviewing ALL applicants to medical school? This would be a logistically very demanding process. Should we even be interviewing those applicants without ANY A-levels? Should we be interviewing applicants who are ten years old? Surely we need SOME criteria to decide whom to interview in the first place.

  Next, Oswal asks whether it is not possible "for students who enjoy literature and read in their spare time to develop similar skills?" Certainly it is possible, just as it is possible in principle for students who enjoy biology to read in their spare time and acquire the requisite knowledge to enter medical school. But we still need to *assess* such knowledge and skills in both cases. In principle the medical schools could organise their own entrance exam, but why bother... *if* the A-levels are enough? There is a separate debate about whether the English lit A-level can do the job, but I would imagine that most teachers of literature A- level would strenuously deny Oswal's claim that the programme fails to "provide a broader experience and appreciation of literature which can only come through self study." Self study can mean all sorts of things, surely! Oswal would not trust an applicant who had merely been "interested" in biology and "studied it himself", as a "hobby" -- he would insist that the applicant had achieved a certain standardised level. So it is with English Literature.

  Finally Oswal asks about "medical disciplines such as research or lab based specialities including biochemistry or pathology where a scientific mindset is more relevant than an ability to communicate and interact with people". I would entirely agree. So let people with such interests study biology or biomedical sciences or physiology in a Faculty of Science, let them do a PhD, let them apply for research grants etc.. That is perfectly respectable career path. Why should we ask them to spend all those years in medical school talking to patients if they are not interested?

  Christopher Cowley

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  Conflict of Interest:
  None declared.

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• Published on: 18 May 2017

  Let’s move towards creating a fairer applications procedure and not just shifting the existing bias

  • Ashwini Oswal, medical student

  Dear Editor,

  Although Cowley (Polemic: five proposals for a medical school admission policy J Med Ethics 2006; 32: 491-494) writes an engaging and entertaining account of how medical school selection criteria could be modified to avoid many of the traditional biases, my main criticism is that the author creates his own prejudices by force feeding us his own viewpoint instead of providing a truly objective and balanc...

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  Dear Editor,

  Although Cowley (Polemic: five proposals for a medical school admission policy J Med Ethics 2006; 32: 491-494) writes an engaging and entertaining account of how medical school selection criteria could be modified to avoid many of the traditional biases, my main criticism is that the author creates his own prejudices by force feeding us his own viewpoint instead of providing a truly objective and balanced discussion.

  In particular the author suggests that pure science graduates are no longer the most suitable for medicine, as has traditionally been considered the case and that preference should be given to those with A- levels in the humanities. I stress that we need to move away from harboring such polarized views which are of little help in creating a fair applications procedure since they simply shift existing biases as opposed to tackling them. If the application procedure is to be reformed to genuinely make it fairer for all, there needs to be a move towards assessing candidates based upon on their individual merits, in contrast to categorizing them based upon their A-level choices as the author suggests.

  More specifically, I do not agree with his rationale for favouring students with an A-level in English Literature. He suggests that the study of literature makes us better communicators and also helps us to better understand the emotions of a patient. This is a fair comment, but why do we need an A-level to demonstrate this? Is it not possible for student’s who enjoy literature and read in their spare time to develop similar skills? Furthermore current 2 year A-level courses may have students study a handful of books in great depth without necessarily providing a broader experience and appreciation of literature which can only come through self study. In addition, most medical schools already screen for an interest in literature by asking candidates probing questions about their interests and hobbies. My overriding point is that one’s educational grounding is not simply restricted to their A-level choices; education is something that is much broader than this.

  One further point that I would like to put forward is that proposals of this kind tend to favour the selection of those with certain personality and character traits. But is this a good thing for medicine? Sure, most of us would agree that we would like our doctors to find the balance between science and humanity, so that they can understand and empathise with us. Similarly none of us would want someone who empathises and understands but has no clue about how to treat us. But what about medical disciplines such as research or lab based specialities including biochemistry or pathology where a scientific mindset is more relevant than an ability to communicate and interact with people. There is a danger that in implementing the author’s proposals, we may exclude perfectly able science candidates to the overall detriment of medicine.

