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The standardised admission ratio for measuring widening participation in medical schools: analysis of UK medical school admissions by ethnicity, socioeconomic status, and sex

BMJ 2004; 328 doi: (Published 24 June 2004) Cite this as: BMJ 2004;328:1545

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Social class data are problematic to interpret

Although an interesting concept, the standardised admissions ratio (SAR) has a number of
problems which make it too problematic for routine use for comparing institutions. In
particular there is reason to believe a) that the UCAS figures may well not be a valid measure
of social class, and b) it is not clear for social class whether the ratio should or could ever
reach a value of unity. That makes interpretation of SARs difficult.

a) Until 2001, UCAS assigned social class on the basis of the very brief, often only one-word,
description of parental occupation included on the application form, the glossary stating that
it is,

“based on an applicant's parental occupation (or the occupation of the person
contributing the highest income to the household if the applicant is aged 21 years or
over). Provision of this information was voluntary ... ”

Even ignoring the 15.9% of applicants overall and the 11.4% of applicants for medicine who
did not provide information, UCAS’ assignments of class are unlikely to be reliable or valid
(and UCAS provides no information that they are). A one-word description of a job can
hardly summarise the subtleties of modern social class, particularly when many 17-year olds
have little idea about their parents’ jobs. Not only is there scope for upwards bias in
describing occupations, but neither is it obvious how UCAS can code such one-word terms
as ‘manager’ – of a small rural petrol station or a multinational oil company? SARs
therefore have a numerator which is close to uninterpretable, a problem further exacerbated
by the denominator being calculated by an entirely different method from a different
database (and finding those figures in the mass of material available at
is nigh on impossible).

b) Post-1945 Britain has been very much a meritocracy, with social class strongly related to
intelligence, extensive social mobility between classes depends primarily upon
, and intelligence showing moderately high within-family correlations).
Since intellectual ability is also a major predictor of examination results and hence university
entrance, it is hardly surprising that individuals from social classes I & II are accepted at
higher proportions than their representation in the population. There is therefore little
likelihood that the SARs for social class will ever approximate the utopian ideal of unity.
Elsewhere I have calculated what the social class distribution might be expected to be if
admission to medical school mainly depends on intellectual ability [3]
. I estimated that the
proportions from social class I, II, III, IV and V would be about 14%, 35%, 41%, 8% and 2%.
The SARs would then be 2.25, 1.18, .97, .48 and .30, with that for social class I being 7.7
times higher than that for social class V.

A long-term view of medical school entrants shows that over the years 1956 to 2001 the
social class distribution of UK medical students remained almost constant (despite different
methods of measurement). The figure below shows the proportions of each social class in
medical school entrants from 1956 to 2001. Methods of assessing social class differ
somewhat between studies and therefore only the broad trends should be considered.
Nevertheless it is clear that over nearly half-a-century, and despite a substantial decline in the
proportion of manual occupations in the population as a whole, there is little evidence of a
broadening of the social class of medical school entrants. The SAR for social class I would
have dropped from 12.3 in 1956 to 6.76 in 2001 but that is only because twice as many of the
population are now in social class I.

Sources: 1956, 1961 and 1966: Royal Commission on Medical Education [4]; 1981 [5]; 1986 [6]; 1991 [7]; 1996 &

Reference List

1. Halsey AH, Heath AF, Ridge JM. Origins and destinations: Family, class and education in modern Britain.
Oxford: Clarendon Press, 1980.

2. Nettle D. Intelligence and class mobility in the British population. British Journal of Psychology

3. McManus IC. The social class of medical students. Medical Education 1982;16:72-5.

4. Royal Commission. Royal Commission on Medical Education (The Todd Report), Cmnd 3569. London:
HMSO, 1968.

5. McManus IC,.Richards P. An audit of admission to medical school: 1. Acceptances and rejects. British
Medical Journal

6. McManus IC, Richards P, Maitlis SL. Prospective study of the disadvantage of people from ethnic minority
groups applying to medical schools in the United Kingdom.
British Medical Journal 1989;298:723-6.

7. McManus IC, Richards P, Winder BC, Sproston KA, Styles V. Medical school applicants from ethnic
minorities: identifying if and when they are disadvantaged.
British Medical Journal 1995;310:496-500.

Competing interests:
None declared

Competing interests: “based on an applicant's parental occupation (or the occupation of the personcontributing the highest income to the household if the applicant is aged 21 years orover). Provision of this information was voluntary ... ”(

06 July 2004
I C McManus
Professor of Psychology and Medical Education
Department of Psychology, University College London, London WC1E 6BT, UK