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.

If someone has the grades and aptitude, surely that is what matters most?
And having done requisite volunteering .
But you are right- The only Med students I knew were from very middle class backgrounds.

@DontBeCatty

Have just googled, according to Wikipedia Adam Kay graduated from Imperial College London in 2004.

@HyacynthBucket

About 20 years ago I saw a TV programme about medical school admissions and interviews. It was clear then that applicants were very middle class. But what struck me most was the panel's decisons on personalities - they very obviously favoured conformity and doing well at school because parents wanted it. But anyone who had more independence of thought did not stand a chance of getting further than the interview. I hope this aspect of selection into medical training has changed for the better.

Do you really think things are the same as they were 20 years ago?

@ClumpingBambooIsALie

I can't see the point of this: 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 (quoted from Newcastle by DontBeCatty).

Caring, committed teenagers might be caring and committed in their everyday life but tend not to express that by taking on demanding care work while they're trying to study for A levels. You do that kind of thing pretty much only because it's going to help you get into med school, so all it demonstrates is your ability to jump through extra hoops. A budding psychopath who wanted to be a doctor would have absolutely no problem making sure they had evidence of their "caring, committed" nature. But a kid who has a home that's difficult to study in, needs to keep their Saturday job to help family finances, doesn't know anyone who would even dream of doing medicine, and goes to a school that's not geared up for preparing kids for med school admissions, might be a lovely kid who'll make a great, caring doctor but have no "evidence".

I think it's something that's easy to fake and difficult to assess, especially via a few forms and an interview. Much better to assess that later on, to the extent you can assess these things, when you have lots of evidence of them in person.

How do you propose to distinguish between applications then? Logically speaking the more competitive something is the more filtering is needed. There’s loads of interviews, admissions advice etc online, no excuse that the school isn’t doing anything.

I do think that work experience is somewhat solvable (every area no matter how rural should have a GP at least!). If there are plenty of ‘disadvantaged’ kids who meet the criteria the solution isn’t to do away with the work experience but open it to more.it doesn’t have to be long - maybe even a couple of days at the local GP.

Nobody is saying you can't apply if you are from a lower socio economic background, but the data speaks for itself (posted by a pp further up). Medical school has historically and currently has been dominated by students from middle class backgrounds. Students on EMA living in high rise council blocks at failing comps are the exception rather than the norm.

The requirement for good grades is true of all professional careers, and it is easy to look up the entry requirements for a medical degree.

Any parent, working class or not, knows that studying medicine requires high grades. I have two nieces who both have qualified in medicine. There were no doctors in our family, no special knowledge. But they each have an aptitude for science and maths and achieved high grades from gcse onwards. They followed the standard route.

Quality of teaching in different schools makes a big difference though, to get the grades in the first place but the issue is not specific to medicine.

You are wrong OP. Many more Medical schools uni now offer programmes for kids from under-priviledged backgrounds from Y9 to coach them through the process and help them with experience and advice on the application process. These programmes support them all the way to their A levels. The criteria is parents who haven't gone to Uni and attending a lower performing comp.

These programmes attract quite a few pupils but in the end only a fraction will go in to pay to medical school because ultimately, they realise it's not for them and or, they can't cope with the demand and requirements of the entrance tests and A level results even when such students will be able to apt with lower grades.

Medical school has historically and currently has been dominated by students from middle class backgrounds. Students on EMA living in high rise council blocks at failing comps are the exception rather than the norm.

How many students from high rises on EMA (does that still exist?) apply for medicine?

I don’t think this is a medical school problem. I happen to know quite a few doctors from pretty normal backgrounds. The privileges you speak of do exist but the way to address this is through the state education system. FWIW I went to a comprehensive school, was the first person in my family to go to university and now work at a top law firm. It’s definitely harder to do this without the sort of connections that come from private schools/parents with a professional background but I think that’s basically true of all competitive fields in life and med school is probably the most competitive of all.

Several posters have commented that disadvantage starts years before a university application and it's sadly true.
I'm a governor of a school which is working very hard to reduce the pupil premium gap in attainment.
We monitor not just exam grades but general participation and the take up of leadership roles by PP students within the school.
It's a very long process to improve accessibility and needs very early intervention and support.

