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Acceptance into medical school and racial discrimination

^a Department of General Practice, University of Manchester, Rusholme Health Centre, Manchester M14 5NP, ^b House of Commons, London, ^c BMJ, BMA House, Tavistock Square, London WC1H 9JR

Correspondence to: Dr Esmail.

For several years the Universities and Colleges Admission Service has monitored the ethnic group of applicants to universities in the United Kingdom. We investigated the acceptance rates to medical school of applicants according to their ethnic group.

Subjects, methods, and results

We obtained permission from the deans of all medical schools in the United Kingdom to analyse the data from the Universities and Colleges Admission Service on candidates who applied and were accepted for places in 1992. We classified candidates as belonging to an ethnic minority group when they identified themselves as being Chinese, Bangladeshi, Indian, Pakistani, Afro-Caribbean, or black. Candidates who did not provide information on their ethnic origin and those from overseas were excluded from the analysis. Applicants were stratified according to score at A level (30-26 or 25 or less, grade A scoring 10 points, grade B eight, grade C six, grade D four, and grade E two, with the maximum possible score being 30). Applicants with passes in the Scottish Certificate of Education were excluded because of problems in comparing the two examinations. To adjust for A level score a stratified analysis using a Mantel-Haenszel test¹ was carried out and expressed as an odds ratio--that is, the odds of white candidates being accepted into medical school compared with the odds of candidates from ethnic minority groups being accepted.

The table shows the likelihood of being accepted into medical school according to ethnic group after controlling for A level score. The overall weighted Mantel-Haenszel odds ratio for acceptance to medical school was 1.15 (95% confidence interval 1.02 to 1.29) for those with A level scores of 30-26 and 2.02 (1.89 to 2.72) for those with scores of 25 or less.

Comment

Many factors could explain the differences between white applicants and those from ethnic minority groups in their acceptance rates to medical school. We were able to stratify A level scores into only two bands. Candidates within these bands might have had a wide range of results, and ethnic differences could account for the number of points scored.

In some medical schools the confidence intervals of the odds ratios were wide because of the small number of applicants from ethnic minority groups and the fact that we used data from only one year. Although these results should be interpreted with caution, we found significant differences in the odds ratio in several schools.

The data we analysed relate only to academic achievement, but other factors are considered equally important in selecting students for medical school. We cannot comment on how factors such as type of schooling, regional differences, and previous experience influence whether an applicant is offered a place. Factors other than ethnic group--for example, sex--could account for some of the differences that we observed.

