Unnoticed by the general public, Irish medical education has been undergoing significant changes in recent years. The changes have been driven by the Medical Council, the statutory body set up to oversee the profession in the Republic.

"The standard of undergraduate medical education is very high in this country," says Professor Gerard Bury, the council's president, "but a great deal of progress in medical education has been made abroad and we are keen to see the benefits of these lessons introduced in this country."

Dr Tom O'Dowd, professor of general practice at TCD, agrees: "Changes are necessary. Medicine is a very conservative profession and, until recently in Ireland, things had not changed since I was a medical student. For years, teachers and students were saying that the curriculum was overcrowded and had to be addressed. We've been encouraged by the Medical Council to decrease our curriculum by as much as 30 per cent in some instances."

Over the past couple of years, the council has reviewed every medical school in the State - UCD, UCC, NUI Galway and the RCSI - and has made recommendations for change. It is currently monitoring progress in this area.

A major theme of the council's programme is the personal development of students, says Bury. Medical education has suffered from "factual overloading and has not encouraged students to become mature adults." Because the approach to medical education has been largely technical, the danger has been that the courses were "technician-type courses."

The new programmes are designed to enable students to enter the era of lifelong learning. "They will learn how to become learners and safe basic doctors and identify specialities for the future. These are important aims and elements of any university education."

The council, too, has recommended a major shift to increase integration of clinical and pre-clinical training. "The basic sciences," says the council in its Statement on Medical Education - 1997 , "should concentrate on material which is of relevance to the practice of medicine . . . The foundation period will therefore include integrated courses, early patient contacts, communications skills, basic clinical skills and innovative teaching and learning methods."

The council has proposed that a new integrated six-year programme, which would incorporate the intern year, should become the standard undergraduate course. Already, UCC is phasing out its six-year course and other medical schools in the Republic are reviewing first-year medicine, which, in the past, was called the pre-med year.

The year is largely science-based and its phasing out is "a recognition that physics, chemistry and biology are done to a sufficiently high level in schools and that there is no need to repeat them," says Professor Kevin O'Malley, the RCSI's registrar. TCD, though, has revamped its first year and is adamant that medicine at Trinity will remain a six-year course.

The council sees no problem with medical schools offering courses of different lengths, provided "the right targets are met with the right methods," says Bury. "We are happy to encourage diversity."

However, when it comes to a five-year undergraduate medical programme, there are pros and cons. Dropping the science year could discriminate against pupils from smaller schools who have less access to science subjects at Leaving Cert level, suggests John Hayden, the HEA's chief executive. Graduates of a five-year course may be too young and immature to practise medicine. However, "if it can be done, you're saving a year," he says.

Education apart, Irish medical schools have witnessed other changes in recent years. One change, it is argued in some quarters, could become a major issue in the future - it is the intake of overseas students which has shown a significant increase. In the year 1992-1993, 840 overseas non-EU students were studying in Irish medical schools and, by 19971998, that figure had almost doubled to 1,564. The four universities - TCD, UCC, UCD and NUI Galway were largely responsible for the increase, according to Hayden. The Government puts a quota on the number of Irish students who can train to become doctors. A new annual quota of 305, based on the number of hospital training places available, was agreed in the early Eighties. There is little evidence that these figures need to be revisited, according to Hayden: "It was scientifically done and the figures have held up."

He points to spare capacity in medical schools since the new quotas were introduced. Admitting overseas students was "a reasonable thing to do," he says, since they pay fees way above the economic rate, which is about £6,000 to £7,000 per student.

Irish medical schools are currently admitting around 250 overseas students each year. The largest educator of this group is the RCSI, which takes in just over 100 non-EU students each year. The RCSI, however, gets no HEA funding and is almost entirely reliant on its overseas intake.

The other medical schools have found that admitting foreign students can be a lucrative option. However, concern has been expressed that, in the race to attract such foreign students, medical schools could be persuaded to admit students with lower qualifications and hence lower the educational standards pertaining here. In the long term this could have a negative effect on Ireland's medical reputation abroad, the argument goes.

"We're conscious of the potential danger," says Bury, but there's no evidence of a huge divergence of standards among foreign students. We must ensure it doesn't happen and we're closely monitoring the issue."

Given the current state of spending on medical education in Ireland, medical schools feel they have no option but to take in overseas students. "It's a concern that we are being driven to take in more foreign students to support our teaching," says O'Dowd. "The money we get from the HEA isn't enough. If it weren't for the foreign students, we would have to lose staff." Overseas students, then, are subsidising Irish students.

The number of medical schools in the Republic is another issue. With a population of under four million, do we really need five schools? "If we were planning Irish medical education from scratch," says O'Malley, "I don't think we would have five medical schools."