Osama Abu-Tair
All around the country, a crusade has been raging on against a great injustice. For the past four decades, initiatives across a range of high-end professional jobs have been at play, working towards levelling the disparity the various statistical disparities within these fields whether they are in regard to gender, race or class. Largely speaking, these initiatives have been very successful with the UK Government’s Department of Education reporting in 2021 that the number of women accepted into full-time undergraduate STEM courses had risen by 49% between 2010-2011. In the same time span, the number of 18-year-olds accepted into STEM courses from disadvantaged backgrounds had risen by 79%.
However, amongst all these success stories and progressive achievements, one field’s absence can be noted – the illustrious field of medicine. Despite sweeping social changes throughout the years, medicine has held hard onto its reputation for being a class-locked field which only the privileged and wealthy can dream of accessing. Further investigation reveals incredibly startling figures with the Government’s own Social Mobility Commission reporting that only 4% of physicians came from working class background.
Putting all this into consideration it only leads one to wonder, how did such a constantly changing and pioneering field fall behind so majorly in one of the biggest social drives of the modern era? More importantly, what is being done to break the status quo and how can we improve further?
How did we get here?
A preliminary skim over the topic quickly reveals that it has many faces and cannot be resolved with a singular miracle solution. Therefore, the collective root causes of the problem must first be taken into consideration to solve it efficiently. Firstly, it would be useful to note that in order for a student in the UK to enter medicine they must complete a five to six year-long undergraduate medicine course from which the majority of practicing physicians are supplied or a four year graduate entry course. For the purposes of this article, we will be focusing on the former.
The admissions process for these courses are rife with factors that favor those from a more fortunate background. For example, the UCAT which is an admissions test utilised by many universities to select interview candidates for medical courses. This test is incredibly difficult to prepare for without splurging out on online courses and package programs. One particularly large program, Medify, is used by over two thirds of the UCAT applicant pool. This leaves those who cannot afford to access such tools at a significant disadvantage compared to their peers.
To take this further, some applicants elect to employ the aid of personalised tutors, some of which cost up to £64 per hour. This further improves the scores of people from financially advantageous backgrounds and expands the disparity in competitiveness between applications from different socioeconomic backgrounds.
Perhaps a more imposing factor in this equation are the interviews that most aspiring medical students must undergo to enter medical school. These interviews do not always present inclusive question, focusing at times on discussions revolving around work experience, extracurricular involvement and positions within volunteering or leadership that may require extensive connections to obtain or are otherwise class-locked financially.
Whilst all the above barriers stand defiantly against those who already have the dream of pursing medicine, there is another, more subtle difficulty at play. The fact of the matter is that the vast majority of non-selective schools do not even provide their students with basic information regarding the potential for them to enter a career in healthcare as a physician, further reinforcing the deeply ingrained popular perception that medical school is reserved for ‘posh’ people.
A result of this aversive behavior to the medical profession by non-selective schools is the large gap in knowledge about the medical school admissions process between pupils attending these schools and their selective or private school counterparts.
As demonstrated in an investigation by The BMJ that included six London secondary schools, pupils attending non-selective schools presented a “hazy” understanding of the process, had financial concerns regarding the pathway and were only superficially aware of bursaries that were available to them that may help alleviate such problems.
Current implementation
Whilst it is very clear that the scale of efforts currently being exerted in response to the present issue are dwarfed by the required drive necessary to resolve it, this is not to disregard the programs and drives being implemented by universities around the UK.
For example, many medical schools have resorted to lowering grade requirements and admission score thresholds for ‘contextual’ candidates from less advantaged backgrounds.
Other places launch widening participation programs such as the University of Bristol who run Next Step Bristol – a program that aims to aid the transition of people from disadvantaged backgrounds to university life. The completion of the program even guarantees an interview as well as providing support with interview preparation and skills training.
How do we go forward?
One may be tempted to simply expand the range of the aforementioned widening participation programs and continue lowering entry requirements for disadvantaged students. However, this can only go so far and has a similar effect to a band aid as opposed to a cure, because not only does it only help those who already aspire to study medicine, it also serves as a crutch that these students will not have continuing into their medical education.
In general, the problem is a lot more deeply rooted than this and can only be solved with a more radical approach. The government needs to level the playing field between school leavers to make sure that everyone has access to the same level of knowledge about the process and the same level of exposure in the form of work experience.
Ref:
1 – Department for Education (2021). More young people are taking STEM subjects than ever before – The Education Hub. [online] educationhub.blog.gov.uk. Available at: https://educationhub.blog.gov.uk/2021/02/09/more-young-people-are-taking-stem-subjects-than-ever-before/.
2 – Social Mobility Commission (2016). State of the Nation 2016: Social Mobility in Great Britain. [online] Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/569410/Social_Mobility_Commission_2016_REPORT_WEB__1__.pdf.
3 – Greenhalgh, T., Seyan, K. and Boynton, P. (2004). ‘Not a university type’: focus group study of social class, ethnic, and sex differences in school pupils’ perceptions about medical school. BMJ, 328(7455), p.1541. doi: https://doi.org/10.1136/bmj.328.7455.1541.
About the author
Periodic content writer and aspiring medical student. I constantly seek out compelling stories, having a particular fascination with the intersections of medicine and social issues in both the UK and the wider global community.