Medicine without chemistry A Level

[AlphaApple]

DD is in her first year of A Levels, Biology, Psychology and PE plus an EPQ. Studying is going well with As and A stars anticipated. She's always been interested in health related careers but after 2 days work experience at our local hospital is suddenly thinking medicine (having previously ruled it out). I understand without chemistry A level, options for medicine are limited.

Does anyone have any experience or advice? E.g. a foundation year or a university that doesn't require chemistry?

If you read the previous threads as I have, you will note that posters did give their opinion on this, quite aside from the studies. Some of them were quite insightful. I could quote but I don't think cross-thread quoting of individual posters is good form irrespective of whether it falls within talk guidelines.Yes indeed, accuracy is helpful.

Edited for missing text.

MrsMedic I have certainly read the threads that I linked to titchy and which included the report that said that research indicated that PBL led to less good outcomes in terms of career progression.

Each of those threads were florid displays of poor form in terms of astonishing levels of rudeness, so I don't think you should be too shy about further poor form merely by cross-thread quoting. That would pale in comparison.

Sorry to reappear but had so many DMs asking about how to get into medical school and can’t keep up with replying as work busy (exams incoming). If you DM me your email I’ll send the spreadsheet asap. Thanks all and good luck !

It’s a shame these threads are being derailed every time. I spoke to the admissions teams at several Unis this week and read some of what has been posted here to them. Their answers are not printable.

Thanks @mumsneedwine. I look forward to meeting some of the said teams at university open days.

DD is musing about the option of taking a year out and taking chemistry to give herself more choice. There are online providers which support you to take it in one year.

This seems to justify ‘poor form’ on this thread on the basis of the bar on other threads allegedly being so low. Strange logic.

For clarity, I personally have had no input into any such alleged ‘astonishing levels of rudeness’ on any of those referenced threads.

A lot of medical decision-making depends on an understanding of chemistry. When I was at medical school, entrants with science A levels (invariably physics, chemistry, and biology) went directly into second year. Scottish entrants with science Highers went into the first of three preclinical years because Highers were less advanced than A levels - such was (and is) the importance of these subjects to medicine, particularly chemistry and biology.

But it is an incontrovertible fact that content has been removed in recent years from A level chemistry to the point that chemistry departments in universities are now obliged to teach what was once taught in schools. In contrast, medical schools teach less biochemistry than they used to. One reason they teach less, but not the only one, is that it was felt to be putting students off. Medical schools score much better in NSSs the more time first to third year medical students spend chatting with patients rather than in laboratories and lecture theatres.

I was asked by a longstanding family friend for advice about his son. He had been to an academic private school, and his intention had been to go into financial services but he wasn't very happy and probably underperformed in his A levels which did not include any sciences. But he now wanted to be a doctor. I gave them the same advice I had successfully given my children - DO NOT. But he was determined. He took a year out to obtain the entrance requirements for a one year foundation course for medicine, including a chemistry A level.
He worked very hard on his course so that he automatically qualified for entrance to a specific long established medical school. He set himself a specific career goal, chose a job that was appropriate to that goal, did a year of research and now he is a middle grade surgeon heading for a consultant post in plastics.

He will succeed because he was patient and put in the hard miles for each step of the process.

However, the NHS is terminally dysfunctional and I would not encourage anyone to do medicine. About a third of medical students plan to emigrate, and half of those not come back. For someone who can't be put off I suggest avoiding PBL (as much as possible).

https://bmjopen.bmj.com/content/13/9/e075598

@Marchesman What are you basing the PBL comment on?

Out of interest, what is your medical speciality? I can see that some areas of medicine require a strong, instantly recallable knowledge of biochemistry (especially endocrinology, but also nephrology, hepatology, respiratory and anaethetics) but I think many doctors acquire this during the early years of specialist training, while most others in other specialities get by on medical-school-level biochemistry. Knowledge of pure chemistry isn't closely related to most kinds of clinical reasoning, and medical-school-level biochemistry doesn't require A-Level chemistry to learn.

Personally, although I don't work at Newcastle, I think their approach of having no A-Level subject requirements but rather relying on good A-Level grades and UCAt as evidence of students' ability to learn the stuff they will be taught at medical school is probably the right one. There is a fair bit in A-Level curriculums that is over-simplified or simply wrong (the latter is noticeable in biology and psychology; I'm not aware of any frank inaccuracies in chemistry), which means anything essential really needs to be re-taught anyway.

Medical schools score much better in NSSs the more time first to third year medical students spend chatting with patients rather than in laboratories and lecture theatres.

I don't agree with this at all. Nothing that happens in the first two years appears to have much influence on NSS scores for a five or six-year course. Students' comments in the NSS are all about things that have affected them in the last two years, most often to do with placements, access to skills labs & libraries, and timetabling (and lack of parking, obviously). And students don't spend time "chatting with patients": they spend time acquiring communication skills and learning thow to take a history. We expect our students to be able to be competent to take a reasonably simple history by the end of year 2 and to have basic skills in physical examination so that they are equipped for placements in year 3 (which make up the majority of their time in years 3 & 4 and all of their time in year 5).

Believe me, year-2 students want more lectures because they are obsessed with exams. Making them learn how to communicate with patients makes us very unpopular. So if what happens in year 2 influenced NSS scores, the way to improve scores would be to do more lectures and have less patient contact. But our job isn't to get good NSS scores: it's to produce good doctors.

If it's relevant, DD is very interested in obstetrics.

@AlphaAppleDM me if want any advice. Know several F2s who have managed to get good enough ranking to secure a training post this year.

