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.

Study: “Regardless of the measure, those from less affluent backgrounds are less likely to apply and less likely to gain an accepted offer to study medicine.”
bmcmededuc.biomedcentral.com/articles/10.1186/s12909-016-0536-1

@titchy I follow thedoctormummy on instagram. She talks a lot about the socioeconomic barriers that can prevent or at the very least drastically hinder those pupils. She was an EMA, council flat dweller and nearly had to drop out in 4th year due to not having a deposit for her accommodation. Yes EMA still exists in my part of the UK.

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

Do you think 20 years is a long time, in cultural history? There's no particular reason to expect things to be any different now than they were say 40 years ago. (Of course things change slowly over time, hopefully for the better, but it's not like their has been some fundamental change in the system or society in the last several decades. Surely all the fundamental factors governing getting into medical school are pretty much the same in 2020 as they were in 1980. Limited hospital training places. Perfect grades. Other less acceptable criteria.)

@Cheerychirpy

It’s the work experience that’s hard. If my kids wanted to do medicine I wouldn’t have a clue where to start getting them the work experience that is required to get in to study medicine. If your parent is a GP however, you can do a stint as a receptionist and that ticks the right box.

I'm sorry but that's bit lame, if your kid really wants to study medicine, they should be able to do a bit of research on the internet and find out what is required. As future doctors, they should be self-starters, able to pick up a phone to enquire if they can do a placement. Mots medical schools don't even require any of this, just excellent grades and some work experience, it could working at Mc Donalds. This defeatist attitude really isn't helpful. In any walk of life, you need to be prepared to work hard and make things happen not wait to be spoon fed.

Bsms offers virtual work exp.
If a prospective student can access Internet bi school or library they can do this
www.bwams.co.uk/post/review-of-the-brighton-and-sussex-virtual-work-experience-platform

Dd attended local comp no family gp or doctor now second Yr med school
Did volunteer with kids with SEN

A big difference from 20 years ago are contextual grades and priority for work experience. Universities do massively more outreach than in my day.

Also workplaces are massively more concerned about the diversity of their staff. My last two workplaces have race and gender targets, though not yet social class. That is a shame as statiscally white working class boys are the group least likely to progress to higher education.

One of my DDs is a dentist, no medics anywhere in our family. She spent the first year of training being quizzed why she was training to be a dentist because “no family members in the profession at all? No Aunts, Uncles, Grandparents’ her peers were gobsmacked that someone with no connections had both applied and been accepted.

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?

Yes - it's not just A level grades, it's BMAT/UCAT grade as well. Being in the top x% is also needed.

It's competitive! Places are capped (financially and due to limited capacity for placements). Three quarters are rejected! Most applicants will go on to get perfect grades - it's surely not surprising the majority are rejected.

Do you think 20 years is a long time, in cultural history?

It's an eon in terms of university policy! Yes, things have changed hugely since then. Hugely.

100% agree.

I work in Medical Admissions and can speak for that university.

There is no discrimination in the admissions procedure (as much as one can ever say that) but I do think there is general discrimination which leads to most applicants being middle-class.

We give lower offers to those who meet certain criteria in terms of postcode and school postcode. We offer a secondary route to admission that doesn't rely only on grades but on background and experience.

It is very true that children of doctors often apply for medicine. However this does not mean they will perform at interview. Actually it is often the ones with parents who pushed them that way who don't do well. They have the high grades but they don't meet the requirements on social skills, awareness of what it means to be a doctor, empathy for patients etc.

In terms of the grade offers: we do have to stick to the grades for two reasons: 1. the courses are way way oversubscribed and 2. it is shown that those who don't get the highest grades are most likely to fail or drop out of the course.

So we do have lots of measures and alternative routes in place. We know that it isn't only white middle class high achievers who make good doctors, and we want good doctors, not only good grade achievers.

However, I would say you are right that generally in society there is a class bias towards white middle class kids being encouraged to apply to medicine and being properly guided through the process. It is definitely important to be super informed and 'on it' from about a year before the application period. They may not be as able to express themselves well in interview, although we do have flags for applicants and interviewers are told not to mark them down on eloquence or appearance.

I can only speak for my uni, not sure how it works at other unis.

This thread has a lot of people wanting things handed to them on a plate.

I got 4 offers for Med school in 2006. I’m from a council estate, rubbish state school (subsequently closed due to continued poor performance) and was the first person in my family to go to uni (despite being the youngest of my siblings).

