Why most Irish doctors in future will be white, female and middle-class

Attempts to diversify entry to medicine have failed – and recent changes may have deepened inequalities

UCC medical student Fionnuala Crowley is critical of the HPAT test for new entrants. After twice failing the test she tried a third time – but  used a different approach. Photograph: Daragh McSweeney/Provision

UCC medical student Fionnuala Crowley is critical of the HPAT test for new entrants. After twice failing the test she tried a third time – but used a different approach. Photograph: Daragh McSweeney/Provision

 

The modern day Irish medical student is likely to be young, female, Dublin-based and from an affluent background.

That is according to a Higher Education Authority study on the profile of medical students.

The report provides a stark snapshot of who our future healthcare professionals will be and how lacking in diversity the student body is compared to many other sectors of society.

While 46 per cent of new college entrants were entitled to student grants on the basis of their family income, this fell to just 14 per cent among new entrants to medicine courses.

The same data for the 2015/16 academic year shows most students were female (58 per cent), while a large proportion of new entrants were from Dublin based (31 per cent).

There have been some efforts in the past to try to promote greater diversity in the profile of medical school entrants.

One approach included the Health Professions Admission Test (Hpat), introduced in 2009.

The case for the Hpat was that it would take some of the heat off the points race and lead to better balance of candidates.

It was also designed to encourage more “rounded” candidates – such as students with higher empathy levels – to enter the medical profession.

But almost 10 years on, many experts say it has failed to shake up the gender balance or diversify the backgrounds of many applicants.

More unequal

In fact, some argued that it has only served to make access to medicine even more unequal than it was before.

A cottage industry has sprung up with prospective students hoping to game the system by spending hundreds of euro on Hpat grinds courses which some argue give an unfair advantage to wealthier students.

The Institute of Education on Leeson Street, and Ashfield College and Bruce College in Cork are just some of the private colleges offering HPAT preparation courses.

A study published last year in the British Medical Journal Open, conducted at University College Cork (UCC) across 290 medical students, has further underlined concerns about precisely what the Hpat has achieved.

“This study suggests no clear link between scores on a selection test, the Hpat-Ireland, which is designed to assess several skill domains including interpersonal skills, and scores on a psychometric measure of empathy, at any point during medical education,” the study found.

Failed

Dr Gerard Crotty, a consultant haematologist, believes the Hpat has only served to compound inequality and failed to make the profession more equal.

“My view is that the Hpat is not more inclusive.

For all the flaws in the Leaving Cert, no matter what part of the country you live in or what socio-economic background [you are from], there is a secondary school and it covers all of the subjects to give you all the points you need in the Leaving Cert – while the Hpat is a separate private exam,” he says.

Even if you don’t have someone to help you at school, you can pay for a private course

“If you go to a south Dublin private school you might have a teacher that’s talking to you about the Hpat and going through how to do it or how to prepare.

“Even if you don’t have someone to help you at school, you can pay for a private course. If you’re in a less well-off area, you might not be thinking about the Hpat or it may not be on your school’s radar,” he says.

A spokesman for the Australian group that runs the Hpat test in Ireland, however, defended the test.

“Hpat-Ireland continues to be a statistically reliable test that is fit for the purpose of selecting those students who will succeed in their medical courses,” the spokesman said.

He also said accusations that the test favours wealthier students who can pay for extra tuition to game the system are baseless.

“Hpat-Ireland has been developed as a test that is not based on learned academic curriculum or study of particular subjects, but as a test of your response to stimulus that will not necessarily be familiar,” the spokesman said.

“Intensive preparation is not advisable or necessary, although wide and critical reading may provide helpful preparation for sections one and two, and some practise in answering questions of a similar type, and under similar time constraints as those found in the real test can be helpful and reassuring to most candidates.”

Gamed

However, Dr Crotty insists the Hpat can still be gamed by students.

“There is no curriculum for it but you can still learn the types of tests and types of questions, hone your skills and learn the pitfalls and how long to spend on each section. Whereas if you just walk in with no preparation, you probably won’t do well,” he says.

My view is there is something wrong with the Leaving Cert because it is just asking for students to regurgitate factual information

“Students who repeat tend to improve their scores; it’s not that their intelligence has improved. It’s not just an aptitude test – you can actually learn some of the techniques off.

In terms of tackling the diversity problem, there are much bigger questions such as whether there should be more access routes to medical courses for under-represented groups.

Some, such as Dr Crotty, also point to the need to reform the Leaving Cert and the points system to reward critical and quick thinkers who could flourish in medicine.

“My view is there is something wrong with the Leaving Cert because it is just asking for students to regurgitate factual information. With the internet and access to all kinds of information in everyone’s pocket – we need to change the Leaving Cert and examine critical thinking,” he said.

New entrant medical students: in numbers

14% Proportion of new entrants to medicine courses are in receipt of student grants 46% Proportion of new entrants to third level overall in receipt of student grants 58% Proportion of new entrants to medicine who are female 42% Proportion of new entrants to medicine who are male Source: Higher Education Authority

One student’s story: ‘Some Hpat courses are outrageously expensive which favours wealthier students’

Fionnuala Crowley’s heart was set on a career in medicine.

While she had secured 600 points in her Leaving Cert, she was disappointed with her Hpat (Health Professions Admission Test) result and missed out on medicine by just six points.

She ended up studying biomedical health and life science at at UCD – but was determined to still give medicine a go.

Crowley sat the Hpat test once more and, yet again, missing out narrowly after another poor result.

She had performed “dismally” in the section of the Hpat that is designed to measure emotional intelligence.

“This had huge ramifications for my mental health at the time. I wanted to do medicine because I was really extroverted, I liked people, I wanted to help people and this test was basically saying I had the interpersonal understanding of a toad.”

Crowley decided to try her luck a third time. This time, she sat down with medical students from UCD. With their help she realised that she was second guessing her answers in the second section and ultimately then choosing the wrong one. Even with this awareness she still wasn’t confident she would choose the right answer on the day.

“The night before my third Hpat I couldn’t sleep. I went into the exam hosted in RCSI with two hours of sleep and a stomach full of coffee and energy drinks.”

She ended up scoring in the top 5 per cent in the country and, to her delight, secured a place in medicine at UCC

Looking back, Crowley says you can “definitely study for the Hpat”. She acknowledges that students from wealthier backgrounds will always stand a better chance of entering medicine – thanks to grinds and other supports – but says the Hpat hasn’t helped.

“Some Hpat courses are outrageously expensive which favours wealthier students,” she says.