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  Conflict of Interest:
  None declared.

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• Published on: 18 May 2017

  A Humanities 'A' Level will make for a well rounded medical student.

  • Ranjit S Bains, Yr 2 MB, ChB

  Dear Editor,

  - I read with interest the article titled "Polemic: five proposals for a medical school admission policy" by C Cowley.

  There are two points I would like to make. As a pre-clinical Medical Student i can appreciate the advantage of having a humanities 'A' Level as this will lead to students acquiring skills that they may not normally acquire in a Science 'A' Level, for example the ability to write...

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  Dear Editor,

  - I read with interest the article titled "Polemic: five proposals for a medical school admission policy" by C Cowley.

  There are two points I would like to make. As a pre-clinical Medical Student i can appreciate the advantage of having a humanities 'A' Level as this will lead to students acquiring skills that they may not normally acquire in a Science 'A' Level, for example the ability to write at length in a coherent and accurate manner. The current situation with regards to the GCE sciences means that students miss out on developing these skills especially in Physics and Chemistry. The ability to write at length is further reinforced by the ever-growing trend for reflective learning and practice.

  Secondly - I do not believe it would be nessessary for the work experience to be FULL TIME. Provided it lasted for a significant duration i.e. 12 or maybe more months and was done regularly - maybe for 3 or 4 hours a week (each and every week) - I think this would be equally enriching. Full time work experience - particularly in a voluntary capacity would possibly prove equally financially taxing due to loss of potential income over that year.

  I do believe that more debate is needed as to whether minimum age for admission to the 1st M.B should be raised as this is something definitely worth thinking about particularly with regards to acquiring more life experience and therefore being better equipped to practice the art of medicine.

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  Conflict of Interest:
  None declared.

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• Published on: 18 May 2017

  Author's response to Simon Lammy

  • Christopher Cowley, lecturer

  Dear Mr. Lammy,

  Thank you for your detailed comments on my article. They were certainly a lot more constructive than some of the bizarre abuse I received on doctors.net.uk. I would like to respond to some of your points:

  1. I certainly do not suggest that the average medical student is a "stereotypical ancient social neanderthal." Of course medics have a wide variety of hobbies. But (i) there is surel...

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  Dear Mr. Lammy,

  Thank you for your detailed comments on my article. They were certainly a lot more constructive than some of the bizarre abuse I received on doctors.net.uk. I would like to respond to some of your points:

  1. I certainly do not suggest that the average medical student is a "stereotypical ancient social neanderthal." Of course medics have a wide variety of hobbies. But (i) there is surely a distinction between studying literature, politics, history etc. as a hobby and studying it as an academic discipline. (ii) Insofar as a medic does read the humanities, he has nothing to fear from my proposals. But those social neanderthals that are in medical school, I suggest, will not be good doctors and so should not be admitted.

  2. You ask for "long term prospective and retrospective studies". I mentioned a number of such studies in my article. But mainly, my article was a polemic, not an empirical conclusion. I was partly inviting others to carry out such research and test my hypotheses, but more importantly, some of the questions I was asking cannot be answered by long term prospective and retrospective studies: questions such as "what is a good doctor?"

  3. Your point about women is a good one, but if I am to take it seriously it would have far-reaching consequences, both in medicine and other professions. Should the postgraduate surgical training have a 'fast track' for women, for example? Or maybe we should allow women into medical school at 18 and men in at 23. Such a move would be supported by the widespread evidence that women are more mature at 18 than men are.

  4. I was amused by your suggestion that "when someone comes in with an aortic dissection singing them a lullaby or reading them a novel is not going to work." No, I don't think it would either. But such an exaggeration reveals what you think of the humanities. Perhaps you would favour omitting the humanities and social sciences from the medical curriculum entirely, leaving only 'hard science'? But to repeat my point in the article, I am proposing *supplementing* the sciences, not *replacing* them, with a humanities prerequisite. It would be a form of tie-breaker among applicants with an otherwise uniformly strong science background.

