The UK government’s belated decision to reinstate predicted grades for A levels was probably the fairest solution available given that the “standardisation” of those predictions disproportionately disadvantaged prospective students from low-income backgrounds.
Hopefully all students – those who received first acceptances and those with reinstated grades – will now have their offers honoured. But the unanticipated increase in the number of students meeting the entry requirements of their first-choice university raises some serious practical issues, especially for medical education.
Crucially, additional places, created through honouring more offers and the subsequent lifting of the cap on medical school places in England, must be funded and supported appropriately without causing adverse impact on existing students and on the welfare of university staff.
Still, this episode, occurring as it does together with Covid-19, will have serious consequences, not only on this year’s admissions process to medical school, but also on admissions to, and experiences of, undergraduate medical education for subsequent years.
The impact of fluctuations in annual medical student numbers are significant. In the long term, too many students in any one year will lead to more new doctors than there are places on the foundation programme. Too many deferrals will lead to a shortage of places in 2021-2, which will itself be manifestly unfair.??
Both these questions relate to the tightly restricted entry numbers for medical courses. Increasing the number of places seems obvious, not least to increase the pool of doctors – although it will only begin to have any effect in five to six years, longer than the lifespan of most governments.
But for medicine these number restrictions are practical. There are limits to the number who can be accommodated in teaching environments, laboratories and clinical placements. Too many students will impact adversely on teaching and supervision by current staff and, thus, on the student experience.
This comes at a time when the medical academic workforce is already under-resourced, understaffed and overstretched, and when universities face an impending financial crisis caused by Covid-19 – resulting in calls for voluntary redundancies, early retirements and pay cuts.
Both medical academics and medical academic trainees are disproportionally dependent on medical research charities, not only for running costs but for salaries. And those charities, too, warn that they are financially overstretched because of Covid-19. To cope, additional resourcing for medical schools to accommodate additional students, and maintain and enhance staff numbers, is an investment that the UK needs to make now.
We welcome the new task force, led by universities minister Michelle Donelan, to help ensure students can progress to the next stage of their education. However, the particular issues facing medical courses need to be dealt with separately. The medical course is longer than other courses, interlinks with NHS organisations, and involves a distinctive mixture of medical education and clinical placements.
The BMA’s Medical Academic Staff Committee and Medical Students Committee wrote to Ofqual and the Office for Students earlier this year to seek assurances that no student should be disadvantaged by the A-levels grades process this year. Regrettably this concern has been vindicated, and the process has proven even more discriminatory against high-performing students from low-income backgrounds than was feared.
There is now a particular obligation to make sure that students from low-income backgrounds do not suffer in any way from the fallout of what has transpired. Deferring entry for some students until 2021, which gives medical schools more time to plan and avoids oversubscription this year, must be non-discriminatory. Resources may need to be provided for students from low-income backgrounds if they are required to undertake a gap year before commencing their studies.
There are clear benefits of improving diversity in medical education and in the medical workforce – it allows doctors to be more understanding and representative of the populations they serve and thereby helps ensure better engagement with health services. As a society, the UK has been moving in the right direction – it would be a betrayal of trust if current events have a retrogressive impact on the recognition and fulfilment of these important principles.
David Katz is deputy chair of the British Medical Association’s medical academic staff committee and emeritus professor of immunopathology at UCL.
