To think medical school admissions favour people from a middle class (or upper middle class) background?

[CampionMN]

The medical school admissions process in this country is deeply flawed in my opinion. It favours people from middle class backgrounds (or upper middle class) and disadvantages people from poorer backgrounds.

I know plenty of people will come in to talk about how they grew up in a council estate, went to the local comp and went to medical school easily. I am aware this happens sometimes but we all know such situations are rare and not the norm.

The typical medical student (and doctor) is a middle class boy or girl who went to a private school or a highly selective grammar school (where teachers knew the medical school admissions process and coached them heavily beforehand). Had family access to doctors and had parents who were very involved in their medical school admission process (some of them wrote their child’s personal statements). This isn’t their fault, nor is it necessarily wrong. However I still feel medical schools should take these factors into account before granting admissions to students and admit those (from all backgrounds) who have a genuine desire to study medicine and a genuine passion to work as a doctor. Not just those who are doing it because it’s the expected path for them or because their parents really want it for them.

There are many, many people from disadvantaged backgrounds who have the desire to do medicine but will never be given the chance. This is because growing up in a home where parents are uneducated/have never been to university means they do not receive anywhere near the level of parental help required for medical school. Going to a not so great comprehensive school means a lot of teachers there cannot advise on how to navigate the entire process of getting into medical school (because it’s so rare for them to send a student to medical school). Having no access to doctors in the family means that no one can help you study for the admissions exams or help you write a good personal statement or help you get medical work experience. It also means your grades may not be the highest because you had additional challenges outside of school that may have affected your ability to revise properly (although they may be considered high for your school).

I also wonder if the selection process is contributing to doctors not being able to cope with working as a doctor. Struggling to accept criticism or being judged negatively. Struggling with to deal with 12 hour shifts (whereas most working class jobs, like care work are 12-12.5 hours long for a minimum wage salary and often no breaks because care homes are usually short staffed).

There’s a class problem within medicine (and dentistry too - everything I’ve said applies to becoming a dentist as well but slightly less so because of the difference in working hours and because dentistry isn’t necessarily seen as the end goal for all smart middle class students).

People from upper class backgrounds tend not to do medicine. So that’s why I haven’t included them.

@titchy

Medical school is expensive.

Eh? It costs the same as any other degree, including the much-maligned Media Studies from Uni of Localtown.

Mmm its 2 years longer and there is no way you could have a job and do the course in the final 2/3 years. So I think it is expensive

(my ExH was a doctor I was with him throughout his degree and his training (which takes another few years)

Last year, there were 28,690 applications for 9,500 places.

You're wrong OP. My brother is studying to be a doctor and my SIL is a junior doctor.

They obviously have various medical-professional friends and very few fit the criteria you're claiming are favoured.

I can only talk of my experience of trying to get into medicine as a "mature" student at 26..... It was impossible. Over 3 years of trying and paying for various entrance exams etc I had to give up. In that time I got one interview for Newcastle. I couldn't afford the interview coaching but read extensively on the process and did everything I could to prepare. I had lots of paid and voluntary carer experience in numerous settings and took a laboratory based job to expand science/biological knowledge as I could not get "prospective medical student work experience" for love nor money.

I was in an interview waiting room with:- a young woman who had flown in on her Dad's private jet from Singapore, a sixth former who had been to a private boarding school and sounded like the queen and a young man who was talking with them about his private school- he had a Rolex on which my DH had clocked and pointed out to me as he is a watch buff. They all chatted together after politely enquiring where I had gone to school and not liking the answer (inner city Liverpool...definitely not private). I was last in to interview- they'd all come out of theirs wishing each other luck and saying that it was a pleasant experience. I went in, got called a liar for making up my niche science job (I'm still there.... It's not made up... 🙄), told that I would make a terrible doctor based on my response to explaining my very real job as "lying wasn't acceptable in the profession" and asked very few questions, but all in a very hostile manner. In terms of interview length I was in there less than 5 minutes compared to the previous candidates 15-20 minutes.

I didn't get in. I have no idea if those other interviewees did. I don't know if I simply wasn't good enough at interview and they'd assessed that in the first 90 seconds of it or if my accent and background didn't fit. I can say it left me absolutely gutted because I came away with the distinct impression that I didn't fit due to accent and background which are obviously things that can't/ shouldn't need to be changed. I think I'd have been a good doctor, they didn't. 🤷🏼‍♀️

I still regret not getting in to this day. With three young children now and a precarious financial situation I know I'll never be able to try again.

I’ve two kids who went through medical school and I agree with you OP. My kids school did nothing to help them, we don’t know any Drs and they did their UCAS forms themselves but I was there to support and encourage them. It was also a massive help that were able to help support them financially.

