Fair access to medicine? Retrospective analysis of UK medical schools application data 2009-2012 using three measures of socioeconomic status

Abstract

BackgroundMedical students have historically largely come from more affluent parts of society, leading many countries to seek to broaden access to medical careers on the grounds of social justice and the perceived benefits of greater workforce diversity. The aim of this study was to examine variation in socioeconomic status (SES) of applicants to study medicine and applicants with an accepted offer from a medical school, comparing the four UK countries and individual medical schools.MethodsRetrospective analysis of application data for 22 UK medical schools 2009/10-2011/12. Data were analysed for all 32,964 UK-domiciled applicants aged <20 years to 22 non-graduate medical schools requiring applicants to sit the United Kingdom Clinical Aptitude Test (UKCAT). Rates of applicants and accepted offers were compared using three measures of SES: (1) Postcode-assigned Index of Multiple Deprivation score (IMD); (2) School type; (3) Parental occupation measured by the National Statistics Socio Economic Classification (NS-SEC).ResultsThere is a marked social gradient of applicants and applicants with accepted offers with, depending on UK country of residence, 19.7–34.5 % of applicants living in the most affluent tenth of postcodes vs 1.8–5.7 % in the least affluent tenth. However, the majority of applicants in all postcodes had parents in the highest SES occupational group (NS-SEC1). Applicants resident in the most deprived postcodes, with parents from lower SES occupational groups (NS-SEC4/5) and attending non-selective state schools were less likely to obtain an accepted offer of a place at medical school further steepening the observed social gradient. Medical schools varied significantly in the percentage of individuals from NS-SEC 4/5 applying (2.3 %–8.4 %) and gaining an accepted offer (1.2 %–7.7 %).ConclusionRegardless of the measure, those from less affluent backgrounds are less likely to apply and less likely to gain an accepted offer to study medicine. Postcode-based measures such as IMD may be misleading, but individual measures like NS-SEC can be gamed by applicants. The previously unreported variation between UK countries and between medical schools warrants further investigation as it implies solutions are available but inconsistently applied.

Physicians as leaders: are we trying to fit square pegs into round holes?

“…The really interesting question is whether medical schools are ‘condemned’ to attract a narrow range of individuals whose social and economic backgrounds make them more likely to make certain attributions about particular groups in society. For example, there is significant evidence that for medical schools in UK individuals from less affluent backgrounds are less likely to apply and less likely to gain an accepted offer to study medicine 27. Physicians have been found to have a less participatory decision-making style28 29 and to adopt a more ‘narrowly biomedical’ communication pattern (characterised by dominating communication and high levels of physician biomedical information, with closed-ended question asking), especially when comparing non-white and white patients 30.…”

‘Why not you?’ Discourses of widening access on UK medical school websites

“…In the UK, the term ‘widening access’ is applied with reference to the recruitment and admission of a diverse group of students who are under‐represented in higher education generally, including those from lower socio‐economic backgrounds or ethnic minority groups, mature or disabled students and those leaving the statutory care system. In medicine, currently the main focus of WA is on recruiting a representative percentage of students from lower socio‐economic backgrounds . As a result, increasing the diversity of the socio‐economic and family backgrounds of applicants and students represents the primary criteria for measuring progress in WA to medicine in the UK …”

“…In medicine, currently the main focus of WA is on recruiting a representative percentage of students from lower socio‐economic backgrounds . As a result, increasing the diversity of the socio‐economic and family backgrounds of applicants and students represents the primary criteria for measuring progress in WA to medicine in the UK …”

“Aspirations of people who come from state education are different”: how language reflects social exclusion in medical education

“…In the UK, for example, evidence indicates that, while medicine has addressed issues of diversity in relation to gender and race, those from less affluent backgrounds remain less likely to apply and less likely to gain an offer to study medicine than applicants from more ''traditional'' (i.e. affluent and higher social class) backgrounds (Millburn 2012;Steven et al 2016). Moreover, other research implies that the few widening access (WA: or under-represented minority [URM]) applicants who do successfully negotiate the complex medical admissions process may go on to feel unwelcome (Orom et al 2013;Greenhalgh et al 2004;Brown and Garlick 2007) and disadvantaged once at medical school (Dickins et al 2013;Nicholson and Cleland 2017;Cleland et al 2015;Stegers-Jager et al 2012).…”