Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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Widening participation and removing the inequity of educational opportunity
- J Pip Fisher (16 May 2008)
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Private education gives applicants an unfair advantage
- Andrew D Beggs (17 May 2008)
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Missing the point
- Sarah R Wright (19 May 2008)
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The Extended Medical Degree Programme at King's College London School of Medicine
- Pamela B Garlick, Gavin Brown, Lecturer in Human Geography, University of Leicester, Professor John Rees, Dean of Undergraduate Education, King's College London School of Medicine, Professor Anne Greenough, Head, King's College London School of Medicine (19 May 2008)
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I am a Hypocrite also!
- Robert A Watson FRCS (20 May 2008)
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Are the authors really arguing against principles of social justice and equity of opportunity?
- Jonathan Mathers, Kenton Lewis, Head of Widening Participation & Student Recruitment, SGUL (20 May 2008)
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Are we forgetting the true social justice premise?
- Carol A Gray (22 May 2008)
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I am a Working Class Student with a View to Becoming a Doctor
- Joanne E Procter (5 June 2008)
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J Pip Fisher, GP to the socially excluded Whitehouse Centre, Huddersfield, HD1 5JU
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Editor, Ip and McManus worry that widening participation schemes for entry to medical school sacrifice "equality of opportunity" since applicants are not all "treated uniformly" (1). It could be argued that the candidates entering medical school through the widening participation programmes have not had the opportunity to attend high achieving schools and have not been had uniform treatment by life chances in childhood. I heard recently of a scheme run by a university in the USA, which might address a number of the objections to such programmes, whilst at the same time helping to redress the class divisions within the UK school system. Rather than considering only exam results, the university gives weight to the rank of the student within their school. An admissions policy that requires students to be in the top x% of their year provides a transparent selection system, treating all students uniformly whilst reccognising that a B grade achieved at a poorly performing school can be as difficult to achieve as an A grade obtained at a well performing school. It is interesting to consider how such a scheme, if widely adopted, would affect the distribution of the children of ambitious, professional parents in the UK school system - would middle class parents be willing to choose schools in deprived areas to "game" the system? 1) Editorial; Increasing diversity among clinicians. BMJ 2008;336:1082-1083 (17 May). Competing interests: I came from a working class background and state comprehensive school. My entry to medical school was through a conventional route. |
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Andrew D Beggs, Research Registrar, Colorectal Surgery London, UK
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Sir, The editorial by Ip et al raises several interesting points. Speaking from the point of view of someone who was educated via the state comprehensive system, I feel that the two systems cannot be compared. Privately educated students have a intrinsic advantage over state school students, both in terms of quality of teaching and pastoral support. The A-level may be a "gold standard" in educational excellence, but the quality of private education is such that it gives students from the state sector a disadvantage in terms of results, and thus in competitiveness in entry for medical school. The paper by Garlick et al demonstrates that in terms of outcomes, the EDMP students are equivalent by the first clinical year. Surely this shows that the problem is that the EDMP students have not had the same educational opportunities to get them up to the conventional entry standard, rather than any intrinsic lack of ability. Speaking as someone who has taught the EMDP students, I found uniformly that they were motivated and intelligent, usually beyond that of the medical students on the conventional course. Generally, they are significantly disadvantaged as they have many social and economic problems that conventional medical students do not have to endure. The whole tone of this BMJ editorial seems grounded in the attitudes of past and does much to reinforce the stereotype of doctors as belonging to a particular socioeconomic group. Competing interests: I was educated at a state comprehensive school. I have taught medical students on the EMDP in 2005. |
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Sarah R Wright, Psychometrician Newcastle University, NE2 4AB
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It is worrying to see statements such as “social class correlates with intellectual ability.” Statements like this contribute to the need for widening participation initiatives in the first place. While a correlation may exist between social class and intellectual ability, it is not causal. Discussing the relationship in this way is like attributing rising crime rates to a rise in ice cream sales, while ignoring other influencing factors (like the weather!) Clearly, the true relationship lies between resources available to the different social classes (rather than social class itself) and a measured educational output (rather than ‘intelligence’). [1] One of the main findings from the HEFCE study (cited in this editorial) was that with regard to higher education, “students from independent schools appear to consistently do less well than students from other schools and colleges, when compared on a like-for -like basis. ” [2] This finding further illustrates the point about the relationship between social class and intelligence, and also highlights the need for creating equal opportunities for deserving students of all backgrounds. 1. Chiu, M.M. and L. Khoo, Effects of Resources, Inequality, and Privilege Bias on Achievement: Country, School and Student Level Analyses. American Educational Research Journal, 2005. 42(4): p. 575-603. 2. Higher Education Funding Council for England, Schooling effects on higher education achievement. 2003, HEFCE. Competing interests: None declared |
