Medical Apprenticeships. Explain it to me like I’m 5.

[W0tnow]

…because I don’t understand. According to this article, these apprentices will achieve a medical degree after 5 years of on the job training and academic study.

But the traditional route involves 5-6 years of study, (including supervised patient contact, but mostly study) and is, by all accounts, incredibly intense. How can you attend medical school, work in a hospital as an apprentice doctor, from day 1, and achieve the same qualifications in the same amount of time? How is that possible? Who is going to be supervising/ training these apprentices? The same staff who currently train first year doctors?

If I understand this correctly, (and I’m sure I don’t) the only difference between the two qualifications, is that one comes with a massive debt.

https://educationhub.blog.gov.uk/2023/06/30/nhs-doctor-apprenticeships-everything-you-need-to-know/

What I don't agree with is dumbing down medical degrees or admitting candidates without proven academic achievement

There's no suggestion this will happen though. They'll be doing the exact same degree at the exact same uni as standard medical students.

This won't work. Who is supposed to supervise these 18 year olds starting their apprentices?

They won't be 18 year old apprentices. The question of supervision is a good one - but the expansion of medical places is happening - very few of those expanded places will be going to apprentices, so the supervision of the apprenticeship per se isn't the issue.

I qualified in dentistry many years ago. At that time you could qualify if you satisfied requirements (clinical experience ie having done x hundreds fillings , braces etc ) in four years and one term .
That was stopped because the EU would not recognise dental qualifications from a degree of less than 5 years. All courses were then converted to five years.
Dental degrees , like medical , vets , after the first year do not have short terms of 30 weeks. You work 45 weeks 8.30 to 5 , weekends , evenings and any time off are spent studying or on electives.
The drop out rate is quite large as the academic rigours weed people out when they fail exams , and the pressures and stress mean some drop out realising this is not for them .
As someone who trained newly qualified dentists in their first post grad year I can tell you they are no where near trained well enough on qualifying for independent work and the same applies to doctors.
A four year apprenticeship will train doctors whose qualifications will be recognised no where else in the world and who will be on a back foot compared to those on a five year traditional course.

But then how would that oncologist have any knowledge/experience to recognise when xyz symptom is not eg a side effect of the cancer being treated but actually something else (thyroid packed up/diabetes kicked in/something else)....

Just because someone may be great a parallel parking, or manoeuvring around a roundabout does not mean you want them to be your taxi driver....they need to have a driving licence and know the whole thing.

@Willowtara what do you think other HCP learn about on their 4 year degree courses?

A four year apprenticeship will train doctors whose qualifications will be recognised no where else in the world and who will be on a back foot compared to those on a five year traditional course.

It's a five year programme not a four year one.

I understand your points however don't agree that school qualifications are particularly or exclusively representative of ability in a given area (Medicine and the Sciences in this case).

I'm sure you're not suggesting that top GCSEs and A Level results are simply the natural intellectual cream rising to the top?

This is because of the disparity in the quality of primary and secondary education quality as well as parental involvement as I'm sure you're well aware.

Of course it is necessary to ensure a high standard of candidate but the point is that plenty of people could meet a high standard if it was not predicated upon being either well supported or actively pushed during their early years (of course there are examples of 18 year olds who have been offered places without this but at my university at least, they are not the majority). The GAMSAT is a pretty rigorous test and can be undertaken at any time, not just at school.

I think that as long as the curriculum of an apprenticeship covers the same content as a Medicine degree, even if over a different period and format, I think that it could be a very valid entry route into the profession.

In terms of other professions with complex knowledge bases, Law has the ILEX route (apologies if it has another name these days). As I mention, Engineering has very traditional apprenticeships and can involve life or death responsibility as well as in depth mathematical and physics knowledge.

Their respective professions. They don't study medicine.

I was an HCP (radiography) so if you think you can catch me out somehow, you can't. I found it easier to read x-rays and had more anatomy knowledge initially, but after some radiology teaching everyone else caught up.

The academic level and required scientific underpinnings just don't compare to medicine. I went to uni with nurses and paramedics; a lot of them were in the bottom decile. It didn't give them an advantage.

In terms of other professions with complex knowledge bases, Law has the ILEX route (apologies if it has another name these days).

There's also an apprenticeship route in Law now!

The academic level and required scientific underpinnings just don't compare to medicine.

The academic argument against them isn't a sound one though. Medicine apprentices will still need to pass the same exams as all other med students. If they fail, they don't progress.

Pardon me , I was conflating the proposed four year medical degree https://news.sky.com/story/how-the-government-plans-to-address-the-nhs-staffing-crisis-from-shorter-degrees-to-extra-medical-school-places-12911822

with the apprenticeship.
The apprenticeship still has the problem of people working and completing a very rigorous academic study at the same time. The problems of the medical degree being recognised elsewhere still exists (this is not just a problem of doctors being able to move abroad but mostly that a lot of high level training goes on in exchanges , training , and research schemes in other countries . This stops if a country does not recognise your qualification) , the problems of fitting the academic structure , the teaching staff , the clinical supervision still remains in the context of providing extra bodies on wards, which is what the point of this is.
Looking at this dispassionately why provide a medical apprenticeship?
Is it to fill a training gap in the present medical education system or
Is it to rapidly fill a hole in manpower ?
In other words will the apprenticeship create better doctors or is it to create bodies to fill a gap , rapidly?

How did you get that from my post?

Where did I say that school qualifications were "the natural intellectual cream rising to the top" when my entire post was about access courses and foundation years, which circumvent the need for school qualifications?

Your reply is extremely odd.

