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.

Thing is that ones like medical applications look for work experience in a relevant field.

If my dc had wanted to go into medicine then I have a couple of relative GPs, one medical researcher, one consultant, one paramedic and one nurse. All of whom would happily arrange work experience. They're all different surnames, so it wouldn't be obvious on a job application. I also have friends from uni who are in medical fields, plus I suspect if I'd talked to my GP he'd have helped arranged work experience too.

So my dc could have got very good looking work experience there with little effort on their (or my) part.

I was also aware that they'd need to do work experience from younger than they would have started so could have had it arranged in advance.

That to me is where the advantage is.
Compare that to someone whose parents think it's a bit of a waste of time, or whose parent know no one who would be able to offer that. When they ask, they're unknown, so less likely to get offered a place if they're up against friend/relatives. They're also less likely to know good people to offer, and may not realise until too late that they are disadvantaged if they don't do work experience.
However even if their work experience is worth far less in terms of giving real experience, they will have worked a heck of a lot harder to get there, and should be rewarded for that.

My dc don't want to go into medicine though.

My job for five years was encouraging children from low socio economic backgrounds to apply for university (the funding for that job ended when the Tories got in). So I have some knowledge and experience of this, and OP is absolutely right. For every story of positive discrimination you will have at least five other middle class grammar/private school students who benefitted from extra tuition, professional parents and stable socio-economic backgrounds, even just a space to study at home makes an enormous difference to a child. Then imagine eight children living in a 2 bed flat in Somers Town. Where do they do their homework?

Mumsnetters, I find, like to imagine that the system is fair, or even skewed in the favour of kids from lower socio-economic backgrounds ('positive discrimination'), because that assuages their guilt about them financially leapfrogging over those children in order to secure a good career outcome for their child. It's bullshit. The system is skewed and will be forever while we have educational segregation in the form of selective and non selective schools.

DD has recently graduated from need school - one of the bigger ones. Very few students that she met while there came, like her, from a state comprehensive.

I have a few friends who are doctors, they all had a parent who was a doctor.

Sure. But you could say this about all sorts of professions. And you have nothing specific to add, so YABU for starting an aimless thread.

According to the BMJ in 2016

"Just 4% of UK doctors come from working class backgrounds, a report by the Social Mobility Commission has found.1"

@burnoutbabe

surely its just that its a very competitive course and would favour children who are more prepared (by parents or organised school teachers) and do the "right things" to get good experience and can write about that on their personal statement?

Plus very good grades too.

Well yes, that’s the problem. The students who have had an extra leg up in how to prepare by parents and teachers are no more deserving of a place. And there is no evidence that they have anymore potential than students from poorer backgrounds.

Even those hard won grades are more difficult to achieve for some children to achieve due to circumstances completely beyond their control.

This equates to an unfair advantage for some children, while other equally deserving children miss out.

And from the same report

"Medicine remained “one of the most inaccessible professions,” said the report, with “80 per cent of medical school applicants coming from around only 20 per cent of schools, the majority of which were independent or grammar schools.” The report also pointed out that there wasn’t a single applicant for medical school from half of all the sixth forms in England between 2009 and 2011.
It highlighted research published earlier this year of UK medical schools’ application data from 2009 to 2012.2 This found that just over 3% of medical school places were awarded to applicants from postcodes in areas of greatest deprivation, compared with around one in four (26%) of those from the least deprived."

@regularbutnamechangedd

Mumsnetters, I find, like to imagine that the system is fair, or even skewed in the favour of kids from lower socio-economic backgrounds ('positive discrimination'), because that assuages their guilt about them financially leapfrogging over those children in order to secure a good career outcome for their child. It's bullshit. The system is skewed and will be forever while we have educational segregation in the form of selective and non selective schools

I don’t think a single poster has suggested that disadvantaged children are, umm, disadvantaged. Obviously it’s easier to get into medicine if you have supportive parents 🤷🏻‍♀️ However many of the facts and anecdotes on this thread are outdated and wrong.

It’s insulting to all the people involved in medical school admissions to think they don’t take every step possible to try to make sure that disadvantaged students aren’t going to be disadvantaged.