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Pamela B Garlick, Director, Extended Medical Degree Programme ( EMDP) King's College London School of Medicine, SE1 1UL, Gavin Brown, Lecturer in Human Geography, University of Leicester, Professor John Rees, Dean of Undergraduate Education, King's College London School of Medicine, Professor Anne Greenough, Head, King's College London School of Medicine
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Editor We would like to comment on a number of statements in the 17th May Editorial, Increasing diversity amongst clinicians, discussing our Extended Medical Degree Programme (EMDP) at King’s College London. Firstly, our aim in setting up the programme was to enable bright, motivated pupils from Inner London state schools to become doctors; we had no intention of future matching of doctors to patients, in terms of class or ethnicity. Secondly, the fifty EMDP places are extra places, funded by HEFCE and added to the 360 places on our conventional medical course; we have not therefore decreased the places for conventional applicants. Thirdly, we believe that we are not lowering standards with the EMDP students. Although they are given lower A level offers to enter medical school, once they are on the course, they have to take the same assessments and achieve the same pass mark as the conventional students. Interestingly, in the two most recent assessments, more than 20% of the EMDP students came in the top 20% of the whole cohort. The increased diversity provided by the EMDP students has had a very positive impact and we believe that the Medical School and these students can be justifiably proud of their achievements. Competing interests: None declared |
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Robert A Watson FRCS, surgeon UNC
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The socio-economic inequalities are deep and hard themes - as those of us from the state comprehensive school experiment can testify to when that inner hypocrite/Darwinian instinct in us emerges and we decide to move houses to a better school district or send our children to private school to help our genes (I mean children). Thus we ourselves disturb any real goal of a meritocracy that most of us profess but do not follow. The real heart of the problem is the inequality of opportunity at school. An interesting social experiment comes from Texas ( WIKI- ‘Texas House bill 588’ – if anyone is interested) where a top percentage of EVERY school (private or public- I think) are guaranteed a good University place thus incentivizing those in less well performing schools (or de- incentivizing – some may say- those in the better ones?) thus creating local meritocracies within all schools! Obviously with any such change some of the middle classes (and real estate agents) may have to take one for the team! – ‘The good of the many versus the good of the few’ – however this is very unDarwinian I’m afraid. Competing interests: I am a current middle class hypocrite/parent |
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Jonathan Mathers, Research Fellow Department of Public Health, University of Birmingham, Kenton Lewis, Head of Widening Participation & Student Recruitment, SGUL
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Ip and McManus provide a highly provocative editorial, seemingly challenging the principles underlying widening access initiatives, as well as the evidence that relates to justifications for adjusted entry criteria for ‘disadvantaged’ students, and subsequent performance within medical courses. However, we wonder were this editorial to be have been subjected to peer review whether the editor’s letter would have read ‘revise and resubmit’, or simply ‘rejection’. Ip and McManus in their title appear to conflate ‘political correctness’ with principles of social justice and equity of opportunity, principles which clearly provide a rationale for widening access initiatives within HE. This may appear like wordplay, but to label such activities as ‘politically correct’ would seem a deliberate attempt to distract from the virtues of the principles underpinning such policies. Are the authors really saying that goals relating to social justice and equity of educational opportunity (which are closely intertwined) should not be reflected within the medical profession? Or are they arguing that these goals have already been achieved within a modern day ‘meritocratic’ Britain and are therefore redundant? As Wright points out their observation regarding the association between social class and intellect (where McManus quotes himself from 1982), with its causal overtones, requires challenge and more nuanced consideration. Elsewhere the authors selectively quote evidence from HEFCE research that has examined the influence of schooling effects on HE achievement [1]. Wright has already pointed out that this report clearly finds that students from independent schools (of which approximately 30% of the applicants to medicine in the UK have attended) have lower levels of achievements within HE than students from the state sector with equivalent academic performance at A-level. The findings related to school performance are also not represented accurately by Ip and McManus, as the impact of school performance was reported as varied based on other factors, including gender. The authors’ statement that “a student’s