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Better, but still not good enough for all

Medicine may be a vocation but medical schools are only slowly waking up to vocational qualifications. Julian MacQueen reports. Some medical schools will consider the new General National Vocational Qualifications as entrance criteria, which must be a ray of spring sunshine to their creators. But there is a caveat.

Dr Barry Mitchell, pre-clinical sub dean at Southampton University, insists for example that, the GNVQ would need to be backed up by chemistry A-level. But the eligibility of the new qualifications is only one issue in the debate surrounding admission to medical school.

Questions of gender, ethnicity and general fairness have been occupying sub-deans for the past 10 years and there have been some notable successes as well as failures. Women now outnumber men at medical school (2,786 in 19934 compared to 2,743 men) yet there are very few Afro-Caribbeans.

However, Josephine Storey, admissions officer at the London Hospital Medical College, says vocational qualifications are still not acceptable, as variations in the different courses mean that standards cannot be guaranteed. She also believes an access course which linked the London Hospital Medical College to a local college of further education would not produce candidates of the right calibre.

While Birmingham University's medical school does not accept vocational qualifications Oxford University does. But the school's pre-clinical adviser for admissions, Dr Tim Horder, says the problem at Oxford goes beyond the type of qualification. Applicants are first selected by individual college tutors, and of those, about one third get through to the second stage, panel interview.

Dr Horder says: "We would certainly accept GNVQs although as yet we've never had one. Oxford is desperately keen to broaden its intake and we are very worried because that intake has a tendency to slip back in the wrong direction. "

He believes that Oxford's image turns away many potential students. "I know for a fact that state schools think we discriminate."

Dr Aneez Esmail, senior lecturer in the Department of General Practice at Manchester University, whose recently published research raised the issue of ethnicity and discrimination in medical school entry, believes that discrimination happens at the short-listing stage.

His research, which incorporated A-level results into an analysis of applications and acceptances by ethnic status, found that some schools did better than others. For example, Southampton came out well whereas St Andrew's did not. The UCAS form records ethnic identity, and although this information is not passed on to the medical schools, admissions tutors can make a guess as to ethnic origin from the applicant's surname.

Given that the number of applicants to medical school of Asian origin is generally high, Dr Esmail says, there may be an informal quota system in operation."If you look at ethnic minority intake, there is a higher proportion of ethnic minority candidates. In my medical school, 40 per cent of all people accepted are from an Asian background."

If ethnic minority applicants are high but acceptance low and given that the overall ethnic minority population in the UK is 5 per cent "schools might be inadvertently saying we have enough ethnic minority candidates." To prevent this happening, one idea is to substitute a number for the candidate's surname and a few schools are already moving in this direction.

Southampton has a policy of calling for interview only mature and overseas applicants; for school-leavers, the information provided by the UCAS form is regarded as enough, and Dr Mitchell says it is a system that works well for Southampton.

Dr Esmail says: "If I have the grades and the qualifications, why shouldn't I be given the same chances as anyone else?" Given the intensity of competition for places, how many potential medical students would risk taking GNVQs when the current entry standard for medical school has just jumped a grade from three Bs at A-level to one A and two Bs. Perhaps that ray of sunlight will be short-lived.

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