I worked throughout sixth form and held a pretty much full time hours job throughout medical school to support myself and continue help supporting my parents.

I worked full time in a hospital as a HCA during a ‘gap year’ to get the required work experience to apply to medicine. Nobody helped me work out the admissions process; school and parents had zero clue. So I went and found that info on my own because it is out there.

My own mothers response when I said I wanted to be a doctor was ‘why do you want to do that? Why don’t you become a receptionist instead?’

Now as a doctor, I teach medical students and I’m heavily involved in the admissions process/interviews as well as WAMS (widening access to medical school) that specifically helps students from lower socioeconomic backgrounds. It was much harder for me than my middle class colleagues but it was most definitely not impossible and there was help if you went to look for it and willing to work hard/had a bit of determination.

My sister was then inspired to study medicine and went back to school (despite dire GCSE and A-level grades), worked her butt off and went to Med school. She had 2 children under 5 and was almost 30 when she started Med school. She had to commute 2 hours each way to Med school due to not being able to move because of family commitments/what was best for the children. Luckily she had a very supportive partner who was also at uni pursuing something he hadn’t had the courage to as a school leaver.

Yes it’s more difficult if you’re not from a privileged background but then again a lot of things are it’s the reason these circumstances are described as ‘disadvantaged’.

So please don’t be discouraged, it’s completely possible.

Same with Oxford and Cambridge. I know 3 working class girls (now 24-ish,) who were/are very VERY clever, academically gifted, and had top TOP grades in maths and various sciences. They were perfect Cambridge material, but because they went to a comprehensive school full of working classes, and lived on a council estate, they were rejected.

The 'fancy' universities blather on about inclusivity and all that jazz, and they do 'allow' the occasional 'commoner' in to try and look good. But the fact is, you are VERY unlikely to get into a top university, even if you are are super smart, if you are from a working class/council estate background.

ANyone who says different is deluded, or lying.

Sorry I’ve not RTFT but just going to chip in my experience of getting into medical school although it was some years ago!

I was grammar school educated and the school was keen to coach students- however the year that I got in they were shocked when a large group of the boys got rejected from all of their choices.

I got two offers- the school seemed surprised as clearly they hadn’t pegged me for it.

My interpretation of this was that those boys had come across as very cocky and arrogant, felt they had ticked all the boxes and got lots of experience so they were in.

Actually the medical school didn’t care if you’d watched knee surgery, the point of the volunteering and experience was to get realistic expectations of the career, and to demonstrate caring as well as other desirable qualities. I got excellent feedback that I had helped out at a SEN setting once a week for a year and could reflect on the experiences I had- it was far better than ‘I shadowed a surgeon for a week it was cool’.

I accept that there are some things you won’t get if you go to a local comp, and I think the ‘secret language’ of personal statements and interviews is one of them.

I dated a guy who was a bit of a knob tbh but was applying to medical school as a postgraduate, he didn’t get some of the nuances. For example if they ask you for an opinion you should give a balanced answer and give points for both sides, and only give your personal opinion if pushed to after that. They asked him what he thought about euthanasia and he just sat there and said he thought it was a really good idea- way to sound like Harold Shipman…

I think some of the experience and extras definitely favours those who are in families who have the money and time to support these. Insight into the job is helpful so knowing people who have already been there and done that, not really unique to medicine though.

Thirty years ago my friend had a daughter who got into medical school. In one of the first sessions, the lecturer asked the students to put their hands up if they had been privately educated. The majority raised their hands,, His response was “well most of us speak the same language “!

TBF this is something med schools are well aware of and some of the newer ones have been deliberately set up to go into deprived areas and encourage applications - Aston University in Birmingham is really pushing for this.

The other big issue is that more girls than boys get in-mainly because with such high A level grades being awarded they are then going back to GCSE’s and as a generalisation-girls tend to do better at those than boys do, so not sure if the answer there either.

Unfortunately some people are disadvantaged, and unis do their best to address that for all applicants to all subjects including medicine. But they can't do everything. Low aspirations amongst peers, family and teachers as well as shitty housing and poverty will all work against students. But for those that are bright enough and ambitious enough, unis will make allowances for any structural disadvantages individual applicants have.

We all keep voting for a party that works hard to ensure that the poor are kept poor, while their rich mates get richer and don't pay taxes.
Universities work tremendously hard to support students from all backgrounds, but they cannot by themselves sort out the inequality in this country.

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.

