2012; 34: 382–391 Predicting who applies to study medicine: Implication for diversity in UK medical schools EAMONN FERGUSON, DAVID JAMES, JANET YATES & CLAIRE LAWRENCE University of Nottingham, UK Abstract Aims: Widening access to medical school is a priority in medical selection. If disadvantaged students do not apply, interventions cannot be effective. To date, no studies have examined factors that predict who chooses to apply to medicine and if socio- demographics influence the profile of those who apply to study medicine. Methods: A large database provided by the UK University and Colleges Admissions Service on all 1,225,156 applicants to UK universities over a 3-year period (2002-2004) was analysed. The relationship between demographics, preference to study medicine and academic performance prior to entry (A level score) were explored using logistic and linear regression and path modelling. Results: Those applying to study medicine were more likely to be female, non-white, of higher socio-economic status and from fee-paying schools. Applying to study medicine was associated with increased academic entrance performance over and above socio-demographic factors. Importantly, in those applying to study medicine socio-demographic inequalities in entrance exam performance was either reduced (for ethnicity and SES) or abolished (for sex and schooling). Conclusions: It is argued that early interventions are needed to increase applications for certain groups to help to reduce socio- demographic inequalities in entrance exam performance and hence medical school admissions. Introduction Widening access to medical school is a priority in medical selection (General Medical Council and Postgraduate Medical Education and Training Board 2001; Ferguson et al. 2002; The Future of Higher Education 2003; McManus et al. 2005; Guiding principles for the admission of medical students 2007; James et al. 2008). Widening access results in greater background diversity, enhancing medical students’ educa- tional experience (Carrasquillo & Lee-Rey 2008; Saha et al. 2008) and producing a motivated and successful workforce reflecting the diversity of the constituent community it serves (Patterson & Ferguson 2007; Pololi, Cooper & Carr 2010; Andrioloe & Jeffe 2011). As such, diverse strategies for widening access have been adopted that focus on: (1) selecting both academic and non-cognitive characteristics (Ferguson et al. 2000, 2002, 2003; Albanese et al. 2003; Cooper & Tauber 2005; Powis et al. 2007), (2) providing access courses (Holmes 2002; Greenhalgh et al. 2006; Reeves et al. 2008), (3) giving guidance on completing application forms (Kamali et al. 2005) and (4) lowering the academic entrance requirements (McManus et al. 2005). The main problem with all these strategies is that they occur late in the application process, once the applicants have decided to apply for medicine and after ethnic, sex and socio-economic biases may already be established. To widen access, it is necessary to encourage a diverse population to apply initially. Surprisingly, while there are studies on medical students’ career preferences (Morrison & Murray 1996; Dorsey et al. 2003; Lambert & Holmboe 2005; Hauer et al. 2008), there are no studies examining factors that influence applicants’ prefer- ence to study medicine in the first place. Filling this gap in knowledge is crucial if we are to indentify any ethnicity, sex and socio-demographic biases in those who apply and to identify which groups need to be targeted for early interven- tions. While there is evidence that ethnic, age and sex distributions of those at medical school are biased (McManus et al. 1989; McManus 1998) and do not reflect the profile of the general population, a commonly held belief is that this reflects Practice points . Certain demographic groups (e.g. males, low SES) are less likely to apply to study medicine and these should be targeted to increase diversity in the application pool. . Interventions to increase diversity in medicine should occur earlier than they currently do – and be targeted well before application not after it. . Those who choose to apply to study medicine have higher A level grades than those who do not. The intellectual, social and motivational processes associated with this effect need to be studied. . For those who choose to apply to study medicine, the effects of social inequalities on exam performance are reduced. There is urgent need to understand the social processes and motivational processes associated with this effect. Correspondence: E. Ferguson, School of Psychology, University of Nottingham, Nottingham NG7 2RD, UK. Tel: 44 115 9 515327; fax: 44 115 9515324; email: eamonn.ferguson@nottingham.ac.uk 382 ISSN 0142–159X print/ISSN 1466–187X online/12/050382–10 ß 2012 Informa UK Ltd. DOI: 10.3109/0142159X.2012.652237 Med Teach Downloaded from informahealthcare.com by 123.254.108.196 on 05/20/14 For personal use only.