They should just give people who enter the public sector a pass on their tuition fees. Stay in the NHS/Education for, I don't know...10 years...and your Uni fees are wiped clean. But how that is done...fuck knows. Maybe this mad apprenticeship idea is a way to do that....make newly qualifies doctors and nurses not have the burden of tuition fee loans.

You insinuated they didn’t cover basic science which is absolutely rubbish. I’ve no knowledge of radiography degrees (which I think are 3 years?), at the time I did my degree paramedics and nurses didn’t even need a degree but I think you’ll find some other professions which are very science based. How much lab work do medical students do?

I’m a clinical nutritionist and I specialise in applied metabolic nutritional therapy.

I did 3 years of Uni with extensive lectures on anatomy and physiology, pathophysiology , pharmacology, biochemistry and clinical practice theory.

All before we got onto 1 year of supervised clinical rotation and we’re not diagnosticians nor performing any medical procedures! It’s madness.

Looking at this dispassionately why provide a medical apprenticeship?

A way for the NHS to use its apprentice levy?

I have experience of quite a few medical/dental students who failed to get the grades to study in the U.K. so went abroad to study in places like Prague and Valencia .
All goes well until around year three when the drop out rate on some courses was close to 80% as many just could not pass the exams to continue on.
Unfortunately , it has to be said , in order to study , successfully , for these types of jobs you have to have the ability to retain and rapidly retrieve large amounts of very complex information in very stressful conditions . Not only to pass exams but to be able to work safely afterwards and continue throughout your working life to study and train.
Having trained many who were on their second degree after studying eg pharmacy, biochemistry, microbiology , all were agreed they had no where near the intensity ,rigour or stress of a medical/dental degree.
Unfortunately I had to counsel two people , one a medic , one a dentist , who had done other degrees first , so qualified in their late thirties/early forties and both said they had no idea what they were letting themselves in for and both, on qualifying , wanted to leave the professions but having spent so much time and money felt trapped into staying.

At no point did I say they don't cover basic science. I said that the breadth and depth of science applied to human anatomy, pathology, physiology and pharmacology is unique to a medical degree. Different aspects are included in other degrees (e.g. pharmacy focuses on pharmacology) but it is the combination of everything, built on with diagnostic skills and the ability to manage illness, that makes a doctor.

@Willowtara no pharmacy doesn’t focus on pharmacology actually, it’s a small percentage of the learning but a popular misconception as they sound similar…

Prior to the pandemic my job involved organising placements for the university students in the hospitals and arranging training for all the junior doctors, I left because it was incredibly stressful as there were not enough doctors employed in the trust to provide adequate training and the medical students & the junior doctors were being severely let down, I can only imagine this is 100 times worse now so I cannot imagine how these apprenticeships could possibly work

I think this is madness. My medical degree (back in the 1980s) was 3 years preclinical and 3 years clinical. After that I still knew practically nothing compared to what I actually needed to know to be a doctor. But take away the preclinical grounding in all the various basic and then applied sciences you need (starting with physics, maths, biochem, statistics, sociology, psychology etc etc and moving to macro and micro anatomy physiology, chem path etc) then this is not equivalent to a "medical degree" at all and surely would rightly not be considered by most countries to be one.

Not in our place.

We have 12 junior clinical fellows. Different person everyday.

APPRENTICES WILL STILL DO THE EXACT SAME DEGREE, SAME EXAMS, SAME EVERYTHING!!!!

ITS IMPOSSIBLE FOR THIS TO BE THE CASE IN THE TIMEFRAME AND WITH THE LACK OF RESOURCES TO SUPPORT THEM.

The present degree is taught full time with extended terms from year two , with weekends and evenings spent studying . There is no spare time, no slack to add on working on wards in addition to what is already done .

How on Earth the apprentices are expected to take on additional work loads ,alongside an already demanding course is unknown.

For medics/dentists/vets their degree bears no relationship to other degrees , there is no slack time , there is a good reason why you do not see these students working in bars etc after first year , that's because there is no time.

All of this is without thinking who is going to supervise/train these apprentices on the ward. Already people are thrown in the deep end , the old adage of "see one, do one teach one" is now often "try to find someone to teach , when that fails look up on internet and fingers crossed" because there isn't the teaching or supervising staff.

My apologies, I stand by everything i wrote but confused your post with another's who was citing her partner's immaculate GCSEs and A Levels as proof of being a high level candidate for medicine. Very long day but I posted as I feel quite strongly about widening access to not only Medicine but other professions.

I fully agree that the existing alternative pathways are useful (and am especially thankful for the 4 year grad entry).

For those that mention this but aren't sure of the format, it is an intensive course, same material and similar structure to the 5 year undergrad but with shorter breaks and no long research project/ dissertation , at least not at my uni. I think students are assumed to have demonstrated the skills involved with that in their previous degree(s).

Anyway, I understand it will be tricky to get the format, workload and teaching resourcing right for an apprenticeship but I'm really not sure why a new format of medical education necessitates a 'dumbing down' of standards if executed well. In our curriculum there is a lot of 'spiral learning' whereby key concepts such as biochem, are introduced then re-covered later in another context or more detail to allow for learning by repetition. As I say, the time that this really falls into place (according to many of my cohort, I don't claim to have conducted a widespread study) is when it is brought to life in clinical placements and applied to real life problems. Therefore I feel that if students were on the wards early, they could learn the theory quite efficiently.

Whether medical apprenticeships are executed well is another thing but I'm just not sure why the catastrophising about this in principle. The gatekeeping I refer to is the insistence that there is only one way to learn medicine and that is the traditional. It's not the case for almost any other field.