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Pressure is growing for a new medical school to accommodate the proposed increase in student places. And, as Barbara Millar reports, there is no shortage of bids to house it

Plans due to be announced early next month for the allocation of thousands of extra medical school places could see the creation of the first new medical school in England for 30 years.

Whether or not the new school comes about may depend on finding the cash to build it, but it is certainly what medical students want. They argue that proposals to add extra medical school places from now until 2005, rising by then to an additional annual intake of 1,000 each year, would put 'unacceptable pressure' on the teaching resources of existing schools.

Trying to squeeze more students into medical schools will have 'an adverse effect on the quality of medical education', warns Lizz Corps, chair of the British Medical Association's medical students committee.

The MSC says that all 17 English medical schools have applied, in one way or another, for a share of the increase in medical students. But Ms Corps and others claim that facilities in some schools are already at maximum capacity.

'Students are forced to sit in aisles in lecture theatres or have lectures relayed to them in adjoining rooms,' she says.

Nick Jenkins, a medical student at Imperial College School of Medicine and chair of the London medical students group, says the situation in most medical schools in the capital is particularly bad following a series of amalgamations: 'At Imperial College, a brand new lecture theatre cannot accommodate the 300 students in my year. The building was redundant almost as soon as it was opened.'

An Imperial College spokes- person dismisses this accusation, claiming that the theatre can accommodate 320.

Medical students are also concerned that patients in teaching hospitals are increasingly refusing to allow students to participate in certain aspects of their care on the wards because firms are too large and impersonal.

'Many patients in teaching hospitals simply refuse to be accosted continually by students, so they can rest and recuperate from their illness,' says Ms Corps.

'But if students do not have the opportunity to practise examination and diagnosis skills under supervision, they will reach qualification without the necessary experience to work competently.'

The MSC believes that to maintain standards of medical education, it is essential to establish at least one new medical school to accommodate the proposed increase in numbers.

Hull University is one of the bidders which hopes to be able to do that. The East Riding, north Lincolnshire and the Humber, with more than a million people, is one of the few parts of the country distant from a major centre of academic medicine, says Professor Tony Horsman, dean of the faculty of health.

'Without doubt, a medical school would bring major benefits for the region's healthcare services.'

The university, with local health authorities, trusts and many of the 165 general practices in the area, would like to offer a four-year accelerated programme to about 100 mature students a year, says Professor Horsman.

Science graduates would have direct entry into the first year, while graduates from other disciplines and mature students without degrees would take foundation courses through residential or distance-learning programmes.

The Open University is also involved in a joint bid to develop a new medical school in the South West, in partnership with Exeter and Plymouth universities.

The new school, with 150 places a year, would also be graduate entry, with each student taking an OU foundation course, with residential schools and early clinical contact in Exeter and Plymouth.

Clinical training would involve trusts and general practices in the South West with 'a greater than conventional emphasis' on community placements, says John Tooke, director of Exeter University's school of postgraduate medicine.

'A graduate entry programme would enable us to broaden the range of people coming through into medical practice for the benefit of patients,' he says.

The OU is a also a partner in a bid by Leeds University school of medicine and the NHS in Bradford and Airedale in which students would start learning part-time with the OU before joining third-year students at the medical school.

Janet Grant, the OU's professor of education in medicine, says spreading the traditional first two years of training over two to four years part- time would make it easier for people with work and family commitments to consider a medical career.

She says: 'We believe this will create opportunities for recruiting minority ethnic students from the local communities, particularly women.'

Leicester University medical school has also bid jointly for 128 extra places with Warwick University. Biological science graduates would take a four-year course, studying parts of the Leicester curriculum via video- linked lectures, says Professor Stewart Petersen, head of medical education at Leicester.

'They then enter full-time clinical work with the students doing the five-year course and will be distributed across all the hospitals used by Leicester University.'

Nick Jenkins believes this sort of bid is most likely to succeed. 'Students being taught by video-link with local support is better than trying to squeeze them all into the one place,' he says.

'We would like to see a new medical school, but the NHS is strapped for cash and a new school, with new buildings and new staff, is probably not a realistic option.'