In the second of our series, we look at what students can expect from some fast-growing and fast-changing subjects

When it comes to jobs, few students are more certain of instant employment than those studying medicine, writes Julia Hinde. According to Graham Buckley, executive director of the Scottish Council for Post Graduate Medical and Dental Education, anyone making it through the rigorous six-year medical training is almost guaranteed a job.

In fact, nearly two-thirds of the 9,953 new doctors granted registration last year by the General Medical Council to work in Britain were from outside the United Kingdom.

Despite this, the Government retains strict enrolment targets for Britain's 24 medical schools. Each year, 4,894 new medical students are admitted, selected from just over 12,000 applicants. Enrolments are planned to rise to 5,100 by 2001.

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One reason for the limited number of medical students is the cost of their training. Each student is estimated to cost up to Pounds 500,000 to train to registration. Medical schools receive up to Pounds 10,000 annually per student from funding councils and local authorities, but most medical training costs are borne indirectly by the National Health Service, as trainee doctors spend increasing amounts of time in hospitals and in the community.

Hospitals with medical students receive extra money from the NHS through a system called SIFT to provide training and support.

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In the face of a dearth of doctors, Sir Colin Campbell, vice chancellor of Nottingham University, is considering increasing the number of student medics. It is believed his Medical Workforce Standing Advisory Committee, due to report later this year, could recommend up to a 20 per cent increase in the number of students, resulting in as many as 1,000 extra medics a year.

How these extra medics would be trained is a contentious issue. There is talk of increasing admissions to existing medical schools, building more schools attached to new universities or establishing postgraduate schools where students who have already completed a non-related degree can undertake a much shorter medical training. The last option would produce doctors relatively quickly and possibly more cheaply.

Any such shake-up would be just the latest in a long list of changes to the medical degree.

Until recently medical schools divided their undergraduate degrees into preclinical and clinical sections. The preclinical period was largely off-ward and included learning basic science such as anatomy, physiology and biochemisty. This lasted between two and three years and was followed by the clinical section, where students finally got to meet patients.

Tomorrow's Doctors, published by the GMC in 1993, changed all that. It said students should meet real patients earlier in their careers and emphasised the relevance of basic science to practice.

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"Tomorrow's Doctors has been introduced in different ways," said Dr Buckley, who is also honorary secretary of the Association for the Study of Medical Education, which has recently undertaken a survey of the ways in which medical undergraduate courses are changing. He said that some schools such as Liverpool and Glasgow had gone wholeheartedly for problem-based learning, where students are taken into the community and hospitals from day one. At the other end of the spectrum is Cambridge, which maintains a more conventional three-year preclinical BSc.

After students finish preclinical and clinical undergraduate degrees they become doctors, but are not registered by the GMC until they have completed a year as a house officer. During this time they are still the responsibility of the university. Proposals for improvements were put forward earlier this year by the GMC in its New Doctor report, including more guidance and structure. This has yet to be implemented.

Medicine fared relatively poorly in the research assessment exercise. Most medical schools submitted their research under just three headings - clinical laboratory sciences, community-based clinical subjects and hospital-based clinical subjects. The result was that large disparate research groups were submitted for appraisal under the same headings.

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Michael Powell, executive officer of the Council of Heads of University Medical Schools, said: "Medicine generally did not do as well as expected - I think it is the nature of clinical medical research, and particularly that related to health service needs, and the size of the unit of assessment, which is responsible for this. The chances of getting high ratings across such a large range of subjects is not very high. In engineering and the humanities such a range would be split into different categories of assessment."

Winners in the RAE were Oxford and Cambridge and the specialist London institutes that have merged into the larger London University medical schools.

Medical schools in England are still have their teaching quality assessed, though this has now been completed in Scotland.

Medicine facts

* There were 12,025 applicants for medicine in 1996-97, 9,407 of whom were British; the remainder came from overseas * In 1996-97, there were 11,618 preclinical medical students and 12,142 clinical students, an increase of almost a quarter on ten years ago * Of the 4,894 students accepted in medicine in 1996, 45.6 per cent were male, 54.4 per cent female

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Source UCAS and HESA

Opinion, page 12