HPAT hinders diversity in medicine

By: Aoife Kearns and Robert Geoghegan

Students from the most well-off parts of Dublin are 14 times more likely to progress to university, compared with students from some schools in the city’s more disadvantaged areas.

A report released this year by the Higher Education Authority found only 10% of the student population were from a disadvantaged background, while 19%, almost double that of the disadvantaged student population, were from an affluent background. UCC, UCD, and the Royal College of Surgeons all have the lowest proportion of students, 5%, coming from disadvantaged backgrounds.

In medicine, the percentage of students from affluent backgrounds is higher again, at 36%. Although there might not be one definitive answer as to why there is such a high percentage in this particular course, President of the Union of Students Ireland (USI), Lorna Fitzpatrick said: “Ireland currently has the second-highest fees in the EU at €3,000 with many students facing additional costs on top of that due to specific course requirements.

“We also recognise that many students wishing to study medicine or in specialised fields such as economics and LIS as outlined in the report may have to move to an area where the course is available to them which can lead to a significant additional cost for accommodation.”

Fitzpatrick highlights how the Health Professions Admission Test (HPAT), could be an additional financial barrier for students.

“USI is acutely aware of the soaring costs of rent and the impact it is having on students’ daily lives. The requirement of the HPAT for those wishing to study specific courses brings with it another additional cost for students and their families which many just cannot afford or struggle to pay.”

Dr. Maitiú Ó Tuathail a General Practitioner, head of the National Association of General Practioners (NAGP) and former Health Service Executive (HSE) Lead Non-consultant hospital doctor (NCHD) said: “The reality is that most medical students come from middle or upper middle class backgrounds and did so before there ever was the HPAT.

“And the reason is similar to that for the HPAT; the majority of these come from private schools or institutes. This means that they get the highest available points in the Leaving Certificate, ensuring them a place in medical school.”

Within the medical profession, there are complex social issues for those graduating into the medical field. Ireland has never trained more GPs than we do now, and the rates of pay have never been higher. However, there are a few of those graduating who are willing to work in this country, particularly outside Dublin. With the introduction of the HPAT, this seems to have exacerbated this problem.

The HPAT explained

In 2009, the HPAT was introduced to assist Irish students with high empathy levels into the medical profession, due to concerns that the old entry system was favouring students with top academic results.

It was introduced to move away from the points race where previous students required an almost perfect Leaving Certificate to gain entry to medical school.

Dr. Ó Tuathail said: “The goal of the HPAT was to make sure those that got into medicine were more balanced and not just academically strong, as was the case traditionally.”

The HPAT exam is now generally sat by students the same year as their Leaving Certificate. Under a revised system the minimum CAO points requirement for medicine have been adjusted and are now counted alongside a student’s HPAT results.

Cost as a barrier for prospective students

Issues surrounding the cost of the exam for students and their families have previously been raised in the Dáil, although there has been no serious attempt to change the current system.

In 2013, Fine Gael TD Mary Mitchell O’Connor released a statement in relation to the fairness of HPAT test for aspiring medical students:

“The HPAT exam was supposed to open up access to medical courses, but I am concerned it is having the opposite effect. Recent reports suggest more than 50% of HPAT candidates take coaching courses, putting them in a superior position to those who cannot afford it.

“As a result, the HPAT exam means the playing field for getting into medicine is more unequal than ever. I think it is time we reviewed the system, and consider who it is really benefiting.”

To put this into perspective TheCity.ie has investigated the hidden cost of sitting the exam when these extra courses are considered.

What do student doctors think?

Ciara Dolan is a second-year medical student who sat the HPAT exam in 2018. She told TheCity.ie that students who can avail of books and extra courses have an advantage: “I think the HPAT is designed to suit a select few people who can score well without the books and courses.

“It is possible to do well without these aids. It just means you’re giving yourself a disadvantage from the get-go.

“One of my friends couldn’t afford to do any of the courses, at grind schools, or buy the books. None of his school would share their notes with him, even though his good friends had bought them, it gets competitive, but fortunately he still managed to get 97th percentile.”

Ciara said the financial burden just adds to the pressure students already face if they sit the HPAT in conjunction with the Leaving Cert:

“If you take the course and use the book, it becomes a new subject for you in the sixth year. I think someone told me at one stage that one HPAT question is worth roughly the same points as all of the Shakespeare section [in English].

“One person I was in school with had a private tutor through MedEntry for two years that I think cost over a grand. He wasn’t naturally good at HPAT-style thinking but ended up getting a score in the high 90s.

“I retook the HPAT after two years of Biomedical, Health and Life Sciences (BHLS) in UCD. I didn’t do a course the second time and got the same score as the first time. The fact that so many people re-sit the exam also skews the results hugely. I have friends who sat it four times.”

What are the alternatives?

Lorna Fitzpatrick said that the cost of further education in this country is the underlying problem: “Union of Students (USI) believes that attending third-level education should be available to all and people should be able to study in whichever field they wish without having to worry about the financial burden they are placing on themselves or their families.

“Education is a public and social good and should be treated as such. Dr. Ó Tuathail said that a system similar to the US model, where a student must do an undergraduate course prior to studying medicine, would be much more appropriate in determining suitable candidates for medicine.

“The US model definitely balances out the playing field, as it means entry is based on an interview, and your undergraduate academic success. That is if you exclude the astronomical cost for attending college there,” said Dr. Ó Tuathail.

“The reality is, whether you choose law, architecture, veterinary medicine or actuarial studies, the findings are all the same. They all come from middle, or upper middle class backgrounds. The problem lies in the fact that those who have the means to pay for education do better than those that do not. That is a more complex problem to address.”

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