What's interesting about this thread is it seems that neither people with the advantage or people who have been able to overcome it want to acknowledge there is an issue. Or if there is an issue it's not just medicine, it's all of society? And the problem is now so big that it can't be fixed.

@Fleur405

I don’t think this is a medical school problem. I happen to know quite a few doctors from pretty normal backgrounds. The privileges you speak of do exist but the way to address this is through the state education system. FWIW I went to a comprehensive school, was the first person in my family to go to university and now work at a top law firm. It’s definitely harder to do this without the sort of connections that come from private schools/parents with a professional background but I think that’s basically true of all competitive fields in life and med school is probably the most competitive of all.

These days it’s not really about ‘connections’. Hiring in most prestigious professions involves large graduate schemes, with several layers of HR and mass interviews. You’re not going to get in because you know somebody. A good university (like mine) provides lots of career coaching, CV review, alumni network etc etc. I myself got set on a career path I’d never heard of by talking to other students.

Low ambition at school is a problem, agreed. But once people get into university there’s no excuse. Ironically the ones who have the hardest time are those who don’t qualify for max maintenance but whose parents can’t afford to top up

@JackieCollinshasnoauthority

What's interesting about this thread is it seems that neither people with the advantage or people who have been able to overcome it want to acknowledge there is an issue. Or if there is an issue it's not just medicine, it's all of society? And the problem is now so big that it can't be fixed.

I'm happy to acknowledge there is an issue - I posted about it. The issue isn't with uni admissions though, at least not now.

The issue does go back much further and is much deeper than simply medicine admissions.

Unfortunately this thread won't help as it's full of people posting incorrectly that medicine isn't accessible to the working class so perpetuating the problem....

Perhaps everyone who wants to do be a doctor should study for an initial three-year degree of some relevant sort, and only then should their be selection for entry to the profession, after which they study more.

I'm not sure how this fits with hospital training, as I know one medical student and she has had to spend some time working in a hospital environment while still doing her degree. It's not clear to me at what stage in the student career this experience needs to be fitted in.

My understanding is that it is the number of training places hospitals are willing to support that is the bottleneck that rations the number of people who can become doctors. For that reason, we can't allow an unlimited number of doctors. But I propose we split medical education into two parts, do the filtering at the half-way stage, and any hospital experience in the second part. The rejects who graduate from the first part will still have a degree that puts them above most graduates when it comes to competing for other jobs.

[quote DontBeCatty]@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”[/quote]
2008. Maybe it's changed since then. I hope so, never been spoken to like that in an interview before or since. 🤷🏼‍♀️

@RandomLondoner

Perhaps everyone who wants to do be a doctor should study for an initial three-year degree of some relevant sort, and only then should their be selection for entry to the profession, after which they study more.

I'm not sure how this fits with hospital training, as I know one medical student and she has had to spend some time working in a hospital environment while still doing her degree. It's not clear to me at what stage in the student career this experience needs to be fitted in.

My understanding is that it is the number of training places hospitals are willing to support that is the bottleneck that rations the number of people who can become doctors. For that reason, we can't allow an unlimited number of doctors. But I propose we split medical education into two parts, do the filtering at the half-way stage, and any hospital experience in the second part. The rejects who graduate from the first part will still have a degree that puts them above most graduates when it comes to competing for other jobs.

This is the US system

I agree with you, OP. I used to be an academic researcher, broad focus on equity in education, one particular piece of research involving final year secondary students from schools in disadvantaged areas applying to study medicine. This included areas in one particular city, I should say, but none of the students I spoke with were accepted. All of them had the grades, however the courses were looking for grades plus a varied and busy extracurricular life, e.g. sports teams, drama clubs, etc. Cost was a big factor - most parents couldn't afford the fees and equipment/clothing needed to regularly play certain sports, and some kids were scared to even go swimming, for example, because the area was so rough they didn't feel safe in the changing areas. So they simply couldn't partake in the extra activities needed to boost their chances.