My PBL comment is based on common sense, and my long experience of General Internal Medicine. But see also McManus et al 2020:

"PBL schools have higher historical rates of producing GPs, teach more general practice, have higher F1 preparedness, produce more trainee GPs, have higher rates of ARCP problems for non-exam reasons and have lower entry grades, less traditional teaching, less teaching of surgery, less examination time, lower UKFPO Educational Performance Measure and Situational Judgement Test scores, lower pass rates in postgraduate Foundation exams overall and lower average marks in MRCGP AKT and CSA exams and in MRCP (UK) Part 1. It is clear therefore that PBL schools do differ from non-PBL schools in a range of ways."

"Even when entry grades and other measures are taken into account, PBL schools (and post-2000 schools) tend to do less well at examinations."

"F1 preparedness" is a trainee self assessment - and it correlates negatively with performance by most metrics. I think you should not feel complacent or defensive about this.

Manchester and Glasgow are PBL and don't have lower entry grades.

My PBL comment is based on common sense

There is a quotation usually attributed to Albert Einstein (although difficult to verify): "common sense is actually nothing more than a deposit of prejudices laid down in the mind prior to the age of eighteen." I'm rather wary of medical practitioners who believe "common sense", rather than clinical guidelines, is a good guide.

I have taught on medicine courses that use PBL and on others that don't. I have been an external examiner at medical schools that use PBL and ones that don't. I cannot see any difference in level of knowledge or understanding between the students on the different types of course. I have taught on a PBL course that produces graduates who feel (6 months in to first FY job) the best prepared for the job of being a doctor and I'm currently an external at the medical school that produces the graduates who feel least well prepared, which is a predominantly lecture-based course in the early years. I don't think that difference is accounted for by PBL vs lecture-based, and nor do I believe there is an argument that courses using PBL produce graduates who are less capable of being doctors. If you have encountered graduates of medical schools that use PBL who aren't capable, I suspect it's not PBL itself that's the cause.

It's worth prospective students - and their parents - remembering that these differences in delivery really only exist in the first two years of the course, with the remainder being about applying and developing knowledge in the context of real cases in clinical settings. And also remembering that there is no such thing as a purely PBL or a purely lecture-based course. All medicine courses use a combination of small-group and large-group - and faculty-directed and self-directed - learning. It's certainly the case that a student who is not capable of self-directed learning is not going to succeed, and this might become apparent a bit earlier on a course that uses small-group learning more heavily in the first two years.

I'm not a PBL zealot, but I absolutely disagree with anyone who thinks all (or even most) students learn better from lectures. This is, however, related in part to my experience of lecture content that is out-of-date or simply incorrect.

In response to someone's comment about Manchester & Glasgow: neither of these uses PBL any more. Manchester uses team-based learning (TBL) and Glasgow uses case-based learning (CBL). I'm not sure either actually fits the strict educational definitions of those terms, but they are both forms of small-group learning that the medical schools will have chosen to use for a reason, and the reason is not to dilute learning or to save money (these styles of teaching are more expensive to deliver than lectures).

Apologies. I looked things up in too much of a hurry. Glasgow does still use PBL in years 1&2. CBL is introduced in year 3.

I'll go and stand in the corner.

I'm more inclined to go with the OED regarding common sense - "good sense and sound judgment in practical matters"- rather than a specious quotation.

When first and second year medical students are not being taught anatomy, physiology, biochemistry, pathology, bacteriology and pharmacology they are learning something else. Something that they should learn on their feet throughout their medical careers (if they need soft or bedside skills*), when the opportunity to learn the basic sciences has been lost.

I'm wary of medical practitioners who rely on anecdote rather than evidence. Happly, in this case your anecdotal experience agrees with more reliable evidence. You may not accept that there is a causal relationship between type of course and clinical overconfidence/underperformance but there is an association - and it is readily understandable.

Predictably, courses that are light on traditionally taught sciences prepare graduates less well for postgraduate surgical examinations. Traditionally taught medicine produced pluripotent graduates - where are the radiologists, haematologists, biochemists, pathologists, bacteriologists, pharmacologists etc of the future supposed to come from? Or to put it another way:

It’s not rocket science. If the curriculum is steeped in teaching of mental health and general practice you get a much higher percentage of graduates who work in that area in future. (Ian Cumming, HEE.)

*edit

Just back from our first open day and DD LOVED it. Medicine is a definite first choice. Acceptance rates are insanely low, what do the 90% who are unsuccessful end up doing??

Exci and terrified in equal measure.

@AlphaAppleabout 60% will get an offer first time round and many more if they take a gap year. You only need one offer and apply up 4. Glad she liked it.

Do you mean acceptance rates for that course or medicine in general? If for that course then find some more reliable back up courses which select on different criteria. Also remember that to an extent all courses are chasing a similar group of students. Some will have multiple offers, others won't have any. Getting a high score on the UCAT will be a large factor and practising interview questions with others.

If she takes a year out she can get relevant experience and also maybe do a crash A level Chemistry course to widen the options to reapply.

But even without chemistry she has 12 choices, maybe more, as Unis have not all declared 2026 criteria. Many many students go to do medicine without chemistry.

I know this was posted over a month ago, but just wanted to say, how unnecessarily rude!

“Only a teacher”

Without teachers where would any of us be?

I am shocked by the ignorance displayed in this comment.

Clearly this poster missed out on the basic knowledge of manners and the useful benchmark of “some thoughts should remain in your head!”

Oh yes, I was only suggesting it as an option to widen choices if she doesn't get a place this year.