I wouldn’t be surprised if the biggest factor that stops students fro disadvantaged backgrounds from applying to medicine is misinformation.

** https://www.hesa.ac.uk/data-and-analysis/performance-indicators/widening-participationn*

Scroll down to table WP6 - 80% of medicine entrants are from state schools.

In response to all the people saying just take all the applicants and see what happens, how on earth would that work? Don't you want the people who get the immense privilege of training as doctors to be the ones best suited to it? Who's going to do the teaching given that clinicians who teach and examine come out of clinic etc to do it? Where are you going to magic up all the placements where medical students do the bulk of their practical learning, especially in the later stages?

There was a thread the other day from a woman considering applying to do Medicine as a mature student. Well worth a read, as it's worrying in the extreme to see how many HCPs are burning out and planning to get out of the NHS. www.mumsnet.com/Talk/am_i_being_unreasonable/a4414782-To-change-careers-and-become-a-doctor-at-39

I posted this on it. Seems relevant here too.

*
Why can't medical schools just take more students? I am not a doctor but I did work for some years in an admin role in a medical school. It's a very complicated degree course to organise and run well. TLDR: you can't increase numbers at the drop of a hat.

If there was a shortage of History graduates (say), the university could fairly easily recruit some more History academics to do the teaching and marking and supervise the students' dissertations, look at ways of finding more rooms for teaching (my own employer used top notch marquees on the grass for a bit when some rooms were being refurbished), check that the library resources would be sufficient (much easier now so much is accessed online instead of in hard copy) and (if they were sensible) also boost the admin support. Admissions decisions are straightforward. Does the applicant have History A level or equivalent with a good grade, and other decent qualifications? Does the personal statement convincingly make a case for wanting to spend three years studying History? In you come.

There's so much more to think about for a Medicine degree. You need a rigorous admissions stage to try to weed out the unsuitable people at the outset, and that requires clinicians and lay people to interview (usually), which is time-consuming in itself.

You also need to run practical exams as well as written exams and other assignments. The practical exams (OSCEs) are a massive undertaking, involving finding clinicians to come out of their frontline NHS jobs for a day or a half-day to act as markers, actors to come in and take on the patient role, actual patients willing and suitable to be examined by a succession of students, lots of invigilators and administrators to keep things running to time, lots and lots of rooms, equipment, partitions, technician support, all needed over several days.

Teaching: medical students spend time in lectures and seminars like other students, but they also have to learn clinical skills and that requires specialist teaching rooms and equipment, and technician support as well as clinicians employed to do the teaching, often alongside a clinical job.

And then there are the placements. Every medical school has a contract with various NHS trusts and GP practices to provide these placements, for which the NHS is paid. The quid pro quo is that the clinicians in the Trusts and practices have to provide not just a range of experience but also teaching and assessment. That takes a lot of time away from clinical duties and means there are administrators employed in the Trusts who deal just with medical students. At my place some students ended up spending a whole year on placement 50+ miles from the university so they were provided with accommodation at the hospital.

The numbers available can't be expanded at the drop of a hat. We all know the NHS is stretched to breaking point already, so hospitals and GP practices are not going to prioritise taking more students over patient care.

And finally, there's pastoral care. My impression is that decades ago it was sink or swim at medical school. Nowadays there is a lot more support given to students and attention paid to trying to help them with the emotional demands of their training, which are considerable. They work so hard and have a lot of tough stuff to process, while also adjusting, like other students, to being away from home, living independently etc etc (I'm talking about those who go to university straight from school here, obviously, but older students will have different challenges and it won't be an easy ride, as many here have made plain).

There are probably lots more things that make it difficult to expand numbers of medical students. These are just some things I noted when I was working. Needs huge planning and investment, and possibly (cloudcuckooland here, though) a huge rethink about how the medical profession operates to make medicine a more viable career option for people over 30, especially those with families, who face a huge uphill struggle to qualify, for all the reasons set out very ably in this thread by doctors and their loved ones.

@titchy

** https://www.hesa.ac.uk/data-and-analysis/performance-indicators/widening-participationn*

Scroll down to table WP6 - 80% of medicine entrants are from state schools.

Lots of grammars in there...

