Professor Arunthathi Mahendran, Director for the Institute of Health Sciences Education
Another month, another crisis in the NHS. Faced with acute staffing shortages, the UK government recently announced plans for apprentice doctors, creating a pathway into medicine that doesn’t involve going to university.
It didn’t take long for the medical profession to make up its mind, with a chorus of voices explaining why the idea is doomed to fail. The British Medical Association’s (BMA) workforce lead, commenting on the BBC website, neatly summed up the mood: "Ultimately, the solution the NHS needs is still the same - a dramatic increase in traditional medical-school places."
However, the BMA’s response is a missed opportunity. Let’s be clear, I’m not arguing against traditional routes into medicine. The UK’s medical schools are some of the best in the world and each and every day, I’m privileged to be part of the extraordinary work they do. But it’s disappointing to see the BMA adopt such a binary view when the reality is, we can and should aspire to do both.
It begins by acknowledging that our existing system has in-built flaws, especially when it comes to equity and inclusion. Despite efforts to widen access, privately educated students and those from wealthier backgrounds continue to dominate medical school places. Shockingly, around 50% of secondary schools in the UK have never even had a pupil apply to medical school. To understand why this matters, we need to imagine life away from lecture theatres and classrooms and focus on the realities of modern medical practice. Doctors today must work with patients who come from different backgrounds and have complex needs.
Adults and young people facing difficult family circumstances, living with poverty or caring for parents with health problems are statistically highly unlikely to find their way into medical school. This is because the system prioritises traditional qualifications without valuing the social capital that these students bring with them. These experiences enable students to empathise with and understand similar patient problems. The debate surrounding access to education is often framed as one of fairness. This is important, of course. But the most compelling argument for cultivating a workforce of healthcare professionals who resemble the population they serve is how they can apply the power of their lived experiences to transform patient care.
So how do we get there? Certainly, medical apprenticeships are worth exploring – it’s where the profession began, after all. But perhaps more important than what any of these programmes look like is how they are taught. To make medical education more accessible, we need to take a long, hard look at the learning experience itself and be willing to challenge the fundamentals of how we teach.
In January this year, Queen Mary University of London was successful in a funding bid to develop a blended-learning approach to our MBBS medical degree. Using a blended approach allows us to quickly remove major barriers to entry, for example not having the funds to live and study in London or being responsible for the care of others. In parallel, blended learning and accompanying digital tools are an opportunity to revolutionise the learning experience. One of our first decisions in designing a blended MBBS was to do so in collaboration with patients, community partners, experts in digital education, policy makers and students – not just established educators.
Blended learning is not a panacea and there are many other challenges to consider as we broaden access to medical education. However, we have at our fingertips a uniquely powerful tool that even a couple of decades ago, wasn’t a reliable, practical solution for learning. We owe it to our profession, to our patients and to our young people to embrace the potential of digital technologies and open-up new pathways into medical education.
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