Older and wiser?

Dundee medical school announces today whether "fake schoolboy" Brian MacKinnon, who claimed he was 17 when in fact he was 32, will be allowed to keep his place. There are several good arguments against it, including the fact that integrity should be a prime requirement in doctors. Nonetheless it raises some important issues including whether an adult of 32 is at a much better age to start a medical degree than a babe of 17.

Crowds of sixth-formers apply to study medicine. Many of them, research shows, know virtually nothing about what it is like to be a doctor. Careers advice, both at school and university, is appallingly bad. If students feel they have made the wrong choice there is a stigma attached to switching to something else. If students ask for careers advice, says Isobel Allen of the Policy Studies Institute, author of Doctors and their Careers, there is a "macho" culture which deems such questioning to be weak: it is evidence that they are uncertain about their future and perhaps lack commitment.

Further along the beaten track, at 28 years old, increasing numbers of doctors say they are disillusioned or regret their choice of career. No one knows how many doctors drop out. A British Medical Association working party is about to investigate: estimates range from very few to 25 per cent.

Meanwhile, some medical school deans admit freely that many school-leavers are not sufficiently mature to start their studies. Some deans privately suggest that prospective medical students should be forced to take a year off between school and university.

The problem of immaturity could become more pressing as medical degrees change. The old style involved absorbing information mainly through lectures. The new style is based on problem-solving and getting the students to pursue what they think they need to know. Although such methods are generally regarded as an improvement, some people feel that they require a more experienced student: someone who has already learned to learn.

In Australia and the United States, such concerns mean that those who enter medical school must already be graduates in another subject. Many deans think that mature students are a "good thing" in their tiny numbers in British medical schools. They enhance the atmosphere on medical courses, providing role models for younger students. They are, almost by definition, highly motivated, given the funds they must raise and the precious years they are committing to study.

Some critics say that British medical schools are ageist. And Stella Lowry, author of a book on medical education, regularly receives letters from 40- year-olds struggling against the system to get into medicine.

Should we be letting them in? Each one costs Pounds 200,000 to put through a five-year medical degree; taxpayers must feel they deserve their pound of flesh after spending that amount. But is it right that we put a moral obligation on our medical students to pay us back for our investment by becoming doctors? And perhaps drop-out rates would be lower among mature students and thus compensate for the number of years lost by the late start to their careers?

These questions are thorny and are being considered by the medical profession at the moment. But some certainties shine through.

Sixth-formers and medical students desperately need much better advice on medical careers. Medical schools should consider screening applicants for characteristics such as motivation and communication skills rather than for having three As at A level (research shows that three Cs are sufficient for meeting the academic challenge of a medical degree).

And the present culture, in which switching course away from medicine is regarded as dropping out, should be stamped upon. Perhaps many potential "drop-out" medics, with their three As in science, might then fill up our undersubscribed science and engineering courses.