@titchy

Medical school is expensive.

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

A four to seven year degree costs considerably more than a three year Media Studies degree. HTH.

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 was with you until this part! What are you basing this on??

@Lindy2

The grammar school system was supposed to try and even out social background and academic education.

If all areas were grammar school areas then those who were most academic would get a highly academic education and those who do better with more vocational learning would benefit from that. Where they lived wouldn't come into it.

Now we've only got grammar schools in a small number of regions, all of which are fairly middle class because the middle class have the funds to choose to live there to benefit from the grammar school system.

If all areas had grammar schools then all areas would be full of the middle-classes tutoring their 11 year olds to get into them, just as in the grammar school areas now.

I had a discussion with DH this evening about current medical students. I qualified in 1995 - I doubt I'd get in now, I didn't get 3 As at A level. I think I've done a decent job though up to now!!
We have a current crop of students who could not give a toss. They are entitled, lazy, can't arrive on time. They are going to be doctors in a year's time. Yes I know they aren't all the same but of this group, the one that stands out is the one that isn't from a medical family but is doing it because she wants to work hard and be a doctor. Her attitude is outstanding.
Again rose tinted glasses, but we worked so hard as juniors. Now they aren't willing to do that

@DontBeCatty The interviews were 2016-17, not too long ago.

@JackieCollinshasnoauthority

That's certainly my recent experience based on a relative who is from a working class family. 4 As at a level and no offers for medicine. She's studying aeronautical engineering instead.

I'm sure most will disagree as their children benefit from this system and won't want to see it changed.

And I knew someone at school whose dad was a doctor who worked for the royal family - said child applied for medical school twice and didn't get in. Went on to study something else.

Funny how anecdotal evidence proves nothing doesn't it.

The accent thing isn't so true in Scotland. I went to the Univ of Glasgow and the medic students all had Scottish accents of all varieties. My beef with them was that a lot had terrible social skills. They sat in the Hall library with their boxes of bones. Dry as dust. The dentists were much more fun and went to Strathclyde. This was in the late seventies mind.

A four to seven year degree costs considerably more than a three year Media Studies degree. HTH

Not upfront for fees and not upfront for kids from low income household. HTH.

Yanbu. My dd is final year dentistry, and getting the work experience, UKCAT, BMAT sorted etc in order to appmy isn't an easy task. She is probably the poorest on her course. There are schemes in place for those who's parents haven't been to uni but moat of her peers on them didn't end up going on to do medicine. Even the final year is skewed to those who have money, you get a much smaller loan and NHS grant. Not a problem for those whose parents can afford to make it up but foe those on maximum loan it's a big disadvantage

(Grad entry is different btw and will have to be part funded by the student.)

Not upfront for fees and not upfront for kids from low income household. HTH.

But surely that amount of debt is off putting?

I was at uni with someone who qualified for the maximum loan & some kind of hardship thing, it just meant they had more debt than I did. And it still wasn't enough so they had to work.

@hygtt

Not upfront for fees and not upfront for kids from low income household. HTH.

But surely that amount of debt is off putting?

I was at uni with someone who qualified for the maximum loan & some kind of hardship thing, it just meant they had more debt than I did. And it still wasn't enough so they had to work.

You'd think, but actually the evidence doesn't show this at all. Demand for uni goes up year after year after year. Even since fees were increased to £9k a year. Leaving with £50, £70, £100k of loan doesn't phase 18 years olds at all! Which is sensible given the repayments are fixed regardless of how much you owe.

Their parents on the other hand...

DD at med school. I’m divorced from her DH. My post code is probably one of the worst to have in England but she used her Dads address to apply so irrelevant if positive discrimination is a thing . State educated. The only real advantage I can see is that she did have a superb role model in the family who actively helped her navigate the path to Uni but this person not a doctor by any stretch.
What’s really interesting is I’ve asked her about her fellow medical students and she insists they are all pretty normal / level headed / down to earth types. I’ve met a few briefly and I tend to agree with her. All lovely, well mannered types but not overly “posh” . I believe my daughter’s success so far is due to her laser focus on her goal to do medicine. No GCSEs or A level grades less than an A . She studied hard.