The report finds that although the proportion of medical students from the lowest socio-economic backgrounds more than doubled between 2012 and 2021, they still accounted for just 5% of entrants at the end of this period. In contrast, 75% were from higher socio-economic backgrounds, based on their parents’ occupation.
Data on nearly 94,000 applicants to UK medical schools was analysed, representing around half of all’UK medical applicants between 2012 and 2022.
Results showed that a relatively small number of schools and colleges provided a very high number of medical students. Of the 2,719 schools or colleges that provided any medical applicants during this period, most had only one applicant per year and 80% had fewer than five per year. But 58 schools and colleges, comprising just 2% of all’institutions, had an average of 20 or more applicants per year. One institution averaged 85 applicants per year over the 10-year period studied.
Crucially, applicants from independent schools were 1.5 times more likely to receive an offer to study medicine compared to those from non-selective state schools. Even after statistical adjustment for their exam grades, socio-economic status and other demographic factors, independent school applicants had higher odds of receiving an offer.
Overall, applicants from lower and intermediate socio-economic backgrounds were less likely to get a medical school offer than their better-off peers. The University Clinical Aptitude Test (UCAT) for medical schools may have contributed to this, as it could have posed an additional barrier for those from worse-off homes. Applicants from lower socio-economic backgrounds with the highest predicted A Level points achieved lower UCAT cognitive scores than those from medium or higher socio-economic backgrounds, which was equivalent to 125 UCAT points (5% lower on average) in 2022.
Admissions processes also vary considerably between medical schools, including the use of Multiple Mini Interviews (MMIs) that aim to assess wider life skills such as communication and social skills, variations in how UCAT scores are considered, the use of personal statements and requirements for prior attainment.
This complex system can be challenging for applicants to navigate, particularly those from disadvantaged backgrounds who may lack wider support through the application process from their school, or family and friendship networks.
Professor Katherine Woolf, an author of the report from UCL Medical School, said: "Getting into medical school remains a huge hurdle in any doctor’s career. Despite the many changes medical schools have made over the past decade to improve access to the profession, our research has shown low prior attainment remained a major barrier to many aspiring doctors from the poorest backgrounds.
"Providing enough doctors to meet the country’s needs will require better support for future doctors, especially those from disadvantaged backgrounds. This support is needed at all stages of a doctor’s career: from school, before and during application to medical school, and throughout the many years of medical education and training that are essential to practise as a doctor."
Students from the poorest backgrounds were more likely to be successful if they applied to gateway medical courses, compared to students from similar backgrounds who had equivalent prior attainment but applied only to standard entry medical courses. These gateway courses include an additional foundation year with lower grade requirements for entry. They were explicitly designed to attract and admit applicants from under-represented groups. Despite this, only 11% of all’entrants to gateway courses were from the lowest socio-economic group, with 46% from the highest. While this was better than standard entry courses (where the figures were 4% and 73% respectively), the Sutton Trust recommends that gateway courses should have a far greater focus on widening participation.
There have been some positive changes to admissions processes, such as the increased use of contextual admissions by medical schools, whereby a university considers an applicant’s academic performance in light of their background and circumstances. However, admissions approaches vary considerably between medical schools, and there is a lack of transparency about admissions criteria on some of their websites. This can make it difficult for applicants to understand which medical schools they should best apply to.
As the Government looks to increase the number of medics trained in the UK, there may be an opportunity to widen access to the profession. To improve the socio-economic mix of the medical students trained here, the Sutton Trust is calling for the Government to prioritise medical schools with a successful widening participation record in any expansion of spaces, to conduct a fair access review across the higher education sector, and to provide clearer information and support for aspiring medics looking to navigate the application process.
The Sutton Trust recommends that medical schools be properly resourced to fully support students from lower socio-economic backgrounds after they start their courses. They should make more ambitious use of contextual offers, review their use of UCAT in admissions, and work more with other medical schools to simplify their admissions processes and reduce the complexity and inconsistency in application processes.
Nick Harrison, CEO of the Sutton Trust, said: "It’s outrageous that working-class kids make up just 5% of medical students, especially when the NHS is facing a chronic shortage of doctors and a heavy reliance on overseas recruitment. The medical profession is stretched to breaking point, and urgent action is needed to widen access and create a more diverse pipeline of talent from all parts of society. Patients benefit from doctors who reflect the diversity of the communities they serve, but it’s clear that we’re a long way from that today.
"If you have the ability, where you grow up or your parents’ income shouldn’t be a barrier to becoming a doctor. Working-class entry into medicine is in a critical condition. The profession urgently needs a shot of equality."
Links
Dr Matt Midgley
E: m.midgley [at] ucl.ac.uk- University College London, Gower Street, London, WC1E 6BT (0) 20 7679 2000