However, if you are really bright and can ace either the BMAT or UKAT then you should be able to get interviews. Medical schools bend over backwards not to disadvantage anyone. Medical School entry requirements are generally much more transparent than other courses and applications and interviews are usually scored in a fair and transparent way.

If you read the entrance requirements for most medical schools they spell out the fact that they don’t need applicants to have done loads of medical work experience.

@titchy

Positive discrimination is illegal.

Errr what? Contextual offers based on postcode are perfectly legal.

And in recruitment guaranteeing an interview for all disabled applicants is also a perfectly legal form of positive discrimination.

Why on earth do you think it's illegal?

Positive discrimination is illegal. However, positive action (which is what contextual offers are) is perfectly legal. Contextual offers are NOT positive discrimination because the applicants still have to meet some specified entry requirements. I've worked in this area for years and have had to defend contextual offers and WP work against those who claim it is positive discrimination and that we just hand poor students places regardless of their ability. That simply doesn't happen.

Agreeing to interview disabled applicants is also not positive discrimination. Those applicants still need to meet the essential criteria in order to be interviewed. Again, it's positive action.

Language is important.

My son and DIL are both doctors. Both from state schools. It is a hard application process, for what is a hard and exacting job. There are things that could be done to support more applications from working class students. notably access to mentoring, interview practice and work experience. Many universities are currently supporting multiple initiatives to support better access. Most of the experience required is open to anyone however. For example working/volunteering in care environments, really good exam results. The UK has some very good doctors and a sound training system which is envied around the world. The issues in practice are around huge workloads and an infrastructure which simply cannot train enough nurses and doctors to meet demands.

The biggest barrier to higher education is attainment - students from the most disadvantaged backgrounds are less likely on average to get the grades needed for entry to the most competitive courses like Medicine. This massive socio-economic attainment gap that starts before secondary school and is only widening during the pandemic, it's difficult for universities to overcome. But universities are trying, whether its through school partnerships, initiatives to raise attainment or provide advice and guidance, or contextual offer schemes that give a lower offer to students from the most disadvantaged backgrounds to account for the barriers they'll have faced in their education. Comments like Universities might say in public that this happens but in reality we all know it doesn’t just don't tally with what is happening at universities across the country.

Well rather obviously a child who is supported at home has the chance to do much better than the one who isn't. That's going to be true in all subjects, not just medicine.
But what's your solution to what can be done about it op? Children are at school 15% of their time, you can pour every single spare school resource in to helping them (and this in my experience is already what happens) but they cannot possibly keep up with what parents can offer.

I was with on most of what you said up until this...

I also wonder if the selection process is contributing to doctors not being able to cope with working as a doctor. Struggling to accept criticism or being judged negatively. Struggling with to deal with 12 hour shifts (whereas most working class jobs, like care work are 12-12.5 hours long for a minimum wage salary and often no breaks because care homes are usually short staffed).

I'm a paramedic and I can assure you even at this grade making a life or death clinical decision 12 hours into a shift and knowing that if you get it wrong you could loose your career or even potentially be done for manslaughter, is vastly different to the work of a social carer or almost all "working class jobs". That's not to say that they are not an making an essential contribution to society and deserve better pay, terms and conditions, but the demands of their work are not even comparable to medical decision making.

Of course the whole process of University admission, job applications etc are biased to some extent.

Interestingly there is public opposition to measures to address this, people are very unwilling to accept that 'meritocracy' is largely a myth.

For med school you have to get your ducks in a row early on in the whole process. Aware or well connected parents can be very helpful with this, for e.g. placements during sixth form etc.

That’s not true. I’m closely involved in the student interview process at a RG University that does extensive outreach. It’s taken very seriously.

@Teaandcakeordeath83. Blimey. When was that?

Interestingly Newcastle guarantees interviews to everyone who meets their UCAT pass mark. They are also upfront about work experience. I’

“Most medical schools need applicants to have had some work experience and to be able to show a commitment to caring. At Newcastle we do not have any specific work experience requirements, but at interview our selectors will be looking for examples of how applicants have shown a commitment to caring”
“We realise that identifying suitable work experience in a primary and/or secondary care setting can be difficult, but there are many ways you can show us that you are a committed and caring individual, such as helping someone less fortunate or volunteering in a hospice nursery or elderly care home”

My sister went to medical school ( is now a consultant) and our background is working class and inner city comprehensive. She does though have the advantages of
Being the youngest of 4 siblings who all went to university so university was a normal thing to do by then.
Being able to live at home and study at the city university
She is a very determined confident person as well as being academically very able. She didn't need the support of others.

This applies to law as well as medicine.
People studying law clearly have funds to keep them going through a degree and an apprenticeship (unremunerated as a barrister).

I’m not familiar with medicine but I’d say it’s the same thing? It takes a long time to start getting paid and even when you do, it’s minimum wage?

