Let’s play a game: a modified version of snakes and ladders.
Most turns involve drawing a “chance card”. There are two players. Player One starts at one side of the board, at “Prosperous City”, and Player Two starts at the other side of the board at “Hardship-ville”. The aim of the game is to get far enough along the board to be offered a place to study Graduate Entry Medicine at your university of choice.
Player One rolls first and lands on a chance card: “You grow up in a leafy Dublin suburb. Move forward three places.”
Player Two rolls. They also land on a chance card. “You are from a single-parent immigrant household. Stay at your current position.”
Player One now lands on another chance card. “Your parents went to university and surrounded you with books throughout your childhood and teenage years. This gives you a broad vocabulary and appreciation for the arts. Move forward two places.”
Player Two’s next card: “Your mum cannot speak English so you don’t learn the language until you start school at the age of five. You find it difficult to grasp the language, so you must play catch up with your classmates. Move back one space.”
Your SUSI grant is barely enough to cover your monthly bus card and phone bill. You must work part time throughout your degree
The game continues. Player One picks up advantageous cards throughout – “You decide to go to a private grinds school for your leaving certificate and obtain 585 points, allowing you to study science at Trinity. Move forward three places.” “Your parents can fund your social activities during your time at university, meaning you are not required to work. This allows you to focus on study and lead a well-balanced life. Move forward one place.” “You are not required to work full time over the summer, meaning you have time to travel and experience different cultures. This broadens your perspective on life and gives you new insights. Move forward two places.”
Player Two, on the other hand, consistently draws disadvantageous cards by virtue of the fact they started at Hardship-ville. “You attend a DEIS school and do not achieve the necessary points to study your first course of choice.” “Your SUSI grant is barely enough to cover your monthly bus card and phone bill. You must work part time throughout your degree. Move back two spaces.” “You must work full time during your summers to get by. Move back one space.”
Both players must now overcome the biggest hurdle to win the game. That is scoring high enough in the GAMSAT, the entrance exam to study graduate-entry medicine. Player Two’s next card reads: “You must save €341 to sit the GAMSAT. This means you take on extra shifts at work. The extra shifts eat into your college work and GAMSAT study time. You sit the exam and find the convoluted language hard to follow. You do not score well. Move back to START at Hardship-ville.”
Player One’s card reads: “You sit the GAMSAT without needing to budget for the cost of the exam. You sit the exam and do well thanks to your well-rounded background and strong grasp of the English language. You are offered a place at University College Dublin. Congratulations, you have won the game.”
Residents of Dublin Four and Dublin Six combined accounted for 14 per cent of all students enrolled in medicine, but these postal codes only account for six per cent of all enrollments from Dublin across all degrees.
As you may have gathered by now, the term “chance card” is a misnomer – the card you get to pick is grossly influenced by circumstance of birth. These influences ripple constantly beneath the surface of the path to studying medicine as a graduate student.
The Higher Education Authority (HEA) published a report in 2019 which found that students from disadvantaged backgrounds comprise just 3.5 per cent of medicine students (compared to the national average of 10 per cent for all fields of study). Some 36.3 per cent of medicine students come from affluent areas (this figure is 18.9 per cent across all fields of study). Residents of Dublin Four and Dublin Six combined accounted for 14 per cent of all students enrolled in medicine, but these postal codes only account for six per cent of all enrollments from Dublin across all degrees.
Clearly, students from disadvantaged backgrounds must overcome so much more than those who are middle or upper class, and the challenges they are faced with are exhausting, perplexing and sometimes even insurmountable in nature. Let me show you how.
As I said, the entrance exam to study graduate entry medicine costs €341, and many people need to sit it more than once. The practice papers offered by the company which runs the exam are the only approved preparation material. These practice tests cost €152. That’s a total of €834 to have a decent chance of securing a place.
Clearly, students from disadvantaged backgrounds must overcome so much more than those who are middle or upper class
Sitting the GAMSAT is a difficult task for anyone, but the difficulty is amplified for those who come from disadvantaged backgrounds. The exam paper expects students to pick up on subtle cultural and colloquial cues that those who are not constantly surrounded by English may not pick up on.
But say a disadvantaged student does this, and scores well enough to study graduate-entry medicine. They must now find €16,500 a year to pay their college fees. This isn’t a huge issue for most students, as Bank of Ireland offers a specific graduate-entry medicine loan. There’s a catch, though. Students must put forward a guarantor, and these guarantors must put up collateral. Usually, students name their parents as guarantors and they can then put their family home up as collateral. This caveat completely excludes students whose families don’t own their own home, or live in social housing, or do not benefit from generational wealth. So this requirement excludes the poorest applicants from getting a loan, thus locking them out of any possibility to study graduate medicine.
Education is meant to be the great equaliser. It is built on the meritocratic belief that hard work and perseverance will inevitably earn you what you deserve and the keys to success. Anyone can sit the GAMSAT. But the playing field is far from even, and this not only negatively impacts the applicants who are affected by the inequality, but future patients and healthcare systems too. A homogenous healthcare system, staffed primarily by those from affluent backgrounds, negatively affects patient care, particularly for minority patients. A jarring example of this is the fact that women of colour have a higher maternal mortality and injury rates, irrespective of income or education level.
As bleak as this is, there is a group of medicine students who are working towards change through “AccessMed”, an organisation set up to give disadvantaged and non-traditional applicants the tools and guidance they need to have a fair shot at getting into medicine. The organisation is in its infancy, but it will no doubt give many students the information needed to have a good try at the GAMSAT and mature medicine application.
Anyone can sit the GAMSAT. But the playing field is far from even
The next AccessMed seminar will be held on Sunday, August 11th. Tickets can be found on Eventbrite or the AccessMed Twitter page. It is, of course, free, because we are tired of the disparity fuelled by wealth in medicine.