It's standing room only in the lecture theatre, and the speaker doesn't disappoint. Andrew Raftery, consultant transplant surgeon and council member of the Royal College of Surgeons, booms his way through the requirements of a doctor: motivation, skill, commitment, enthusiasm, confidentiality and, above all, communication skills. "You'll have to be able to talk to all sorts of people," he warns. "If you're a junior doctor they'll vomit over you and give you four-letter words."
In a well-pitched performance, he casts himself close to many people's idea of a consultant: a Conservative earning £180,000 a year "and that's with no private work", and then goes on to reveal that he was the first in his low-income family - his father worked in a factory -to go on to further education, and that he failed two of his A levels first time around, and didn't do brilliantly in the repeats. "If I can do it, so can you," he urges.
The audience is a group of a hundred 13-year-olds, accompanied by their parents, who have been chosen to take part in Sheffield University's innovative outreach and access to medicine scheme. Over the next five years they will take part in a series of activities aimed at helping them through their A-levels and into medical school. This year they will spend a day at the university, meeting current students and discussing why people go to medical school and what the course involves; they will meet a doctor from an accident and emergency department, and discuss "fact and fiction in medicine" with the aid of clips from TV's Holby City, ER and Scrubs.
This will be followed by residential summer schools, work experience, advice on filling in the university application form, mock interviews, and visits to hospital departments. They will learn skills such as giving injections and taking blood. Those who get through the five-year programme are guaranteed an interview for one of the 20 ringfenced places at Sheffield medical school. But they must get ABB grades - or thereabouts - in their A levels.
No lame ducks
"This is not a system for letting lame ducks into medicine," Raftery stresses. "The idea is to take bright people from disadvantaged backgrounds so that they compete on a level playing field, but we do allow them to slip one grade at A-level." Applicants, he says, do not have to tick the boxes of the medical student stereotype: "Prefect, well-travelled, Duke of Edinburgh Award, three As at A-level, and plays the cello."
The scheme, launched in October 2001, targets more than 80 underachieving schools in Yorkshire, Derbyshire and North Nottinghamshire, aiming to increase aspirations and create more diversity in the medical workforce. To be eligible, pupils must have parents who did not have further education, or have special reasons for needing to study locally. It is looking, Raftery says, for young people "who, through no fault of their own, do not play the cello but could make good doctors".
Helena Hinds remembers being warned that she was "aiming a bit high" when, aged 14, she told a careers adviser at her school in her mining village in Derbyshire that she wanted to be a doctor. But now, aged 20, she is a third-year medical student at Sheffield, thanks to the access scheme. "Nobody in the village did anything like that," she recalls. Undeterred by the initial rebuff, she went to a college to do A-levels and the head of science there told her about the access to medicine programme. She applied.
"Even though I always wanted to be a doctor, because I wanted to work with people and am fascinated by illness, I had all sorts of negative preconceptions," she says. "I didn't think people like me went to university or medical schools. [The access scheme] broke down those barriers and made me feel I could do it."
Assim Rafiq, now a first-year medical student at Sheffield, says: "I felt medicine was just for the middle classes. But when I came to the talk I was surprised how normal the people were." The youngest in a family of four, he went to a comprehensive school with a poor reputation, but, with support from the Sheffield access scheme, took A-levels in biology, chemistry and psychology and got three As.
He says he has been struck by the variety of skills required in different medical settings. Shadowing a hospice nurse, he was surprised not only to see patients having manicures and enjoying painting sessions but by seeing the nurse cry when a patient died. He was reassured that it was OK to express emotion in medicine. He is hoping to become a heart surgeon.
Natalie Roberts, also in her first year, was the first person ever to apply to medical school from her comprehensive in Doncaster. She was offered a place if she got BBB in her A levels. She achieved A, B and 2Cs and was accepted.
The Sheffield scheme was launched in the wake of the public inquiry into the death of 35 babies at Bristol Royal Infirmary. Published in July 2001, it said: "We need to guard against future generations of doctors and other healthcare professionals being drawn from too narrow an academic and socio-economic base."
An analysis of medical school intakes for the years 1996-2000, published in the British Medical Journal last year, found "massive inequalities by social class". Pupils from social class 1 (professional) were 34 times more likely to go to medical school than those in social class 5 (unskilled). No black people from social class 5 were admitted to medical school in the years covered by the study. "This has serious implications for the sort of doctors we get and their knowledge of life," says Daniel Dorling, professor of human geography at Sheffield University, who carried out the research. "We select people who are very good at science and so get doctors who are technically able, which is important, but they may not know much about life. And much of a GP's work is talking to people about their lives."
There is evidence that negative perceptions of medical school deter gifted pupils from disadvantaged backgrounds from applying. A study of academically able pupils aged 14-16 year in six London secondary schools found that those from lower socio-economic groups "saw medical school as culturally alien and geared towards 'posh' students". They "greatly underestimated their own chances of gaining a place and staying the course".
The study, led by Trisha Greenhalgh, professor of primary care at University College London, highlighted "a remarkable lack of knowledge about what actually goes on at medical school, and about medicine as a profession". It concluded that there was a need for local initiatives using unconventional approaches and mentors from non-traditional backgrounds.
Another scheme, under way at the Guy's, King's and St Thomas' School of Medicine, has taken some of these issues on board and is targeting pupils from five inner London boroughs (Lambeth, Lewisham, Southwark, Tower Hamlets and City of Westminster) who would not normally achieve the necessary A-level grades to train as doctors.
Partly funded by the Damilola Taylor Trust, the access to medicine programme offers 50 extra places at the medical school. Most students come from working class backgrounds, and many from families where neither parent is working, says the project manager, Gavin Brown.
Slower pace
Successful candidates are offered the chance to take the medical course over six years known as the extended medical degree programme, instead of the traditional five, allowing students to study at a slower pace, with more support during their first three years. Last year there were 200 applications for the 50 places. Applicants must achieve a minimum of three Cs at A--level, including chemistry and another science. But no single element of the application requirements, which include an interview and personal qualities assessment test, is considered more important than the others.
Launched in 2001, the programme is already showing encouraging results, says Brown. "Although the dropout rate is slightly higher among those on the extended programme, the good news is that the top third of those students perform among the top quartile of the whole medical school. Even our weakest student outperformed 100 students who had come through the conventional route.
"If you are a young person from a privileged home counties' environment, it takes some time to feel at ease with many of the patients you will see in hospitals in this area," Brown adds. "Local students on the extended programme often find it easier to talk to people."
Stania Kamara, 20, is in the third year of the extended course at Guy's, King's and St Thomas' medical school. She came via school in Lambeth and says the extended degree programme gives her time to work in hospitals and to study. She expects to be about £30,000 in debt by the time she finishes. "It's challenging, and university can be quite daunting at first," she says, "but now I can't imagine doing anything else. And I can definitely see myself as a doctor."