No I think they would've known from interviews that she was working class @titchy. Anyway, I think it's a systemic issue rather than the direct actions of individuals at university admissions

BMA had some good stuff here:

questionnaires.bma.org.uk/news/therightmix/index.html

I think I agree with you (although would be interesting to see what the evidence/stats say) but this isn't just confined to medicine? Isn't this the case for all more prestigious courses/professions?

I agree OP, but I also don't think the contextual offers 'discriminate' against other students, but they make it a more even playing field, which can only be a good thing surely?
You only have to look on the higher education boards on here to see how invested some parents are in facilitating their dc's application. If you have a parent who has never been to university, they are a lot less likely to be able to do this, let alone stump up the money for books and coaching.
It would be a lot fairer to have a % system Re the grades and the top whatever % get in. No UCAT, no interviews, no work experience necessary.

@Rosiiiiie

This applies to law as well as medicine. People studying law clearly have funds to keep them going through a degree and an apprenticeship (unremunerated as a barrister).

I’m not familiar with medicine but I’d say it’s the same thing? It takes a long time to start getting paid and even when you do, it’s minimum wage?

Yes it is similar to law. It takes 5/6 years to train as a doctor but even after you finish medical school, you have two additional training years where the salary isn’t that high but it’s above minimum wage.

I agree op through personal experience. I went to a low achieving secondary but achieved top grades at gcse and a-level across all subjects.

What I didn't have was anyone to explain the process, any way to get experience through connections and I couldn't have afforded travelling to interviews etc as I had no income. I did end up at university but on a course that didn't lead anywhere.

When I've looked at the expectations of med applicants now as an adult, there's so much more to it than just good grades. My life as a teen was part carer and then once I was 17 I had to get a job on top of school so that I could buy essentials for myself. I had no time for extra curriculars and grew up in a house where money was extremely tight so didn't have opportunities like musical lessons, sports etc that would have appealed to universities anyway.

It was rubbish for me because I would have given my right arm to study medicine. Atleast if my kids ever decide to go down that route I will be able to help them prepare.

Universities might say in public that this happens but in reality we all know it doesn’t.

And you know this how?

Having done both medicine and dentistry, the selection process 100% favours middle class/upper middle class students

Applying for med school, with the knowledge of what the selection process was like, with friends in the field was so much easier than dental school. I knew what to say, what I needed to do. Yes I was much older but these are things that students with family in the field knew first time round. I had no clue when first applying because my school and family had no clue. Yes nowadays with Google it's much easier but you still need to start young, and have that background that values both education and extracurricular activities

I remember reading a couple of people's personal statements when applying for med school and it clicked as to why I only had 1 offer for dental school. I had excellent grades and I thought a decent personal statement but tbh it wasn't a patch on my privately educated friends.

The things you need take time, things like volunteering, most people will play sports and musical instruments for years which cost money. Many of my friends were coached and had tutors for their exams, went to courses on how to get into med/dental school. It was honestly like entering a new world when I first started

There's also lots of expensive exams and equipment you need throughout your early years as a student and as a new graduate. And I think a lot of the staff just don't really understand that the might not be costs some people can afford. I remember my personal tutor telling me to give up my part time job and get my parents to give me money as if this was something really simple.

That's not to say that no one from a lower socioeconomic status will ever get into med school, but it is easier if you are from a wealthier background, if you come from t right school and have family in the field.

The degree as well can be quite brutal, you need to be confident and well spoken, it favours that kind of public school attitude and often the tutors (rightly or wrongly) will favour a privately educated style persona.

@yellowflowersintherain

I think I agree with you (although would be interesting to see what the evidence/stats say) but this isn't just confined to medicine? Isn't this the case for all more prestigious courses/professions?

@titchy

Study showing most medical students come from privileged backgrounds: www.theguardian.com/society/2016/jan/22/medical-school-students-wealthy-backgrounds

Across the UK:
“Among English students, 38% came from the most affluent 20% of postcodes, compared with 54% of those in Scotland, 55% from Wales and 51% in Northern Ireland. In England, 8.7% of medical students were from the poorest 20% by postcode, against 4.3% in Scotland, 6.5% in Wales and 3.2% in Northern Ireland”

I can see there being huge advantages to having contacts in medicine in the past but now there are free online courses guiding you through how to apply for medicine which you would hope anyone from any background with the potential to be a good doctor would be able to find within a few minutes via Google.

Oxford University publishes an annual report demonstrating the work they are doing in terms of positive discrimination to recruit people from many kinds of disadvantaged background, including those from less privileged parts of the country and families on low incomes. However, I still agree that not enough is done to ensure equality of education in order for children from low income households to make it to the too jobs. The biggest hurdle for medicine is the length of the course which is crippling financially, like architecture or law. Similar inequalities are seen in foreign languages and music but no one gets upset about that as you can't usually make the same kind of money there.