A little and large dose for medical schools

Last week two medical schools merged with Imperial College to form the UK's largest medical school. Soon St George's will be the only free-standing medical school left. Julia Hinde talks to the two heads

ROBERT BOYD, principal of St George's medical school, was formerly dean at Manchester, one of Britain's largest medical schools. He now heads a more modest institution taking 172 medics annually.

It shares 1,000 nurses and midwifery students with Kingston University, but remains independent in medicine. It will soon be the only medical school not twinned to a university science department.

Having moved from central London to Tooting in the early 1980s, St George's, unlike many of the small and now-merging medical schools, already has a large local patient base, so that students experience all areas of hospital and primary medicine.

Intakes remain relatively small, helping to boost a sense of identity and a personal approach.

But a smaller school also means fewer opportunities for international research excellence, as well as higher administration costs.

"There are a number of pros and cons of small and large medical schools," Professor Boyd says. "On the research side, the advantages of large institutions mean you can afford very expensive equipment. It is also easier to build up teams of researchers in a wide range of subjects.

"Smaller institutions can do a limited number of research areas very well. You need a research atmosphere but you get that with three areas of international excellence, as with a dozen."

Professor Boyd said that many of the London mergers will not involve students coming together on single sites.

"It's a massive challenge to manage a really big enterprise so that people feel a sense of ownership and belonging," he said.

Quoting from a 19th-century text, he adds: "A university is an alma mater knowing her people one by one, not a foundry or a mint or a treadmill".

He argues that the fashion in higher education for mergers could do away with diversity.

"St George's brings diversity and new perspectives. I see our particular role as encouraging innovation."

The school is currently investigating offering three-year medical degrees for postgraduates.

But Professor Boyd acknowledges that the school will have to collaborate: "For George's to flourish it needs to work with other schools."

He stresses that constraints to collaboration between institutions must be removed if smaller schools are to prosper.

"We need to move from a situation when we glory in the failure of our competitors, to where we are pleased when they do well."

CHRISTOPHER EDWARDS, head of Imperial College's medical school, says that until recently medical schools were "characterised by a couple of staff in one area and a pair in another".

"But that is not the basis nowdays for being competitive in a high-technology world where we need to be able to afford an expensive laboratory base."

Imperial has just merged with Charing Cross and Westminster, and the Royal Postgraduate medical schools. It now takes 286 medics annually, which will rise to 320. This means it can produce the critical mass of researchers and equipment needed for modern research in most areas.

This, and the presence of basic non-clinical science departments in the college with specialist teaching and research, means advantages for students, who are offered a wealth of opportunities not available at smaller schools.

"Twenty-first century medicine will be pushed by advances in science," Professor Edwards said. "We want to produce students able to take this on board and be critical."

Those institutes that tend to do high-quality research often have large numbers of researchers.

He also suggests a positivecorrelation between the research assessment exercise and teaching quality.

But Professor Edwards admits that a number of hospital sites across London could make things harder for the new college. "Geography is a disadvantage. Communication becomes important".

The college will do its upmost to maintain a community feeling despite its size.

"We will try to keep students in relatively small groups throughout courses with their own individual tutors so as to maintain a personal touch,"he said. "The students going through St George's will get a different experience, but diversity is likely to be a good thing."