Why is there so little social diversity in medicine?
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Version 0 of 1. Medicine in the UK has traditionally been deemed an elite profession that excludes those from low socioeconomic groups. A mere 7% of students are privately educated, but 26% of medical students went to fee-paying schools. However, when you look closely at the figures, many students leave school at 16, and 18% of 16- to 18-year-olds are in fact privately educated; the proportion is even higher for those studying science subjects. Suddenly, the figure of 26% of privately educated medical students seems to reflect numbers studying sciences at school. It is not surprising that the majority of doctors come from more affluent backgrounds. I do not come from a privileged background. But I had opportunity. I did not attend a state school but was awarded a bursary to study at a private school. My husband, a hospital consultant, was state educated. His father was a bus driver and arrived in the UK as an immigrant in the 1960s. In many places in the world, perhaps neither of us would have been given such opportunities. It is opportunity that social mobility organisations and medical schools themselves are asked to create, in order to remove this disparity in entrants. Universally, access to medical school is limited due to a lack of places; this generates stiff competition and entry criteria tighten every year. Historically, selection for medical school has consisted of exam performance and interview scores (most medical schools will interview their applicants). In recent years, we have seen the introduction of a national UKCAT aptitude test, which all candidates complete. Universities are also moving away from a single interview, which can be an arduous experience for candidates. The new multiple mini interviews (MMIs) consist of several short stations, which test candidates on standard questions (Why do you want to study medicine?), ability to complete a practical task, communicate effectively or explore an ethical dilemma. These seem to be a fairer way of judging students, who may otherwise perform badly through nerves or even assessor bias. It has been surmised that MMIs favour state students, but in my experience as an assessor this is not always the case. MMIs favour those who are confident, communicate well and display empathy: all the qualities we would expect from a good doctor. Often students from failing schools do not perform well, if they have had neither coaching nor exposure to similar situations. And modifying the selection process further is unlikely to have major impact as few students from less affluent backgrounds apply in the first place. Many of the widening access to medical education programmes promote initiatives, such as arranging mentoring or work experience with doctors, and by introducing summer medical schools for sixth formers. This is certainly showing some encouraging results but it does not get to the root of the problem, and you only have to look at school dropout rates to see why: one in five students will leave school after GCSEs; of those who continue in education, few will study core academic or science subjects. State-educated medical students are usually from good comprehensive or grammar schools, which operate within narrow geographical boundaries. These are often in affluent areas, with little chance of access to those from broken families or challenging neighbourhoods. Many of the independent schools’ bursaries, such as the one I was educated on, have since been abolished. University tuition fees have also changed the demographics of students. Medicine is usually a five or six-year course, or even longer if students undertake foundation or catch-up medical courses. Students from low-income families are discouraged at the prospect of spiralling debt, which can run into hundreds of thousands of pounds. The government’s controversial plans to change the junior doctor contract and to consider tying newly-qualified doctors to the NHS for four years is unlikely to increase diversity in applicants. A mix of poor schooling, lack of aspirations and financial deprivation limits access to the medical profession. It is simplistic and even detrimental to try to tackle it through university or social mobility organisations alone. Our aim should always be to have competent and empathetic doctors from different social and cultural backgrounds who reflect our society. One way of improving diversity is by having doctors from EU and non-EU countries as well, but we still need to increase access to the professions within the UK to young people from all social backgrounds. The solution to this societal and educational problem is complex. It requires a wider commitment from us and the government towards our children, their education and wellbeing. If you would like to write a blogpost for Views from the NHS frontline, read our guidelines and get in touch by emailing sarah.johnson@theguardian.com. Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views. |