Wednesday, 26 March 2014
Health Professions Admission Test Administration
I welcome the Minister of State to the House. I wish to raise an issue related to HPAT which is the exam that students who wish to study medicine must undertake.
Concerns have been raised recently in the media. I think this examination was introduced in 2009. I am not too sure about the extent of what it has achieved since 2009. The concerns raised relate to over 700 people who attended a particular two-day course in preparation for this examination which was not part of their school curriculum. It would appear that some of the questions were very similar to those they were given during this two-day course. My understanding is that the course costs €595 so we are now pushing entry into medicine into an exclusive area and it is an unfair system from the point of view of people who cannot afford to get the grind or attend these preparation courses.
I ask that the entire idea of HPAT be reviewed. Has it actually achieved anything? Someone who might not get through HPAT this year might do it next year. Does that make them a better doctor in six years' time? I am not sure it does and I am not sure it is a way of assessing someone as regards working in medicine. I know it was a system adopted from Australia but it is time we reviewed it to see whether it has achieved anything to date, whether it is likely to achieve anything and whether it is just an additional cost being imposed on parents which is unnecessary and will not achieve anything in real terms.
Two thirds of all medical graduates are leaving this country within 12 months of graduating. They have decided even before they have come out of college that once their intern year has been completed, they will leave. The cost of medical education in this country per annum is €90 million because it is a five-year course. If one works it out at €30,000 per student per annum, it is €150,000 and with 600 students per year, it adds up to €90 million. Within 12 months of that investment, 60% of it goes out of the country. It is time that we looked at the issue of medical education and also at HPAT to see if there is real value in it and whether it is necessary.
I am very grateful to the Cathaoirleach for giving me a small amount of time. I did not realise that this item was on the agenda and I wanted to take advantage of the Minister of State's presence to state that this is an area about which I have had some concerns. When the examination was first introduced, there were a number of high-profile cases of youngsters in this country who had full marks in the leaving certificate but who were not accepted for medical school. The clear logic of that is that there was something that these children could be assessed on at the age of 17 or 18 which determined that 15 years hence, they would not be suitable to be appointed as specialists in hospital medicine or as general practitioners. I do not accept that this is possible. I expressed grave concerns at the time. When we have a national examination in the leaving certificate which, in truth, is as incorruptible as anything can be and if we are going to accept children into professional courses like medicine after secondary school, this should be the final authority.
Let me go further. The idea of accepting children into medical school after the leaving certificate is a mistake. The time to do this is after they have had a phase of education at third level for three or four years. We should move towards the models that exist in north America and other parts of the world where medicine is invariably a graduate programme. Simply put, I was 14-years-old when I was making the subject choices for the leaving certificate in terms of going into medicine. As it happened, I am extraordinarily happy that I did go into medicine but I do not think this is the way we should be educating and selecting people. People should get a relatively broad education with a strong science focus, go on to third level education, get a full mature understanding of what is involved in a career in medicine and then make a decision as to whether they wish to practice it.
I thank Senator Burke for raising this Adjournment matter which I am taking on behalf of my colleague, the Minister for Education and Skills. At the outset, we should clarify that the selection criteria and process for admission to medical schools is a matter for the medical schools and universities in line with their statutory autonomy in respect of academic affairs. I genuinely take the points that have been raised by Senators Burke and Crown in respect of the culture that exists around admissions to medicine. I am not delivering the script entirely in that sense. An international tender process was undertaken by the medical schools and the Australian Council for Educational Research, ACER, was chosen to administer the new entry process to medicine, which we know as HPAT.
The introduction of HPAT in 2009 had regard to the findings of "Medical Education in Ireland: A New Direction. Report of the Working Group on Undergraduate Medical Education and Training" or the Fottrell report. It recommended that leaving certificate results should no longer be the sole selection method for entry to medical education at undergraduate level. It recommended that a two-stage mechanism should be applied consisting of the results obtained in the leaving certificate and a standardised admissions test which would assess non-academic skills and attributes regarded as important for the practice of medicine.
In 2012, the group undertook a comprehensive evaluation of HPAT to determine the educational impact, reliability, validity and stakeholder acceptability of the new entry and selection approach. It made the following recommendations. HPAT-Ireland scores should be valid for a period of one year only instead of two years. A redistribution should be applied to the weighting of HPAT-Ireland sections to reduce the contribution of section 3 scores to the overall score in order to reduce the impact of repeat effects. Further practice material should be made available to all HPAT-Ireland applicants, which also includes some examples of correct responses and the rationales to these to ensure adequate opportunities for all to become familiar with the test format and sample items. It was agreed that due consideration would be given to the need to ensure that students are given adequate notice of the changes proposed by the expert group.
An investigation is currently under way by ACER amid allegations that students who attended a HPAT preparation course had seen and were coached in how to answer certain questions that appeared in this year's HPAT examination. ACER takes very seriously the integrity of candidates' results in HPAT. The reliability and validity of its tests is therefore of paramount importance to ACER. The investigation will first attempt to establish the degree, if any, of similarity between the test questions and those allegedly believed to have been provided by the coaching college in question. I am given to understand that based on the briefings we have received that this process is extremely thorough. Candidates' optical mark recognitions have to be scanned and re-scanned. Data analysis has to be carried out by a minimum of two psychometricians. There are many areas of analysis involved; the detection of anomalies is just one part of the standard analysis process. The results of the investigation may lead to some test units being removed from all candidates' scores obtained in the 2014 examination. The Department has asked that it be kept informed by the Higher Education Authority of progress on addressing this issue.
The fact that it costs €595 to attend a two-day course is not dealt with in the reply. We are now making getting into medical education beyond the reach of some people financially. This is probably not the only grind they are attending. The second issue I am concerned about relates to the second last paragraph in the reply, which states that "the results of the investigation may lead to some test units being removed from all candidates' scores obtained in the 2014 examination". This is causing a lot of uncertainty. People who sat the examination and think they have done a very good paper are now left in a state of total uncertainty as regards what is in and what is out.
This is an unsatisfactory position and this issue should be reviewed.
I acknowledge the points made by the Senator. However, I do not wish to be pedantic but the Senator's question did not speak to costs specifically, rather it spoke to the current operation of the HPAT medical school entrance exam amid recent claims that students who attend a certain revision course had prior knowledge of several of the questions that appeared in the examination. I am happy to revisit the issue of cost and the admissions system.
I note the points made by the Senator about the grind school effect. This is endemic in Irish education and it should not exist at all if one wishes to have a completely equal system for all. It is one of the quirks of the Irish education system that there is a way of gaming the system, so to speak. I do not mean "gaming" in any kind of underhand way but there will always be a market for a grinds methodology. I agree with the Senator in that regard because this excludes many citizens who simply cannot afford grinds but who have more than adequate ability to become wonderful physicians. It is an aspect we need to address. I will raise the matter with the HEA.
With regard to Senator Burke's second point, I will undertake to provide a clarification for the Senator.