Entirely anecdotal of course but I've noticed a change during my career. When I started at medical school in the early 80s I was definitely in the minority, being from a working class background and, what would definitely be viewed as a failing comprehensive school now. A large percentage of my peers came from well off backgrounds and over half had medical parents. To be honest, quite a few of my friends on other courses were from fairly well off families too but I do think medicine had a higher percentage of privately educated students than most courses. (Except History of Art. Everyone I met who was studying that was terribly posh.) And the people who were teaching me were almost exclusively very obviously "born to it". I hardly ever met a Consultant with an accent that sounded anything like mine.
In subsequent years I think it changed. I met a lot more doctors from working class backgrounds later on in my career, and didn't feel quite such a freak.
But towards tge end of my career I started noticing a lot of very well heeled students again. I assumed it was something to do with costs. It is a lot of debt to take on if you don't have parents who can afford to help out. Additionally I do think it is easier to achieve the necessary insight and experience if you have parents in the same or similar professions and attend a school who is set up to faciliate that. Though the same could be said of other courses as well of course. A couple of my children's friends have started vet medicine this year and tgere us no doubt that the one whose parents are vets found the process a great deal easier.
One thing I do think is different though is that less children are following their parents into medicine than in the past. I can only think of 2 Consultants I know who have children who are currently medical students or junior doctors, and one GP. Even a decade ago that would have been a much, much higher number. Most of my former colleagues have, like me, actively discouraged their own children from studying medicine. Not that most need much discouragement.

Tractor — as I said in a previous post, I would (in fantasy world) embark on a program to vastly increase the numbers of places at medical school, as we don't produce nearly as many doctors as we need. Then I'd just give a place to anyone who wants it and has the aptitude. I can't see that the other stuff is distinguishing between candidates in any useful fashion. It's just being used as a way to cut down the number of candidates. You could just as easily cut down the number of candidates by only taking students with grade 8 in a musical instrument, or a driving licence, or attached earlobes. Doesn't mean it's useful.

We have a friends son who would be classed as from a disadvantage back ground - he really wanted to be a doctor and managed to get to uni on a course BUT he really sadly struggled once there and dropped out mid second year and is still at uni but doing a different course (still medicine related)
The one thing he found was he as much as a bright intelligent person didn’t have the support or background - whether that be someone in his family that was a doctor or he felt his education wasn’t equal and even felt a little excluded by others on his course.
Sad as I genuinely believe he could have been a doctor but couldn’t quite break that glass ceiling for him :( it may have been huddles that he put in as well but sad that he couldn’t overcome them.

Unfortunately this thread won't help as it's full of people posting incorrectly that medicine isn't accessible to the working class so perpetuating the problem....

Has anyone explained the fair and background-neutral process by which 2 out of 3 candidates, all three of which have perfect grades, are rejected?

(Assuming all anecdotes are out of date, and there is no longer selection on grounds that favour people from privileged backgrounds.)

@JackieCollinshasnoauthority

What's interesting about this thread is it seems that neither people with the advantage or people who have been able to overcome it want to acknowledge there is an issue. Or if there is an issue it's not just medicine, it's all of society? And the problem is now so big that it can't be fixed.

Survivor bias… www.nature.com/articles/d41586-021-02634-z

@5keletor

I agree with you, OP. I used to be an academic researcher, broad focus on equity in education, one particular piece of research involving final year secondary students from schools in disadvantaged areas applying to study medicine. This included areas in one particular city, I should say, but none of the students I spoke with were accepted. All of them had the grades, however the courses were looking for grades plus a varied and busy extracurricular life, e.g. sports teams, drama clubs, etc. Cost was a big factor - most parents couldn't afford the fees and equipment/clothing needed to regularly play certain sports, and some kids were scared to even go swimming, for example, because the area was so rough they didn't feel safe in the changing areas. So they simply couldn't partake in the extra activities needed to boost their chances.

This is spot on.

.

My DS is a Dr, no medical people in our family. Non selective but excellent secondary school. He applied for 2 weeks work experience in the local hospital scheme. And got a part time job in a care home as an HCA. The problem that some students hit is the interview process, where they set up various scenarios that the applicant has to deal with, these definitely favour those with interpersonal skills that can be practiced in advance. But then again working a proper job in a care setting is good preparation