Ethnic and sex differences in selection for admission to Nottingham University Medical School

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

We analysed applications to Nottingham Medical School by students from the United Kingdom and the rest of the European Union for 1997, looking at sex and ethnic group.

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 χ² 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.

Table.

Decision by ethnic group and sex. Values are numbers of applicants (percentages of group; percentages of each decision category)

Decision category	Ethnic group					Sex
	White	Non-white*	Total	P value of white v non-white		Male	Female	Total	P value of male v female
Total No of applicants	1954 (76.8)	591 (23.2)	2545†			1279 (47.3)	1422 (52.7)	2701
Rejection at:
Academic stage	384 (69.4; 19.6)	169 (30.6; 28.6)	553 (21.7)	<0.0001		230 (57.4; 18.0)	171 (42.6; 13.0)	401 (14.8)	<0.0001
Questionnaire stage	1015 (74.6; 51.9)	345 (25.4; 58.4)	1360 (53.4)	<0.01		848 (49.3; 66.3)	871 (50.7; 61.3)	1719 (63.7)	<0.0001
Statement review	189 (87.9; 9.7)	26 (12.1; 4.4)	215 (8.5)	<0.0005		74 (38.1; 5.8)	120 (61.9; 8.4)	194 (7.2)	<0.005
Interview	165 (88.2; 8.4)	22 (11.8; 3.7)	187 (7.4)	<0.0005		47 (32.4; 3.7)	98 (67.6; 6.9)	145 (5.4)	<0.005
Offered a place	201 (87.4; 10.3)	29 (12.6; 4.9)	230 (9.0)	<0.0005		80 (33.0; 6.3)	162 (67.0; 11.4)	242 (9.0)	<0.0005

^*Asian (Bangledeshi, Chinese, Indian, Pakistani, other Asian) and black (African, Caribbean, other black) 

^†Does not include 157 candidates whose ethnic group was not supplied to Universities and Colleges Admission Service.