Careers: Doctor Doctor

In which a Chemistry teacher encourages you not to think “doctor” when your kids achieves a string of A grade GCSEs…

**Throughout this post, where I say “doctor” I mean a person with a medical degree, rather than a PhD**

We find it easy to tell an 18 year old they won’t be a professional footballer or singer but find it difficult to tell them that they aren’t destined to be a medical doctor.  I’d say during the first week of teaching AS Chem around 50% of my new students (approx 80 16 year olds) say that they wish to study medicine; by the beginning of the second year of the course I end up with around 12 candidates who will apply via the UCAS system.  So where do the others disappear to?

The Work Experience

Students need to be proactive in getting work experience, especially if Careers provision at their school isn’t so good.  Ideally, they should be doing some long-term volunteering (retirement homes are a favourite), speaking to a doctor in their preferred area of medicine, do a week’s work experience in a hospital.  If a student isn’t willing to seek this out for themselves (and keep up with it), they won’t be offered a place.

Many students realise at this point they don’t really want to work directly with the public, or find any area related to medicine that is of more interest to them.  There’s nothing quite like being around bodily fluids to realise that the only reason you wanted to be a doctor was the prestige of the title…

The Grades

Minimum A level grades for direct entry to Year 1 of a medical degree are AAA.  Some universities stipulate minimum GCSE grades.  If after the AS results come out, students do not have at least AAB they are recommended (by schools) to apply for other courses.

Parents quite reasonably expect that if their child got an A at GCSE Chemistry, they should be capable of an A at A level.  One of my hardest jobs in the first 6 months is helping both parent and student to realise that the skill set is totally different – it’s still possible to cram in the last week before the exam for their GCSE; at A level this will never work as most marks are scored for the application of knowledge in novel contexts.  Many students do not realise this until it is far too late.

Many universities offer summer schools (one-week residential course in the summer after Year 12) in Medicine, either as part of their own programme or as part of the Sutton Trust programme for widening access to students from non-traditional backgrounds.  I recommend all of my students interested in medicine apply for these as they give them a flavour of the life of a medical school and lets at least one medical school get to know them as a potential applicant.

The Aptitude Tests

Most universities want their applicants to have taken one of the UKCAT or BMAT aptitude tests before applying.  Most schools and colleges will put on some sort of practise / coaching for this but if a student won’t give up an hour a week to train, it is likely they’ll be spooked by the questions and won’t perform well.  As universities have applicants all expected to achieved AAA, these tests are often the deciding factor and to ignore their importance is to shoot oneself in the foot.

These tests are arranged privately by the candidate and sat at an external test centre.  They also incur a fee (but if students are eligible for a bursary from their school under the old terms of EMA, the fee can often be at least partially covered).

The UCAS form

UCAS is the standard application method for undergraduate entry to university.  Applications for medicine must be in earlier than standard applications (typically mid-October as opposed to mid-January) and students can apply for up to 4 medicine degrees and an additional non-medicine degree.  As well as listing their academic qualifications thus far and predicted A level grades, students write a personal statement to show their interest in the subject and how they have proven medicine is for them.  Their school will also write a reference – medicine references tend to be given over to staff who are experienced in writing these references in order for students to give the student  the best chance; if students haven’t done much in the way of extracurricular work pertaining to their application, it is very hard for both teacher and student to write decent statements.

The Interview(s)

Should a student have all the requisite skills on their UCAS application, they will be interviewed by interested universities.  Some interviews are traditional panel-type interviews, others are a circus of short interviews but all will include assessing the candidates’ knowledge and understanding of both their science, ethical concerns in medicine, and the latest research in medicine – in other words, the old “reading around the subject” chestnut.  If the candidate doesn’t show sufficient interest and awareness of current themes in medicine, and empathy towards case studies it doesn’t matter how good their grades and UKCAT scores are, they won’t be offered a place.

 

So all in all, the application to medical school is incredibly intensive – even for students who breezed through their GCSEs, it’s very labour-intensive and good grades alone are not enough.  Hopefully you can see by my descriptions of the various steps for post-16 students to get medicine-ready, there are many points along the way where students may falter.  For students who, based on mock grades, are unlikely to achieve 3 A grades there is little guidance towards other medicine-related degrees.  I do a lot of work promoting careers such as pharmacy, physiotherapy, nursing, midwifery, diagnostic and therapeutic radiography, occupational therapy, podiatry, optometry, audiology… The degrees / training courses for these careers require considerable work experience and/or work shadowing from their applicants and by the time that the student has realised their grades are unsuitable for medicine, they have no time to get this experience before the UCAS application is due in.  Others have very little interest in the human body or dislike working with others – by directing them toward medicine, they’re closing their minds to other degree courses which may suit them down to the ground.

