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Medical schools continue to favour white, middle class candidates

BMJ 2004; 328 doi: (Published 24 June 2004) Cite this as: BMJ 2004;328:1518
  1. Burke Katherine
  1. London

    Medicine is still very much a career for the middle classes, and the class divide could widen even further when top up fees are introduced, a BMA discussion paper has warned.

    In the paper the BMA collated figures from medical schools in the United Kingdom showing that students from white, middle class families still have twice the chance of being accepted into a medical degree course than their working class peers.

    Figures from the Universities and Colleges Admissions Service (UCAS) cited in the report indicate that the socioeconomic makeup of UK medical schools is stuck in a time warp. Almost two thirds (64%) of the students who enrolled in medical or dental school in 2003 came from the managerial and professional classes—only a slight fall from the 76% figure for the intake of 1966.

    Although ethnic minorities seem to be well represented at medical school, they still have less chance of getting a place than their white counterparts. Of those who applied to medical and dental school in 2003, 62% were white, but of those who were accepted, 69.5% were white. By contrast, 25% of those who applied were of Asian origin, but Asians made up only 22% of those who were accepted.

    “When we do research, [students from ethnic minorities] are still disadvantaged because given the same grades as a white candidate they are much less likely to get into medicine,” said Dr Aneez Esmail, vice president of the Medical Practitioners Union and an expert on discrimination.

    Launching the report, the BMA's head of science and ethics, Dr Vivienne Nathanson, warned that when top up fees are introduced in 2006 medical schools may receive even fewer applications from students from poorer backgrounds.

    “If they come from a social economic background where their parents aren't able to support them, many of these students are going to qualify with £60 000 [$110 000; €90 000] debt,” she said. “Many people aren't going to go on these courses.”

    The BMA says that pupils from low socioeconomic groups are put off applying to medical school or are unfairly filtered out. They may not even get an interview, because their predicted grades are too weak—even though they may go on to get better A level grades than candidates from private schools who received a more optimistic forecast that helped them get in. Filtering on the basis of personal statements or referees' reports may also favour applicants from the higher social classes, the report says.

    All medical schools should try to get pupils from inner cities and sixth form colleges to raise their aspirations, through outreach programmes and summer schools, says the report.

    Medical schools should thoroughly audit their selection procedures and redesign them to stamp out discrimination, the report recommends. The Council of Heads of Medical Schools should also work out what attributes make a good doctor and feed these into the selection criteria, perhaps through the use of psychometric testing. Medical schools should also work out what the optimum age is to start their course, since the system generally favours 18 year old school leavers, said Dr Nathanson. (See pp 1508, 1541.)

    The Demography of Medical Schools: A Discussion Paper is available at

    View Abstract

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