UK’s disadvantaged students match those from top schools in medical training

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illoDisadvantaged students from the UK’s worst performing schools do just as well or better in medical degrees as students from top schools, even when their A-level results are worse, The Independent reports a major study has found. These pupils actually outperformed their privately educated peers with the same grades and the researchers, led by the University of York, say competitive medical school entry requirements should be lowered for applicants from a school with low average A-level results.

Considering the “context” pupils were educated in could also help to address diversity issues in medicine and doctor shortages, which are particularly acute in the most disadvantaged regions, the report says.

Currently half of medical degree entrants are privately educated, despite just 5% of students in the UK going to private schools, and black and minority ethnic doctors are seriously under-represented in some specialities. “This study suggests that relaxing A-level grade entry requirements for students from the worst performing secondary schools is beneficial,” said Lazaro Mwandigha, from York’s department of health sciences. These students are “just as able to keep up with the pace of a medical degree”, he added.

The report says the study comes as a diversity row embroils Oxford University where some colleges accepted just a handful of black students and just 11% of entrants were from a disadvantaged background – though this is up from 7% in 2013.

Labour MP David Lammy is quoted in the report as saying: “The truth is that Oxford is still a bastion of white middle-class southern privilege. They have to explain why you are twice as likely to get in if you are white as if you are black and why you are more likely to get in if you are from the South than the North of England when you apply.”

While the university accepted the criticism it said a part of the problem was down to a “very large pool” of white applicants with three As or more at A-level, and a very small number of black students with these grades.

But the study suggests that only focusing on top grades means the best future doctors may be missed.

Abstract
Objectives: University academic achievement may be inversely related to the performance of the secondary (high) school an entrant attended. Indeed, some medical schools already offer ‘grade discounts’ to applicants from less well-performing schools. However, evidence to guide such policies is lacking. In this study, we analyse a national dataset in order to understand the relationship between the two main predictors of medical school admission in the UK (prior educational attainment (PEA) and performance on the United Kingdom Clinical Aptitude Test (UKCAT)) and subsequent undergraduate knowledge and skills-related outcomes analysed separately.
Methods: The study was based on national selection data and linked medical school outcomes for knowledge and skills-based tests during the first five years of medical school. UKCAT scores and PEA grades were available for 2107 students enrolled at 18 medical schools. Models were developed to investigate the potential mediating role played by a student’s previous secondary school’s performance. Multilevel models were created to explore the influence of students’ secondary schools on undergraduate achievement in medical school.
Results: The ability of the UKCAT scores to predict undergraduate academic performance was significantly mediated by PEA in all five years of medical school. Undergraduate achievement was inversely related to secondary school-level performance. This effect waned over time and was less marked for skills, compared with undergraduate knowledge-based outcomes. Thus, the predictive value of secondary school grades was generally dependent on the secondary school in which they were obtained.
Conclusions: The UKCAT scores added some value, above and beyond secondary school achievement, in predicting undergraduate performance, especially in the later years of study. Importantly, the findings suggest that the academic entry criteria should be relaxed for candidates applying from the least well performing secondary schools. In the UK, this would translate into a decrease of approximately one to two A-level grades.

Authors
Lazaro M Mwandigha, Paul A Tiffin, Lewis W Paton, Adetayo S Kasim, Jan R Böhnke

The Independent report
BMJ Open abstract


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