school performance does not predict a student’s subsequent university performance” does not tell the whole story therefore. This report also finds that – “The subject areas where the strongest school performance effects exist are in subjects allied to medicine and engineering. The performance effect in these subjects is around three times stronger than the effect seen for the overall data.” [1. pg 25] Other contentions are that such initiatives are costly and risk reducing standards. However, and ironically, after having criticised the EMDP study for not having a control group to demonstrate the effect of academic and pastoral support on outcomes, the observation relating to the costly nature of widening access activities is made without reference to comparative data for costs of conventional routes and students. Undoubtedly, such initiatives have costs associated with them, but what we require to come to valid and robust conclusions of their relative worth, is comparative cost data. It should also be noted that the EMDP is only one of many varied initiatives that need evaluation and comparison, before we can draw conclusions as to their merit. Perhaps Ip and McManus are jumping the gun here somewhat. The authors conclude by asking the question “Is it worth our while to widen participation, particularly if this risks reducing standards? Political ideology says yes, but the evidence is pending and costs are rising fast.” Let’s examine the basis for this conclusion. Are we really risking reducing standards? The evidence to date seems to suggest not. Retention rates appear broadly similar on the EMDP. Some of the students are reported to have results in the top 20% of their cohort. Research from SGUL shows that adjusted entry criteria students from poor performing schools have equivalent results in first year final exams [2]. Regardless of this contrary evidence Ip and McManus seem to point the finger solely at widening access students. Conventional route students do not all perform exceptionally. They do not all pass every exam at the first attempt. Aren’t they too lowering standards? When arguing that political ideology is driving WP policy initiatives it is all too easy to invoke the ‘dumbing down’ argument. Perhaps this is also an attempt to veil a particular ideological stance as an argument based in [selective] ‘evidence’? 1. Higher Education Funding Council for England, Schooling effects on higher education achievement. 2003, HEFCE 2. St George’s University of London. Widening participation works, results show. 2008. www.sgul.ac.uk/index.cfm?5BD25ADF-99A1-3752-953B- E079E11F4373 Competing interests: None declared |
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Carol A Gray, Lecturer in Veterinary Communication Skills University of Liverpool, Leahurst Campus, Neston CH64 7TE
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Surely one main aim of increasing diversity in undergraduate medical/dental/veterinary undergraduates is to add a level of cultural and social enrichment to a fairly blinkered cohort of higher education students? A secondary aim may be to increase the numbers who want to work with socially disadvantaged patients/clients, but as the author remarks, we cannot expect those from disadvantaged backgrounds to go back and work in similar areas, any more than we can expect those from more advantaged backgrounds to work only in affluent areas. Competing interests: Widening participation coordinator in the Faculty of Veterinary Science, University of Liverpool |
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Joanne E Procter, Student Runshaw College, PR25 3DQ
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I feel that this article is far too general and also absolutely incorrect. I myself am from a working class family, and this year will be applying to Medical school with the hope of eventually becoming a doctor. I am 17 years of age, and my friend is 16 years old, also working class, and also hopes to become a doctor. We both went to a high school which is regarded locally as one of the worst in the area, and yet I obtained 10 A*'s and one A at GCSE, and my friend obtained 11A*'s. One of my other close friends also obtained 9A*'s and two A's - she is another working class girl from a single parent family. I don't think this fits in with the assumption that the working class are not intelligent enough to become doctors, and let me assure you, cases like this are not a one off - I have friends who have attained 13A*s at GCSE, and we are all predicted grade A's at A-level, despite not having had upper-class education. In my opinion class has not to do with intelligence - good grades and the ability to become a doctor come from hard work and good interpersonal skills, which I feel are, if anything, exemplified by many of the working class, as we have more experience of communicating with people from all walks of life, and traditionally have to get used to hard work from an early age. I feel it was unforgivable to generalise by saying the the upper class are more intelligent, and I myself know this to be absolutely untrue. Perhaps yes, it would be true to say that there are many doctors from an upper-class background, but I think this is more due to the financial aspect of University education than anything else. Working class people may be regarded as less intelligent, but more than anything this is due to the fact that for financial reasons they are forced to go out to work earlier than the upper classes and so are not able to further their education. Reading this article has disappointed and somewhat offended me, as I work extremely hard to achieve good grades in my education and to hear these kind of comments after my friends and I have grades which, I am sure you will agree, are far better than those many middle class students acheive, is infuriating and upsetting. I can only hope that this opinion is not one shared by the majority. Competing interests: None declared |
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