Elaine Griffiths looks at the downturn in applications to medical school, and the particular problem of the shifting gender balance

50 years ago

Medical schools need to select medical students who are well motivated and have the skills and aptitudes that make good doctors. One such skill is the ability to pass exams. Just passing exams, however, will not necessarily make a student a good doctor. Medical schools are currently concerned, not just about the drop in the number of applicants for each place but also the lack of successful male applicants. Why is medicine no longer attracting bright sixth formers and can anything be done about it?

The criteria used for selection into medical school are similar throughout the United Kingdom. They include academic ability, insight into medicine (including work experience and attendance at courses like Medlink or equivalent), extracurricular activities and interests, personality, motivation, and linguistic and communication skills. The problem lies with the weight given to academic criteria, particularly to A level grades, which make medical school a challenging choice at a time when the number and variety of higher education courses open to bright students is greater than ever. A career in medicine has not only received sustained bad publicity for several years but is also associated with high debts at the end of the course. These issues must be tackled to reverse these trends.

Previous academic performance is a good but not perfect predictor of success in medical training. The ability to pass exams does not necessarily correlate with a person being a good doctor. How many academic professors have earned their reputation on the basis of their surgical prowess? Medicine will always need a proportion of highly academic entrants to innovate and pioneer medical research, but most doctors will increasingly be working in partnership with their patients to make modern medicine truly patient centred.¹ Communication skills and practical abilities are equally as important for todays doctors.

Research suggests that previous academic performance overpredicts success in UK medical schools by students from ethnic minority groups. Students from these groups, however, training in the United Kingdom may perform better in medical exams than white students.² This confirms that the academic selection criteria in the subgroups that have been studied are not as good as we would wish. In contrast, interview ratings for overall suitability have been shown to be predictors of success in medical training.² We can collect additional information that has predictive power from an interview, which is over and above academic performance.

The evolution of the ward round

Female students often perform better at interview compared with male students. This brings us to the reasons for the lack of suitable male applicants. Female students now perform as well, or better, than male students of science in every examination from age 11 to 18. More female students than male students than take A level biology; if the current trends continue, this might happen in chemistry as well.³ We could reverse this by promoting medicine as an accessible and attractive career to boys younger than 16 years old.

Alternatively, we could accept that in future women will predominate in medicine. The female sex is an independent factor associated with success in medicine. Not only do women perform better than men in medical training, they are more likely to get an honours degree. Their ability to pass exams and achieve high academic standards is not in doubt.

The problem is that fewer women currently choose a career in hospital medicine. With the increasing percentage of female medical students, this could result in a lack of hospital doctors. Postgraduate training for hospital specialties is still designed by male doctors and based on the “marathon” and “obstacle course” concept rather than being skills based. It is also driven by the need to provide 24 hour cover. Careers in hospital medicine have to be made more attractive to women; training needs to offer family friendly options and include greater flexibility. Perhaps we can learn from the Norwegians who expect both men and women to work part time when they have young children. That way, both men and women share in the parenting, maintain their skill levels, and compete for career opportunities on even terms. Glass ceilings must be broken and candidates should be promoted on merit not on sex. Courses that are truly skill based would enable people to acquire the necessary skills at a pace suited to their personal needs.

We also need to ensure that those training to become doctors come from a wide variety of backgrounds to reflect the needs of people in an increasingly multicultural society. Medicine has to be seen to be accessible to students irrespective of socioeconomic, geographical or cultural background. We should encourage candidates into medicine who have taken a first postgraduate qualification either in a science subject, nursing, other profession allied to medicine, or, possibly more controversially, any degree.

Current medical training has been largely designed by men for men, and this has backfired. Medicine is for people from all walks of life with the right skills and aptitudes. Cognitive factors (previous academic ability) are important in predicting success but cannot be used exclusively to predict success. Non-cognitive factors (personality, learning styles, interviews, references, personal statements) and demographic factors (sex and ethnicity) all have an important role to play in choosing the right doctors for the future.