My advice to parents and other teachers is to try and find out why a child has expressed an interest in medicine and assess whether they have the potential to achieve the entry requirements and the determination and temperament to do the additional work required to help their application.  If they’re only interested in being called “doctor”, there are several types of doctor.  If they want to work with people but are unlikely to make the grades, investigate some of the other careers available on the NHS Careers website.  If they like the problem-solving aspect but dislike working with the public, there are many biomedical science and medical research careers which may suit them better.  If they are insistent on being a doctor, then support them all you can but remember: you can’t do it for them.

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Practical: Finding the percentage of calcium carbonate in eggshells

*** Do your own risk assessment – who am I? Your mother / head technician?? ***

This practical is adapted from an example calculation in Advanced Level Practical Work for Chemistry (2004) by Andrew Hunt.  It is an example of a back titration so quite a fun calculation and has plenty of sources of error to quantify and discuss.  I’d recommend setting aside 90 mins for this experiment – the titration is relatively quick but making the standard solutions takes time.

 

BTEC Level 3 Scenario: You are working for Defra (Department for Environment, Food and Rural Affairs) and have been asked to investigate the health and welfare of battery hens.  Your supervisor has suggested that healthier hens have a higher percentage of calcium carbonate in the shells of the eggs they lay.  Your task is to calculate the percentage calcium carbonate in a battery hen’s eggshell and a free-range hen’s eggshell through back titration.  You will then analyse the errors in the experimental error and conclude whether there is a real difference between the calcium carbonate content of eggshells from hens kept in different conditions.  You will submit your findings in a lab report written in the style of a scientific journal article, including abstract and discussion. [Teaching Note: can be used as part of P5M5D3 in Unit 22 or P1M1D1 in Unit 19.]

 

Preparing the Standard solution

  1. Crack a free-range egg and dispose of the contents. Rinse inside with distilled water and remove membrane / air sac.  Allow to dry.  Weigh on a 2d.p. balance.
  2. Grind egg to a fine powder using a pestle and mortar.
  3. Measure 40 cm3 of 1.20 mol dm-3 hydrochloric acid into a 250 cm3 beaker.  Add the ground eggshell to the beaker and stir until no more bubbles of gas form.
  4. Take a filter funnel and paper, place in neck of a 250cm3 volumetric flask.  Decant the solution into the flask. [NB  The acid is in excess. We want the unreacted acid to go into the flask – try to prevent the shell from getting into the filter funnel as it will block it.]*
  5. Wash the remaining shell with approx. 50cm3 of distilled water and decant this solution into the volumetric flask through the filter funnel.
  6. Top up the volumetric flask to the meniscus with distilled water.  Invert 10 times to mix.**  Label as Excess Acid from Free Range Shell, with your name and the date.
  7. Repeat steps 1-6 for a battery-farmed egg and label as Excess Acid from Battery Shell

 

The Back Titration

  1. Fill a burette with 1.0 mol dm-3 sodium hydroxide solution.
  2. Pipette 25 cm3 of Excess Acid from Free Range Shell into a 100 cm3 conical flask.  Add 3-5 drops of methyl orange indicator.
  3. Perform a rough titration.
  4. Perform additional titrations until 2 concordant results have been obtained.
  5. Repeat steps 1-4 for Excess Acid from Battery Shell.

 

* I have found that this stage takes a long time and so is suitable to be left across a break.  Ensure the filter paper isn’t block – if it is, replace it with a fresh funnel/filter paper.  This of course will lose some acid soaked into the original filter paper.  Vacuum filtration is an option but has its own risks of contamination.

** Bubbles of gas often form in the volumetric flask.  I have removed these using a Pasteur pipette; I have taken the meniscus as being the line of the solution, ignoring the level of these bubbles.

 

Calculations

Students will calculate the number of moles of acid in the original 40cm3.  Using the balanced equation and the average titre, they will calculate the number of moles of hydrochloric acid neutralised in the titration.  The difference will be the number of moles of acid that reacted with the egg.

From the balanced equation, students will calculate the number of moles of calcium carbonate that reacted.  They will then convert this into grams and work out the percentage of calcium carbonate found in the eggshell.

