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Dear CareerDoctor,My career plan is in a mess. I want to become a doctor. Throughout the biomedical science course I studied, I worked as a nurse, and I am presently a paediatric special care nurse (unqualified, so it pays a lot less). I'm also involved in clinical research. However, I do not see a career in nursing, although I enjoy having contact with patients and working in a multidisciplinary team. At the moment I spend my time working as a stressed-out and unsupported nurse--where do I go from here?ShahDear CareerDoctor,I am a second-year pharmacology student, and I do not feel that laboratory jobs are right for me. I am thinking of a career in medicine after my degree. I acknowledge there will be a lot of competition for places in post-graduate medicine, and I was wondering how I may boost my chances .Thank you--I hope you can help me.Rachel

Dear Shah and Rachel,

It is entirely possible to break into medicine at a later stage in your career. Your graduate training may even be to your advantage (see this article from the Student BMJ Web site), and in any case it allows you to choose from two alleys of entry: the traditional 5-year courses or the new 4-year programmes for graduates that you mentioned, Rachel. So first of all, I want to reassure you, Shah, that your career plan is not in a mess--the commitment to the medical profession you have shown by working as a nurse for the past few years will give your application to medical school a real boost. But you need to develop a much more positive attitude before you start applying, and I hope this column will help you with that, while suggesting to Rachel ways in which she can give her applications more impact.

Regular or Accelerated Course?

As you've probably guessed, the first thing you need to think carefully about is which course you want to go for. The UCAS Web site is the best starting point to see what is on offer. The key advantage of the shortened courses is financial. As you will both have completed a first degree, you will not be eligible for any local authority funding for a second undergraduate course. However, graduates on medical degree courses receive funding for the last 3 years of the course from the National Health Service. This means that your financial commitment is for the first year of an accelerated course or the first 2 years of a 5-year course. However, although the courses are a year shorter, the content of the degree is unchanged (reassuring for those of us on the receiving end!), so you must be prepared to go through a course significantly tougher than your undergraduate studies.

Even if you have already decided to apply to medical school as a graduate entrant, there are still a few options for you to consider. Indeed the "missing" year of learning is incorporated in different ways. Some institutions will have a very intensive first year (effectively squeezing the first two years of a conventional degree into one year), which will make other work commitments virtually impossible. One example is Newcastle University, where the first year of the accelerated course lasts for 45 weeks, and the final 3 years are common to all students. Other courses, such as the one at the University of Wales, Swansea, follow a "three into two" approach, which will give you more breathing space if you need to fund yourself for the first year through paid work.

You are right, Rachel, in thinking that entry onto the graduate courses is very competitive--some admissions tutors I talked to mentioned a ratio of applicants to places up to double that for traditional entry--so it is important you do not rule out the traditional courses. To put things into perspective, though, some of the tutors said they were struggling to fill up their places for the lack of enough high-calibre applicants.

Know the Applications Procedures and Criteria

Whatever course you choose, you'll need to apply through UCAS in much the same way that you did to get onto your first degree courses. So I'd recommend that you research the applications procedure now, even more so as the closing dates for entry to medical schools are early. Your careers services should be able to help. Some institutions follow the same procedure as for their traditional courses, but others have entrance exams or use the Graduate Australian Medical School Admissions Test ( GAMSAT). The attraction of the latter is that they look at a wide range of skills and knowledge relevant to medical studies, including verbal reasoning and written communication, and offer a standard means of comparing applicants. Intensive courses are available to help science graduates prepare for the GAMSAT and interviews for medical school.

As well as using different methods, each medical school will have slightly different criteria when selecting graduate entrants, so deciding which of them appear to value the things you have to offer may both help you refine your choice and boost your chances of success. Having said that, there are a number of common themes in what makes an applicant successful. You must of course demonstrate a high level of communication skills, a genuine interest in helping and supporting people, evidence of motivation to study and practice medicine (including a realistic view of the less savoury aspects of the profession!), and a well-researched interest in medicine. If you can't find the time to have opinions on the current medical issues or do some background reading around fundamental elements of the course, then you are unlikely to convince anyone of your burning desire to study medicine.

Also be aware that the qualities of graduates are judged against much higher standards than post A-level/Higher applicants, so you'll need to provide compelling evidence that you have the required skills and attitude. The academic intensity of accelerated courses will be very high, so many tutors will be looking for proven academic ability (i.e., first-class degrees or higher degrees) and ability to cope with pressure. But there is more to it than good marks. They are looking for applicants who have already made a difference to people's lives and can convince them that they will make a real contribution to the profession. So they will screen your CV to see if your altruistic activities are an important and long-standing feature of your life, rather than a few months cynically completed to pad out your UCAS form. Work experience and shadowing professionals in different medical disciplines are also essential, so Shah, you have a real advantage here, but keep looking for opportunities to spend time with different medical professionals.

You will also be expected to be more mature, and by this I mean you should demonstrate a deeper understanding of your own strengths and the commitment to address any weaknesses. This emphasis on self-reliance reflects the independent attitude you should have to your medical studies--the responsibility for learning lies with you. As a whole, it would probably be a good idea to gain some insight into what life will be like as a medical student and doctor, and the BMA Web site is a good place to start.

Meet a Graduate Medic Who Did It ...

Then get background info.

Demonstrate Understanding of the Demands and Recent Changes

You will give your application an extra edge if you show you understand the demands of the course, its learning styles, and the differences with longer courses if you are applying for an accelerated one. Most institutional Web sites describe their courses in some detail; see Newcastle University, for example. You should also demonstrate knowledge of the recent changes in the way medicine is taught. For background information, look at the latest Tomorrow's Doctors report. A key change is that all the different disciplines for the learning and understanding of medicine are being brought together, often based on current clinical cases. Another one is that much of your learning will be in a team, so your experiences (and enjoyment) of this kind of working is something to articulate in your application.

Admissions tutors will also expect you to have researched the funding situation and planned how to finance the early stages of your study. If you haven't thought through this yet, I'd strongly recommend the University of Wales, Swansea, Web site, which has a guide to funding bodies. Your careers service should also have directories of trusts and charities that may provide grants or loans.

Finally, I spoke to a local GP who was a graduate applicant in the late 1980s. Having failed to get into medicine after her A-levels, she opted for an anatomy degree and took on additional modules to match the medical degree syllabus as closely as possible. Meanwhile, she asked about the possibility of graduate entry to the medical school of her choice and was rejected, repeatedly. Undeterred, she kept the medical school up to date with her academic progress and eventually extracted a vague promise of a place if any students failed--and finally, she convinced them to take her onto the course. She secured funding from her local authority (again after lengthy negotiations) to cover her fees for the unsupported first years of the course and researched other grants to cover her living expenses. She finally found an obscure grant available to women from her hometown studying for professional qualifications.

Although the system was very different back then, her inspiring approach characterises some of the qualities you need to demonstrate: tenacity, initiative, and understanding of the demands of a medical degree and the career which follows. If you can find the same drive and energy, you have every reason to believe you will succeed in this competitive area.

All the best in your career,

The CareerDoctor