Ethnic and sex differences in selection for admission to Nottingham University Medical School |
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Ethnic and sex differences in selection for McManus's study of applications to medical school by students in the United Kingdom and the rest of the European
Union1 refuelled the debate about discrimination.2 3 McManus showed that 18 measures were
independently associated with receiving an offer.1 Applicants disadvantaged in selection included those from
ethnic minority groups and men.1 Methods and results The admissions process for applicants to University of Nottingham Medical School is detailed in the school's admissions policy document, which is reviewed annually. Copies are available to all applicants on request and obtainable from us. The process comprises four stages. Academic stage examines whether the applicant meets the medical school's minimum academic requirement. Questionnaire stage - Those passing the academic stage complete a questionnaire about work experience, extracurricular activities, and positions of responsibility. These responses are scored. Statement review - The two statements (applicant's and referee's) on the application form of the applicants with the top 960 questionnaire scores are reviewed by two assessors. Insight, motivation, personality, and communication skills are scored. The 480 candidates with the top scores are selected for interview. Interview - In an interview of 15 minutes knowledge of Nottingham and the course, insight, motivation, personality, communication skills, and interest in medical topics are assessed and scored. Offers are made to the 260 interviewees with the top scores. In 1997, 2701 candidates from the United Kingdom and the rest of the European Union applied to Nottingham through the Universities Colleges and Admission Service. The decision for each applicant was noted along with ethnic group, sex, and stage of the process. Statistical comparison of frequencies was by X2 test with Yates's correction. Significantly more non-white and male applicants were rejected at the academic and questionnaire stages, whereas significantly more white and female applicants were rejected at the statement review and interview stages (table). The net effect was that significantly more white and female applicants were offered a place.
Comment Discrimination is "the unfair treatment of a person based on an irrational preference."2 Selection by ethnic group or sex would be discriminatory because neither predicts success in a medical course or career. We believe, however, that the higher rates of offers to female and white applicants do not represent discrimination. They arise at the academic and questionnaire stages, which are objectively scored without reference to ethnic group or sex. Indeed, at the statement review and interview, where true discrimination could operate, non-white and male applicants are significantly more likely to be offered a place. Selection on the basis of academic ability is reasonable: a proved relation exists between this and success on a medical undergraduate course.4 Our unpublished data for the first 21 years of Nottingham Medical School show that scores at O level or GCSE and A level are significant independent predictors of success at all stages of the course. Unlike in McManus's study, for most applicants we can select only on achieved GCSE and predicted A level grades rather than achieved A level grades. Nottingham Medical School is the only one to use a questionnaire in selection. It aims at avoiding discrimination by consistently scoring, for all academically suitable applicants, non-academic factors considered relevant to a career in medicine. We now question, however, whether such factors accurately reflect suitability for medicine. Our goal is that selection is only on the basis of evidence based predictors of success, including perhaps psychometric testing.5 We encourage all medical schools in the United Kingdom to examine their admission practices as we have done to ensure that the process is fair and non-discriminatory.
Contributors: DJ initiated the research and participated in collecting and analysing the data and in writing the paper. LD participated in data collection and analysis and writing the paper. DJ is guarantor for the study. Funding: No additional funding.
(Accepted 11 March 1999) Discrimination is not always explicit James and Driver's analysis of applications to Nottingham Medical School by students from the United Kingdom and the rest of the European Union for 1997 found that significantly more white, compared to non-white, applicants were offered a place. They state that the higher rates of offers to white applicants do not represent discrimination because they arise at stages in the selection process which are objectively scored, without reference to ethnic group. However, we now know that discrimination does not have to be explicit, overt and readily identifiable for it to exist within institutions. As the Macpherson report makes clear , institutional discrimination can exist where the allegedly objective practices, protocols and procedures of an organisation result, albeit unintentionally, in deleterious outcomes for certain groups. In other words discrimination can be subtle and insidious too. The fact that a procedure is shown to result in significantly fewer applicants from one group being successful is, in itself, prima facie evident that discrimination may be occurring. Reference to ethnic group being explicitly made is not a necessary condition for discrimination. Bruno Rushforth 2nd year medical student, Manchester Medical School b.j.rushforth@stud.man.ac.uk
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