Students from less advantaged backgrounds are grossly underrepresented in Britain’s top universities. This underrepresentation of certain groups is particularly pronounced in highly competitive courses such as medicine. In England, for example, 80% of medical students come from just 20% of the country’s secondary schools. This leads to a profession dominated by certain demographic groups.
This imbalance isn’t just an issue of “fairness” or social equality. It is well established that UK trained doctors from affluent backgrounds are less likely to choose to work in rural or deprived areas. This is especially true in less desirable specialisms such as general practice and psychiatry.
This has left the NHS heavily reliant on the recruitment of overseas doctors to fill such posts. But such staff are frequently recruited from low and middle income countries that can ill afford to lose their own homegrown doctors.
It has been highlighted by Julian Simpson, who has written on and researched the subject, that this “shortage” of doctors willing to work in certain areas stems, fundamentally, from a “lack of alignment between the aims and needs of the NHS and the social and professional aspirations of doctors trained in British medical schools”.
Recent research shows that, once in university, students from England’s most poorly performing secondary schools generally do as well academically as their peers from England’s highest performing schools. Even if they achieved somewhat lower A-level grades. Similar findings from higher education in general have been reported.
This lends evidence to a fact that seems intuitive. That is, the grades a pupil achieves at A-level (or equivalent) are, on average, at least partly dependent on the school they attend. So, in order to make university admissions fairer, should students who attend schools where pupils generally leave with lower grades, be offered places based on reduced A-level achievement – known as “grade discounting”?
Some universities – such as Birmingham, Southampton and King’s College London – have already trialled such A-Level “grade discounting” for medical school place offers for applicants from less advantaged backgrounds. The early evidence from such schemes is that the differences in academic outcomes between students entering with reduced A-level requirements and mainstream entrants are minimal, at most.
At present, it is unclear whether any meaningful differences would exist between qualified doctors who entered medical school via conventional policies or those who had gained admittance via such schemes. After all, people just want to be treated by safe, competent and compassionate practitioners.
Like for like?
But rolling out such an approach on a university wide scale, wouldn’t be a straightforward matter. For a start, there is the issue of how to effectively “contextualise” A-level (or equivalent) achievements. In this way, clear information about how to compare secondary schools would have to be available to university selectors – and such information currently is not always easy to come by. Likewise, for overseas applicants, making comparisons between institutions would be difficult, if not impossible.
Then there is the issue that some pupils from less advantaged backgrounds may not even consider applying for more prestigious or competitive courses at university. So such A-level grade discounting would have to be part of a package of measures to increase universities’ outreach among schools and the dissemination of information to teachers and careers advisers.
Such policies would also be clearly vulnerable to “gaming” from well-resourced families. It is easy to imagine, for example, how some advantaged pupils may be independently schooled until the last couple of years of their education, and for them then to be moved to state schools to take advantage of such admissions policies.
In the US, “affirmative action” policies have been used to encourage ethnic diversity within some universities. Such policies have been weighed and tested through the court system. The resulting verdicts make it clear that such approaches to widening participation cannot rest solely on the issue of “moral equality”. Rather, the case has to be made based on the educational advantages of a more diverse population of students.
The most recent US Supreme Court verdict also stressed that any “positive discrimination” in favour of underrepresented groups should also be proportionate and regularly reviewed. This implies that “grade discounting”, involving modest reductions in the A-level requirement for entry to certain courses for certain disadvantaged applicants, if applied with clear objectives and regularly reviewed, is likely to withstand legal challenge, at least in the US.
So while grade discounting is unlikely to cure all the lack of diversity on the most competitive university courses, it may well play a useful role as part of a package of measures designed to widen access to certain professions in the UK.