Population-based longitudinal analyses of offer likelihood in UK medical schools: 1996-2012

Abstract

Context: The challenge of ensuring 'fair' selection processes confronts all medical schools around the globe. In the UK, historical analyses suggest applicants who are male, non-White, and from less advantaged socio-economic and school backgrounds have been less likely to be offered a place at medical school. We provide a contemporary population-based longitudinal analysis of the likelihood of receiving an offer to read medicine in the UK stratified by key socio-demographic characteristics.

Methods: We calculated the likelihood of receiving an offer among applicants to UK medical schools during 1996-2012, adjusted for sex, ethnicity, schooling, parental occupation, educational attainment and year of application. To investigate differences across time, models were fitted with interactions between application year and each of the other explanatory variables.

Results: There were 154 957 applicants, including 86 361 females (55.7%) and 68 596 males (44.3%). The majority of applicants were White (n = 94 519, 61.0%). The most common parental occupation category was higher managerial and professional (HMP) (n = 60 167, 38.8%) and 68 313 (44.1%) applicants came from grammar and independent schools. The likelihood of receiving an offer to study medicine varied three-fold across the study period, peaking in 2001 against the 1996 baseline (odds ratio [OR] 2.94, 95% confidence interval [CI] 2.78-3.11; p < 0.001). Throughout the study period, female applicants (OR 1.21, 95% CI 1.19-1.24; p < 0.001), those from more advantaged family backgrounds (OR 1.26, 95% CI 1.24-1.29; p < 0.001), and applicants who had attended independent or grammar schools (OR 1.25, 95% CI 1.23-1.28; p < 0.001) were more likely to receive an offer. Compared with Asian, Black and Other ethnic groups, White applicants had a greater likelihood of receiving an offer, with ORs of 1.56 (95% CI 1.54-1.61), 2.33 (95% CI 2.17-2.50) and 1.45 (95% CI 1.39-1.51), respectively. Differences in odds between White and non-White applicants reduced slightly during the study period but the overall advantage for White applicants persisted. The advantage for female applicants diminished markedly from 2007 onward. There was no clear trend in the advantage for students from HMP families, but from 2005 onward the odds of success for applicants with grammar and independent school backgrounds increased.

Conclusions: Despite efforts to make selection processes more equitable, our findings suggest that persistent advantages remain for some demographic factors.