In their statement of principles, the Council of Heads of Medical Schools indicate that the purpose of a medical education is to graduate individuals well fitted to meet the present and future needs of society for medical care.[1] They go on to state that this can be achieved, at least in part, if the social, cultural, and ethnic backgrounds of graduates reflect broadly the diversity of the patient population. It seems that this principle is not currently met by medical schools in the United Kingdom. In a study commissioned by the Council of Heads of Medical Schools in 1998, McManus found that certain groups (students from ethnic minorities, sixth form colleges or further education institutions, and lower socioeconomic groups) were disadvantaged when seeking admission to medical school.[2] As a result, the council devised an action plan in which medical schools were required to draw up policies relating to equal opportunities as a matter of urgency.

In general, the groups of people that are underrepresented in the medical profession tend to be overrepresented in the patient population as a result of many factors, including poverty, poor diet and housing, poor educational standards, and occupational factors. Pupils from lower socioeconomic groups are disadvantaged in many ways when applying for entry to medical education. Their secondary schools are not usually those with a record of high academic achievement, and progression to further or higher education is not a tradition. Similarly, the pupils come from backgrounds where participation in higher education is rare. They often do not have the opportunity to undertake suitable work experience and thus have difficulty demonstrating through their application that they are suitable for a career in a caring profession. As a result, their application forms do not often contain the type of features usually looked for by admissions tutors and may therefore not be considered further.

Schemes aimed at widening access Should be designed to attract this previously untapped pool of potential doctors into medicine, thus providing the NHS with a clinical workforce which more accurately reflects the socioeconomic base of society. Such schemes need to raise awareness of higher education in general and to show pupils that a career in medicine, which might at first seem outside their wildest aspirations, is in fact possible. The schemes should attempt to provide some sort of compensation for pupils’ relatively poor academic base and in particular should provide the type of generic, transferable skills to which such pupils may have had limited exposure. Communication skills are particularly important in this regard. Finally, the schemes should make appropriate work experience and exposure to the profession in general available to the pupils.

A new recruitment programme

The University of Sheffield as a whole has shown a longstanding commitment to widening access to higher education, particularly in the local area, and already attracts high numbers of students from lower socioeconomic groups, as evidenced by the substantial Widening Participation premium additional funding allocated by the Higher Education Funding Council for England to the University for 1999-2000. The medical school already participates in some of these activities and will shortly begin a new recruitment programme aimed specifically at students from non-traditional and underrepresented backgrounds. This early outreach programme is described in detail below, but the medical school has already shown its commitment to widening access by welcoming applications from applicants with nontraditional backgrounds. We already have a relatively high proportion of mature students (25% of entrants to the six year foundation course and 14% of entrants to the five year course). Students with a background in nursing are particularly welcome, and we have a relatively high proportion of students with nontraditional educational backgrounds, including BTEC and GNVQ courses.

The Compact Scheme

The Compact Scheme began in medicine in 1994. It provides individual support by trained admissions staff, and the formal academic entry requirements are relaxed where appropriate. Year 12 pupils whose personal, domestic, or financial circumstances may prevent them from displaying their full academic potential are helped in the application and admission process. Pupils are first identified in their schools and, if thought to be suitable, are referred by the school to the university and then to the scheme’s liaison officer for the school of medicine. In an informal interview, students are assessed in general terms and are given advice and support about their application. The majority then proceed to the formal interview stage, along with the standard applicants.

We feel it is important that such students should not be made to feel “different” from their fellow applicants and thus, although the interviewers are made aware of the pupil’s special circumstances, the other applicants being interviewed at the same time are not. Similarly, once admitted, these students are not identifiable in any way to their fellow students or to teaching staff, unless the students themselves decide to inform them. They receive no special treatment and in particular are not identifiable during assessment episodes. They are, however, followed closely during their studies and are made aware that they may seek advice and guidance from the liaison officer at any time.