In my time working in the HE sector, I've know two students do a three year Classics degree before doing Graduate Entry Medicine. Another did three years' Veterinary Science before realising he wanted to work with people, not animals, and went down the Graduate Entry route. Of the medical students I've known, it's not the high flyers academically who've got the places, but those with excellent inter-personal skills. But they do still tend to be from privileged backgrounds, where sport, music, travel and anything else contributing to a good all-rounder, are all on tap. I've know others who've dropped out before starting Clinical Medicine.

Certainly, it makes sense to make this career decision at a later point, and doing Graduate Entry Medicine only adds on one additional year of study. There are also lots of other jobs in a hospital environment which don't require you to have studied Medicine.

@mummywithtwokidsplusdog

If you have a ‘poorer’ postcode you are now positively discriminated for by universities for all courses- including medicine.

* 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).*

I KNOW that's not true. Many of my family are doctors, as are their friends and colleagues. I'm trying to think of ONE who came from a private or grammar school education. Most (like my kids ) entered university and medical school from state comprehensive schools.

In Scotland, ever since 1965 the entire state secondary education system has been comprehensive . Non selective. No 11+.

There are no state grammar schools or selective entry "academies".

@ClumpingBambooIsALie

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.

Even if you vastly increased the number of places not everyone with the desire and aptitude would get in.

Rather than all of the random things you mentioned - relevant work experience is some indication of desire and ability. It can be ‘faked’ but so can anything else, unless we have a magic scanner that shows how caring, calm under pressure etc someone is

This is mumsnet home of the middle classes mainly so you are not going to get an unbiased opinion on this.

Sadly I think you are mostly correct, the better schools know the system, know how to do the ucas applications etc........ a sink estate school with a very bright child is just not going to have the experience of those types of applications.

I think a big expansion of places would be the best place to start, nevertheless, because when something is scarce, the privileged will always find a way to make sure they get past whatever hurdles you put in place, whether that's certain kinds of work experience or coming across in a certain way at interview or speaking Portuguese. So I think the fairest thing is to work out what's actually necessary and reliably measurable (whether it's academic aptitude or existing scientific knowledge or something else) and then either set a cut-off or do a lottery, perhaps with compensatory adjustments for socio-economic advantage, because more criteria means more hurdles to trip up the less-privileged.

@RandomLondoner

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

Do you think 20 years is a long time, in cultural history? There's no particular reason to expect things to be any different now than they were say 40 years ago. (Of course things change slowly over time, hopefully for the better, but it's not like their has been some fundamental change in the system or society in the last several decades. Surely all the fundamental factors governing getting into medical school are pretty much the same in 2020 as they were in 1980. Limited hospital training places. Perfect grades. Other less acceptable criteria.)

I think medical school admissions have changed significantly in that time, actually. I applied in 2001 - most places' standard offer was AAB-ABB, and there was no admissions test except for the MVAT for Oxbridge. The Personal Statement was widely used to select applicants for interview. Some universities had widening participation schemes but by no means all.

In the last 20 years, the standard offer is now at least AAA, if not one or more As (though A did not exist at A-level when I applied). ALL UK medical schools now use some kind of admissions test - UCAT/BMAT, and far fewer use the PS for selection. Theoretically these tests are meant to be better differentiators between those with natural ability and those who've been coached for A-levels, but it is still possible to get coaching for those tests too. Interview formats have changed in many places to be "Multiple Mini Interviews" with more objective assessments rather than the traditional panel interviews. And widening access schemes, foundation years etc for people from disadvantaged backgrounds, are much more widely available. There have also been several new medical schools opened in recent years, increasing the number of places available. So yes, it is looking quite different! Also, the explosion of the internet and information availability has helped to level the playing field - anyone can access tonnes of good quality advice and resources online, whereas 20 years ago many poorer students wouldn't have internet access and if your school careers adviser didn't know much you were stuck!

Overall, I think there's no denying that pupils from a working class/non-university background have a harder time getting in than those from more "traditional" medical backgrounds. It is getting better, and I think medicine is probably working harder than many other high-flier degree courses to achieve this, but the process is slow. FWIW I am not from a medical family, but I did go to private school (on a Government Assisted Place, back when they existed) and while my parents were not weathy by any means, they were passionate about education and very supportive.

Interesting views. In my experience & I've known med school entrants from all walks of life, it's very much down to the individual applicant and their all round achievements & not simply academically. An applicant has to prove dedication to something other than grades eg sport, music etc and be at the top of their game in those pursuits. They definitely prefer applicants with loads of interests and hobbies.