Admissions exams are on the rise in the UK, especially for subjects such as medicine. But Yasmin Anwar finds students and academics are sceptical.

On a rainy day in January, 1,400 young people from across the UK queued up in London to take part in a day-long set of tests. The graduates, from a range of science and non-science disciplines, hoped to win a place on a graduate-entry course to study medicine.

But first they had to get through the Graduate Australian Medical School Admissions Test (Gamsat), a gruelling five and a half hours of examinations intense enough to leave some in need of medical attention. Awaiting them were two multiple-choice papers in social science and physics, chemistry and biology and two essays on themes such as "Growth without planning is the ideology of the cancer cell". Just 90 of the 1,400 candidates won a place.

This punishing ritual, which is routine in countries such as the US, is likely to become more common here. UK universities are under government pressure to widen access to their institutions; at the same time, there is an increasingly noisy academic debate about the diminishing value of A-level results in distinguishing the top candidates. Now, all of a sudden, admissions testing is back in fashion. Some institutions such as Cambridge University are introducing a "thinking skills" test that seeks to gauge students' potential across the board. Others are bringing in tests focused on specific subject areas where there is a high demand for places.

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Four years ago, St George's Medical School in London pioneered a graduate-entry course in medicine for both science and non-science graduates, but it needed a means by which to select candidates. To keep costs down, it borrowed an Australian model, the Gamsat, which was created in the 1990s for medical studies. Nottingham and Peninsula Medical Schools signed up to the tests this year, and the University of Wales Swansea will do so next year.

Not all medical schools approve, however. Some say that the cost of running the test - each candidate must pay ?150 to take part - is too high and will harm attempts to widen participation. They also want a test designed with Europe rather than Australia in mind.

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To address the concerns, the Australian Council for Educational Research, which devised the Gamsat, held a seminar in London last May.

Representatives of 17 of the UK's medical schools went along to discuss the development of a new university selection test, the Medical Schools Admission Test (Msat), tailored to the UK. The first exams, which will cost ?15 per candidate, will take place at King's College London in January. The ACER will maintain control and, as with the Gamsats sat in the UK, papers will be sent to Australia for marking.

The UK has no body equivalent to the ACER, but other contenders in the admissions test stakes are emerging closer to home. In two weeks, students applying to the Royal Free and University College London Medical School, as well as to the medical schools of Oxford and Cambridge universities, the Cambridge Veterinary School and the Oxford Physiological Science course, will be guinea pigs for a pilot Biomedical Admissions Test (Bmat). The test, which was devised by the University of Cambridge Local Examinations Syndicate, will cost ?15 per candidate. Students will take the two-hour test in their own school or one near by.

The Bmat will not, in its first few years at least, be used to select for interview. As with other admissions tests, the hope is that it will provide extra information for admissions tutors comparing candidates from different backgrounds or with different qualifications.

Sir Derek Roberts, provost of University College London, thinks it will level the playing field. "It will provide an opportunity for the brightest and the best to compete for admission to medical school on an equal footing, irrespective of their background," he says. But is there evidence to support such optimism?

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St George's Medical School is about to publish a paper that examines its graduate medical school intake. According to admissions tutor Patricia Hughes, there is a strong correlation between A-level results and Gamsat scores. In the US, results from college SATs (which used to be known as Scholastic Aptitude Tests) are found to correlate directly with a candidate's family income, even though the tests were introduced to provide an objective measure of ability. The College Board, which runs the SATs, asks teenagers taking the exams to note their family income, and it has found a marked rise in scores for every extra $10,000 (?6,000) of family income.

Research shows that for most exams, performance tends to improve with practice (giving rise to a cottage industry in crammers). There are no set texts or accredited academies linked to the Gamsats, but a handful of organisations have been quick to offer prospective applicants revision help - at a price.

Many academics remain unconvinced about the case for admissions tests on the grounds that they deepen social inequality. One university academic who prefers to remain anonymous says: "If educational institutions wish to see a wider social participation in academic excellence, the answer lies in resourcing and improving state primary and secondary education - admissions tests simply examine how well people are prepared for the admissions test."

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Despite the inconclusive case for admissions tests, a growing number of pupils who have already been through the UK's test-heavy schooling system are likely to face another day in the exam hall. What is certain is that the conditions in which exams such as Gamsats are held will have to improve.

Many of this year's candidates criticised the fact that they were held at sites across London only. Moreover, those taking exams in the Royal Horticultural Halls had to queue outside for at least 20 minutes on a cold wet day before gaining entry because of the number of people taking part.

Queues for security checks were followed by queues for the cloakroom.

One candidate from Sheffield says: 'What got me was that it was impossible for everyone to get to the toilets during the breaks between the exam papers. The queues for the loos were really long. In the end, I had to leave the exam room during one of my papers, which I was a bit annoyed about."

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The Universities and Colleges Admissions Service, which administered the Gamsats, blames teething troubles. A spokesperson said: "The arrangements for the test had been made before Ucas took over the administration and before the unexpectedly high demand was known." For the 2004 test, Ucas will use several smaller test centres with better facilities. Small details, perhaps, but these things matter when the stakes are so high.