Likelihood of acceptance to medical schools in 1992 of white applicants compared with applicants from ethnic minority groups according to score at A level
----------------------------------------------------------------------------------------------------------------------------------------------------------------------
                   Score at A level 30-26                                      Score at A level </=25
----------------------------------------------------------------------------------------------------------------------------------------------------------------------
                 No of applicants  No of acceptances                         No of applicants   No of acceptances                        Odds ratio for all strata
-------------------------------------------------------Odds ratio of      ----------------------------------------Odds ratio of     ----------------------------------
                             Ethnic          Ethnic      acceptance                    Ethnic            Ethnic      acceptance                   Weighted
                            minority        minority   (95% confidence                minority          minority    (95% confidence             (95% confidence
Medical school        White  group   White   group       interval)*           White    group    White    group       interval)*        Crude      interval)+
----------------------------------------------------------------------------------------------------------------------------------------------------------------------
Aberdeen                105     7      15       3       0.22 (0.04 to 1.41)    102       14       10       0                             0.82     0.72 (0.18 to 4.17)
Belfast                 226     3     129       1       2.66 (0.19 to 75.2)    134        3        1       0                             2.83     2.71 (0.15 to 159)
Birmingham              643   133     139      19       1.65 (0.96 to 2.89)    465       207      13       1     5.79 (0.79 to 119.30)   2.54     1.88 (1.12 to 3.26)
Bristol                 572    78      85      10       1.19 (0.56 to 2.56)    338       91       16       3     1.46 (0.39 to 6.44)     1.50     1.22 (0.66 to 2.45)
Cambridge               428   140     161      35       1.81 (1.15 to 2.85)     70       46        3       0                             2.12     1.88 (1.21 to 2.97)
Charing Cross and
 Westminster            223   139      33      18       1.17 (0.6 to 2.27)     512       467      59      22     2.63 (1.55 to 4.52)     2.02     1.93 (1.30 to 2.95)
Dundee                  256    14      32       2       0.86 (0.17 to 5.82)    318       90       42       6     2.13 (0.83 to 5.78)     1.78     1.76 (0.80 to 4.47)
Edinburgh               615    99     104      24       0.64 (0.37 to 1.09)    246       47        0       0                             0.64     0.64 (0.37 to 1.09)
Glasgow                 237    20      39       2       1.77 (0.37 to 11.54)   199       41        9       1     1.89 (0.23 to 41.04)    2.39     1.81 (0.51 to 7.72)
King's College          161   150      28      30       0.84 (0.46 to 1.55)    325      346       14      11     1.37 (0.58 to 3.29)     1.05     0.99 (0.61 to 1.62)
Leeds                   749   173     112      21       1.27 (0.75 to 2.16)    562      263       29       4     3.52 (1.16 to 11.94)    1.98     1.61 (1.01 to 2.60)
Leicester               338    78      64      17       0.84 (0.44 to 1.60)    436      202       24       7     1.62 (0.65 to 4.21)     1.37     1.06 (0.64 to 1.79)
Liverpool               385    80      76      25       0.54 (0.31 to 0.96)    472      142       30       3     3.14 (0.9 to 13.13)     0.98     0.84 (0.52 to 1.39)
Royal London Hospital   158    82      29       8       2.08 (0.85 to 5.23)    343      327       36       7     5.36 (2.24 to 13.41)    3.02     2.77 (1.89 to 4.31)
Manchester              543   186     109      51       0.66 (0.44 to 0.99)    479      272       30      11     1.59 (0.75 to 3.42)     1.01     0.83 (0.59 to 1.18)
Newcastle               566    87      90      10       1.46 (0.7 to 3.12)     509       83        9       1     1.48 (0.19 to 31.51)    1.47     1.46 (0.73 to 2.99)
Nottingham              929   162      92       8       2.12 (0.97 to 4.81)    750      210       17       3     1.60 (0.44 to 6.93)     2.28     1.98 (1.04 to 4.14)
Oxford                  271    74      77      14       1.70 (0.86 to 3.39)     78       31        2       1     0.79 (0.05 to 22.8)     1.76     1.63 (0.86 to 3.26)
Royal Free Hospital     209    85      25       6       1.79 (0.66 to 5.08)    449      359       39      13     2.53 (1.28 to 5.08)     2.08     1.88 (0.9 to 3.93)
Sheffield               613   132      77      16       1.04 (0.57 to 1.93)    616      238       33       3     4.43 (1.29 to 18.30)    1.82     1.55 (0.92 to 2.69)
Southampton             405    61      58       8       1.11 (0.48 to 2.66)    505      150       22       5     1.32 (0.46 to 4.05)     1.47     1.19 (0.63 to 2.41)
St Andrews              110    14      32       2       2.46 (0.48 to 16.92)    97       49       12       1     6.78 (0.87 to 143.07)   5.40     3.83 (1.12 to 20.53)
St Bartholomew's
 Hospital               199    92      43      24       0.78 (0.42 to 1.45)    256      145       16       3     3.16 (0.85 to 13.87)    1.16     1.07 (0.63 to 1.85)
St George's Hospital    244   132      61      25       1.32 (0.87 to 2.00)    476      369       44      14     2.58 (1.35 to 5.03)     2.02     1.85 (1.23 to 2.83)
St Mary's Hospital      296   138      37       7       2.67 (1.10 to 6.77)    704      442       34      13     1.67 (0.84 to 3.38)     2.14     2.03 (1.20 to 3.56)
University College and
 Middlesex              472   217      59      18       1.58 (0.88 to 2.86)   1085      810       28      15     1.39 (0.75 to 2.59)     1.78     1.50 (0.98 to 2.35)
United Medical and
 Dental Schools of
 Guy's and St Thomas's
 Hospitals              233   152      68      55       0.73 (0.46 to 1.15)    253      284       23      15     1.79 (0.87 to 3.91)     1.20     0.96 (0.65 to 1.40)
Wales                   288    69      70      11       1.69 (0.81 to 3.36)    442      186       23       5     1.99 (0.70 to 6.06)     2.18     1.79 (1.00 to 3.38)
----------------------------------------------------------------------------------------------------------------------------------------------------------------------
*White candidates: candidates from ethnic minority groups.
+Mantel-Haenszel test.

A higher proportion of applicants to medical schools than in the population overall are from ethnic minority groups.² Medical schools may therefore inadvertently be trying to restrict the overall numbers of students from ethnic minority groups to reflect population distributions in the United Kingdom. This may explain why white students with lower A level scores (25 or less) seem to have a greater chance of being accepted than their colleagues from ethnic minority groups with similar scores. There did not seem to be any selection bias in favour of white candidates among applicants with scores of 30-26.

The process of selecting students for undergraduate medical courses has long been a problem for those having to select. Admission policies are not standard or defined so the policies of individual medical schools vary greatly.³ Our data suggest that some medical schools could be accused of practising discriminatory admissions policies.

AE and DP were commissioned by the Medical Practitioners Union, London SE1 1UN, to carry out this study.

1. Fleiss JL. Statistical methods for rates and proportions. 2nd ed. New York: Wiley, 1981:173.
2. Vellins S. South Asian students in British universities. A statistical note. New Community 1982;10:206-12.
3. Anderson J, Hughes D, Wakeford R. Medical student selection: a tentative attempt to establish a code of practice. BMJ 1980;280:1216.

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