They will repeat this process for the other eggshell.

By real difference (mentioned in the scenario) I mean that after calculating the percentage error in measurement, the student should calculate the range in which the true percentage calcium carbonate for each egg is found.  If these ranges do not overlap, there is a real difference.

The Importance of Being Practical

So as part of the ever-changing modifications to English examinations, practical work is no longer to be counted towards A level Biology, Chemistry, and Physics. The current system is far from perfect but I am terribly afraid of throwing the baby out with the bath water.  Grade boundaries are very high in the practical modules and there have been many complaints about teachers coaching their students towards higher marks.  My personal opinion is that tightening security measures would be a better option than a separate teacher assessed module that doesn’t count toward the qualification (and will invariably be seen as lesser by those outwith science education).

 

The Complaint: Grade Inflation

In my board, the A grade for the practical modules in 2013 was 88% (versus 80% for the written papers) and 50% for the E grade (versus 40%).  I hear in other exam boards, the situation is worse.  The reason behind this seems to be two-fold – poor security measures meaning papers are leaked online and coaching by teachers.  This can be as overt as one local grammar school where a student who transferred to my centre claims that for assessed titrations, the teacher put a volume “to aim for” on the board, or the slightly more subtle doing an almost identical practical the week before with only the spectator ions changed.  My solution to this would be a return to the old-fashioned practical exam whereby all students across the country would be doing their practical exams on the same day.  Yes, we can predict the content by the requests to technicians but perhaps the use of red herrings on orders or different candidate numbers being set different tasks using similar equipment would help to rid us of teacher bias.

 

The Complaint: These modules don’t assess hands-on science skills

I tend to think of the practical assessments as more a skills check than a measure of whether students can follow the scientific method to plan, carry out, analyse and evaluate an extended investigation (what we would describe as “doing science”). Does it make it any less valuable? I’d say no – as a former FE teacher who taught students from a variety of educational backgrounds, I found students who had done the iGCSE abroad often didn’t know one end of a burette from the other and were playing catch-up from Day One.  If this is happening in FE, I dread to think about the basic practical skills having to be taught at university level. I will also confess that in my practical modules at university, we were rarely called upon to plan and carry out experiments, more follow the given method and analyse the product and/or results.

Many teachers would prefer a return to a long-term project, as found in the Scottish Advanced Higher or in IB but this government appears to be cancelling coursework in all subject areas for fear of cheating.  A solution would be ensuring questions based on PPA were an integral part of all written papers, and a written exam based on planning, analysis, and evaluation of given examples would make up 20% of the grade (replacing the controlled assessment).

 

The Complaint: Practical controlled assessment replaces high-quality practical work

The suggested 12 experiments students are expected to do for the separate practical pass-fail mark would ensure a more high quality learning experience.  I have worked in a school in London where if I even wanted so much as a beaker I had to order it a week in advance; the classrooms were bare of practical equipment.  The cynic in me believes that in a time of budget cuts, certain unscrupulous centres would advocate the teaching of these techniques by demonstration only and various publishing companies would be more than happy to step in with videos and “interactive” animations, removing our kids further from the actual manipulation skills needed for a hands-on scientist.  On a pass-fail scale on practical skills, universities will be unable to differentiate between candidates applying for science degrees, and teachers will be under immense pressure to award a pass to all students.  I think it also makes UK exams even more sellable abroad if centres need not worry about having the equipment and teachers able to teach practical work.

 

My conclusions

Yes, the assessment of practical work as to change to combat grade inflation but to remove it entirely risks the value of being a hands-on scientists being lost.  A candidate will still be able to achieve an A* at A level even if they fail the pass-fail teacher assessed practical certificate.  Complaints from universities about lack of manipulation skills in undergraduates will continue.

In an ideal world, I’d like to emulate the work of Advanced Higher Chemistry (SQA) where students undertake an extended practical project but the DfE seems to detest coursework of any kind.  Instead I want the twelve practicals to be embedded in the type of questioning found in the written paper to ensure practical work is seen to be the equal of theoretical.  I also want a return to an exam-style practical with a written examination based on planning, analysing, and evaluating alongside a practical examination based on the implementation of these techniques; it need not be for the same experiment but should show a broad range of skills.

I will always be an advocate of teaching science through doing science but I feel in an age of budget cuts, the decreasing value of practical work in the eyes of non-teachers will lead to me having to fight the bean-counters even harder for my share of the budget.