  5. I find the passion of your invective against older students in the last couple of paragraphs a little odd. Most schools have the same standards for both school-leavers and older applicants, and so -- in purely academic terms -- they are surely equally able, no?

  I hope I have not misunderstood your points, and would welcome taking the discussion further.

  Christopher Cowley

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  Conflict of Interest:
  None declared.

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• Published on: 18 May 2017

  Don't Measure A Students Success Based On Your Own Limitations

  • Simon Lammy, 3rd Year Medical Student; RUMS Clinical President

  Dear Editor,

  The recommendations suggested by C Cowley (Polemic: five proposals for a medical school admission policy J Med Ethics 2006; 32: 491-494) although appearing thoughly insightful purely represent another attempt by another medical educationalist who spends more time thinking about training this great nations future doctors than training them.

  Concerning his first recommendation the fanciful notion...

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  Dear Editor,

  The recommendations suggested by C Cowley (Polemic: five proposals for a medical school admission policy J Med Ethics 2006; 32: 491-494) although appearing thoughly insightful purely represent another attempt by another medical educationalist who spends more time thinking about training this great nations future doctors than training them.

  Concerning his first recommendation the fanciful notion that making a humanities subject a stringent requirement so as to benefit the medical student and broaden his experience is ill-advised. Although most medical students study pure sciences they do possess a grounding through other avenues of learning towards subjects that do not necessarily encompass the above. Just have a conversation with us. One shall rapidly discover to ones surpise that we are not the stereotypical ancient social neanderthals as modern educationalists make us out to be.

  Concering the second notion about english literature and its supposed creative benefits to prevent us from stereotyping patients can he just re- read what he wrote please? On the on hand he mentions that a scientific mind set of stereotyping symptoms and recognising patterns progresses science. But on the other he insists that such an education void of literature stimulates such a though process which he does not consider wholesome. So what is it please? Where is the balance? Concerning creativity it is somewhat bewildering that such as academic in the twenty first century would assume that such a step would improve our abilities to think creatively. In the age of the iPod and music downloads and everything internet based medicine no longer attracts the same stereotype that exists during his generation. Times have changed without the need to tamper. Also have any long term prospective and retrospective studies been done on this? In an age of evidence based medicine it is ridiculous to wish to redesign the entire undergraduate medical process without conducting large scale studies from sixth form through to consultancy and then retirement to assess this.

  Concerning the third point a minimum age of twenty three would be extremely disadvantageous to women. For women to complete undergraduate medical education by thirty a lesser percentage would become consultants in competitive specialities (when we are trying so hard to ensure that the tables are even as that is what MMC is supposed to be about). One is essentially saying that the longer you delay completion of undergraduate medical education the less women are to enter certain specialties are other factors outside of medicine being to predominate (families). What about the divorce rate?

  Concerning the fourth point when someone comes in with an aortic dissection singing them a lullaby or reading them a novel is not going to work. Hard science and its correct application saves the day. We learn less and less science and more and more explanatory things which is not making us better doctors! Shipman probably had great communication skills!

  Most graduates who comment that they benefitted from medicine more as a graduate are talking from a skewed perspective because few would have had the intellectual aptitude and motivation to succeed in medicine straight from school unlike the thousands of school leavers who obviously do.

  Medicine is only crumbling because educationalists constantly try and mend a wheel that is not broken! We constantly attack the school leaver. To enter the competitive world that is medicine straight from school and possess the strong motivation and drive to not only pass but succeed and become some of the worlds most talented humans is to congratulated. Most so called enlightened graduates did not possess that at their age that is why they are only doing medicine now and not then. To insult the school leaver as an immature poorly shaped and naive poor comminicator is pathetic. This is especially so when most have parents who are doctors and so since young they have had a thorough comprehensive idea what medicine is about. They are not naive.

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  Conflict of Interest:
  None declared.

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