Prescriptions For A Doctor
Sydney Morning Herald
Monday October 21, 1991
TO GET into medicine at the University of Sydney this year, students needed an HSC score of 99.25. At the University of NSW, they needed 98.2.
Both universities are now looking curiously at NSW's newest and least traditional medical school at the University of Newcastle, where those with academic results not quite as glowing - in the top 10 per cent as opposed to the top 2 per cent of the HSC, or with reasonably good results in another university course - can gain entry on the basis of personalised interviews.
In medical circles, there is a widely held view that students do not have to be in the top 2 per cent of the HSC to cope with the demands of medical courses. But the HSC score is a convenient sorting method for the larger universities and is seen to be above personal bias in a highly competitive area.
Sydney University is widely regarded as having the most classical and traditional - and least hands-on - medical course, with its graduates making good researchers, academics and administrators. NSW's course is reportedly more rounded, with more patient contact fitting graduates for general practice.
Newcastle is regarded as most innovative, with the strongest commitment to patients and preparing students best to become general practitioners.
According to one administrator in a leading teaching hospital, Newcastle's doctors are "extraordinarily good" communicators. This may be due to its different selection procedures - which aim to choose those who are caring and show perseverance - coupled with its course content, which is perceived as far more hands on than that of Sydney and NSW.
But, the administrator pointed out, there was "something for everyone in health". While the best doctors were those who had a way with people, anaesthetists, for example "only put people to sleep" and researchers "may not have to talk to anyone, and may be discovering the most important things just talking to a test tube".
Still, with growing community pressure for our professionals to be accountable - after all, educating a doctor costs up to $24,000 a year -universities are feeling the pressure to produce graduates as far removed as possible from the negative stereotype of the arrogant, rushed, unfeeling and infuriating, apparently all-knowing doctor.
NSW University's Dean of Medicine, Professor Darty Glover, said proposals were being drawn up to allow the admission of a small group of students -about 15 - on criteria other than straight academic: communication skills, involvement with school activities such as debating, or activities such as belonging to community organisations of any description.
"If they can demonstrate achievements in other than academic areas, we might be able to admit them below the (usual) cut-off although the score will still be high," Professor Glover said.
When complete, the proposals will go to a full faculty meeting. It was possible that the scheme would begin operating in 1993, Professor Glover said. The 15 would be monitored through their undergraduate course, but "if there was no difference, there would be no point in continuing", Professor Glover said.
Sydney University is also considering two proposals which involve personalised interviews.
The executive officer of the university's Faculty of Medicine, Mr Tom Rubin, said the faculty would today consider the proposal that its medical course become a graduate course, with students already having a degree before doing medicine, "so they're more mature when they make their decisions".
"The idea has been buzzing around for years, but now we are looking at it more seriously. If it's approved it will still have to go the academic board and senate.
"It's partly to improve selection procedures. If we do this, it would almost certainly include some interviewing."
While almost 75 per cent of the 210 enrolling students at Sydney gain entry based purely on their HSC scores, 25 per cent - that is 60 to 70 students each year - come from other courses.
From next year, Mr Rubin said, these students might have to undergo interviews so that better choices could be made, particularly at the margins.
"But we haven't yet determined the criteria we'd be looking for," he said.
While the search for appropriate criteria continues at NSW and Sydney, Newcastle has it all worked out.
The secretary of Newcastle's Faculty of Medicine, Mr Brian Kelleher, said the university's minimum academic standard for HSC students - 90 this year -was a fair way below other universities' cut-offs.
About 40 per cent of Newcastle's students do not come straight out of the HSC, and they cover the whole spectrum - among them teachers, nurses, physiotherapists, scientists, engineers, economists, social workers, dentists, occupational therapists and arts degree graduates. These students need to have more credits than passes, and no fails, in their tertiary studies.
Those who don't have the HSC or tertiary studies - among whom there have been electricians, plumbers, bricklayers and cooks - can gain admission by doing well in a year-long open foundation course, covering English, politics and history, followed by one year proving themselves in a university course.
HSC and other applicants who fulfil the academic criteria are put through a series of psychometric tests assessing personal qualities such as "how caring they are towards others, their tolerance of ambiguity, perseverance, motivation and self-confidence".
The tests - which Newcastle has used for the last decade, and which are being updated by the Australian Council for Educational Research - look at how students deal with moral dilemmas such as that of a doctor faced with a truck driver who has a heart condition wanting a medical for a driver's licence.
Mr Kelleher said: "Do you say he's okay, he's the breadwinner (because) if he loses his job, they'll be consigned to poverty for the rest of their lives, or do you say he's not okay because he's likely to go out and die at the wheel of a truck?"
Another would be that of a doctor who has a drug which has been tested on animals and works for a particular illness, but frequently has terrible side effects. There is no understanding of what causes the side effects and who will get them, but the patient is terminal.
"You can't pick and choose between patients," Mr Kelleher said. "Do you give the drug? Knowing that it could either cure them, or kill them, does the doctor give, or sit back and palliate the condition so they can die with dignity and grace? It's the sort of thing doctors have to face in day-to-day practice."
Mr Kelleher said there were no right answers to these questions, but the testers looked for people who were open-minded in their approach to the questions, not people with narrow views who said there was only one answer which was indisputable."
Students are chosen for interview - by panels of academics and community members - on the basis of these tests.
In the process, applicants are also assessed as to how likely they are to get on in the course, which is delivered in small tutorial groups.
Mr Kelleher said: "They're not anonymous people in a lecture theatre of 200. A shy retiring person who doesn't say anything and can't accept the views of others is not going to perform in this course.
"We get ribbed by other universities because it's fairly complex and they argue that the amount of effort is not worth the result.
"We'd defend it on the basis of looking at the results we're getting. A person who scores highly in interviews is statistically more likely to graduate with honours than one who scores lowly, and a person who scores poorly is more likely to withdraw or fail than one who does well at the interviews."
Against interviews as a method of selection are the arguments that no-one has a clear picture of who will make a good doctor.
Professor Glover said that Sydney University had, in the early 1980s as an experiment, interviewed all its first-year medical students, looking at "the same sorts of things as Newcastle", - their communication skills and their motivation for doing medicine. Their progress was monitored.
"Some of those who would have been rejected on first impression did every bit as well as those who gave a favourable impression. One of the ones who would have been rejected finished up winning a first class honours and uni medal," Professor Glover said.
"It's extremely difficult to predict who's going to do well and who's not. No-one can say who's a good doctor and who's not ... there are surgeons, GPS administrators, radiologists ...
"If they are selected on the basis of an interview, you have to have a clear picture in your mind ... (but) personal skills and attitudes can be quite different for these different groups.
"It's very difficult to sort out students at the end of a school career, to say here is a student we don't believe will be suitable."
Despite moves to experiment with interviewing, Professor Glover said, the faculty was not convinced that any other method of selection, including Newcastle's interview and psychometric testing, meant students would do better in the undergraduate course or perform better, or be more considerate, as doctors.
The most comprehensive report on medical education, the 1988 Government-commissioned Australian Medical Education and Workforce into the 21st century, recommended that the Government should sponsor wide-ranging research into the question of selection and curriculum for medical students. As yet, however, nothing has eventuated from the Government.
The consensus appears to be that while Newcastle is admirable in providing a second chance for able people, its selection method needs more evaluation before other universities will even consider their introduction on a broad scale.
© 1991 Sydney Morning Herald
