How Many Tests Can an Intern Take Before You Call Him a Doctor?

The High Court of Justice has ordered the Health Ministry to explain a draconian regulation that prevents a medical student who has failed his internship twice from being examined a third time.

As the protests about the difficulties facing medical students in examinations in Israel mount, the High Court of Justice has ordered the Health Ministry to explain a draconic regulation that prevents a medical student who has failed his internship twice from being examined a third time. Only two weeks ago, a group of medical students from abroad petitioned the High Court about the level of the examination they were required to undergo in Israel in order to do their internship in this country. The internship is the seventh and last year of studies before the student becomes a doctor.

In June 2010, a medical student from the Galilee petitioned the court when the Health Ministry refused him a third chance after he twice failed his internship in surgery. The student studied medicine in the Romanian city of Jassy and came to Israel to do his internship after passing a preliminary examination in August 2007. He then spent two months in one of the surgical wards of Haemek Hospital in Afula. At the end of this period, the doctors stated that he had failed. The student was sent to do another internship in another surgical ward of the same hospital during the months of February and March, 2009 - and again he failed. He was then informed that he would not be entitled to be examined a third time.

The student petitioned the High Court through the offices of attorney Amad Dakuar, arguing that that 10 years of study would go down the drain as a result of this decision. The petition claimed the ministry was going beyond its authority in deciding this and that it was contravening the Basic Law on Human Dignity and Freedom vis-a-vis occupation. The petition also said there was no other profession in which a person was not permitted to be examined after failing twice.

The ministry said that "the doctor failed two internships and then requested a chance to do another internship in the same hospital. The opinion of the head of the department about his qualifications was extremely negative and he stated that 'I would not wish to leave a patient in his hands for even one minute.'"

For his part, the plaintiff produced a letter of recommendation from the head of the pediatric ward in the hospital about his ability to function in that department during the internship. His lawyer argued that "the reason [his client] failed twice in the surgical wards of the same hospital was that he had clashed with one of the doctors in the department." He added that the petitioner had not been informed that he was allowed to undergo an internship in another hospital.

The Health Ministry does not keep records about students who have failed the internship twice and been prevented from a third chance. According to a senior ministry source, however, "this is a rare case." During the hearings in court, it transpired that the regulations were set up by the deans of the country's medical schools some 40 years ago, but were not approved by the ministry's legal department, the attorney general or the Knesset's health committee.

"Before a student begins his internship, he is informed clearly in writing that if he fails, he has only one chance to repeat the test," the ministry explained. "It must not be forgotten that we are dealing with human lives. The authority is anchored in para. 71 C of the Doctors' Edict and it authorizes the head of the hospital to refuse to grant a license to someone about whom there is not a positive opinion of his work as an intern in that hospital."

The three justice of the High Court - Edmond Levy, Hanan Meltzer and Yoram Danziger - have meanwhile instructed the ministry to explain within 45 days why the regulation should not be canceled.

The ministry spokesman said that as long as the matter was before the court, no comment could be made about changing the regulations.