This year’s group of A level students who want to pursue medicine have already experienced considerable disruption. The government and universities must do all they can to support them, say Malcolm Reed, John Atherton, and Katie Petty-Saphon
The UK’s response to the covid-19 pandemic has been characterised by some real successes (preventing the NHS from being overwhelmed, for example, and qualifying medical students early to work in the NHS) and some notable failures (high mortality in care homes and problems procuring personal protective equipment). The controversy around the awarding of grades to young people whose A levels were cancelled has now been added to the list of failures.
Most medical students and doctors are aware that any predictive modelling process requires extensive validation before implementation. While there was insufficient time to validate the algorithm developed to provide calculated grades for A level and Advanced Highers candidates, it is now understood that avoiding grade inflation was the driving priority for the algorithm, even amid warnings that it would have a negative impact on students from less privileged backgrounds. After a very difficult week for many candidates, the government decided to use centre assessment grades (CAGs) provided by schools and colleges, rather than algorithm calculated grades.
While this news was a relief to many students, it does not level the playing field completely. A recent preprint study concluded that school predicted grades are overestimates in approximately 45% of cases. Underestimates are made in about 6.5% of cases, mainly affecting students from disadvantaged backgrounds. Furthermore, students from lower performing state schools with AAB or ABB A level grades who go on to medical school are likely to academically outperform students with AAA grades from independent schools.
Despite specific worries being clearly identified in relation to the outcome of grade changes delivered by the algorithm, the initial decision to proceed with it was still made in the knowledge that this exacerbated rather than ameliorated the negative outcomes for less advantaged students. This is a significant cause for concern.
Medical schools normally make more offers than they have places in order to ensure full recruitment. A consequence of the use of CAGs is that there are now many more students eligible to enter medical school than places available, but most schools are already full. In addition, many students who were initially rejected by their first choice school but accepted by their second choice may request reconsideration by their first choice.
The announcement by the Department for Education (DoE) that the cap on numbers for medicine and dentistry has been lifted is very welcome, as is the confirmation of additional funding from DoE and the Department of Health and Social Care for clinical placements for this year’s cohort. In reality, however, the number of places offered by medical schools is also dependent on funding clinical placements in the NHS. While this has been confirmed for this year only, it may not be available for students who may have to defer due to lack of capacity in some schools. Space in medical schools reopening after shutting down due to the covid-19 pandemic will be constrained by the requirement for social distancing in university campuses, which will have a particular impact in specialist facilities, such as anatomy suites.
All of this will result in some students being deferred until next year, potentially having an adverse impact on first time applicants in 2021, who have already experienced significant disruption to their school education. It is therefore essential that ongoing funding is available to enable a full intake of first time applicants next year alongside those deferred from 2020.
In addition to a commitment to students, medical schools have a societal responsibility to ensure that graduates are safe and competent to practise for a career of sometimes 40 or more years. In recognition of this dual role, medical schools have two regulators: the Office for Students (or an equivalent in devolved nations) and the General Medical Council.
Concerns have been raised that a proportion of this year’s entrants to medical school would not have gained entry in other years and will struggle academically with the course. It is true that medicine is a long course with rigorous student assessment, and while the majority of students graduate without problems, some do fail to progress to graduation. The current academic entry requirements to study medicine are undoubtedly elevated by the extreme competition for places. We don’t know the true minimum academic requirement for success, but it’s likely to be less than the current typical requirement for AAA at A level or equivalent.
Nevertheless, universities will need to ensure that they provide both academic support and other appropriate measures to ensure their students’ success and to maintain the safety of future patients. Pastoral and psychological support will be particularly important for this cohort of students who have experienced considerable disruption, which will continue at least for the start of their studies at medical school due to the ongoing impact of covid-19. We are confident that, with the appropriate support, this year’s entrants to medical school will flourish and make a valuable contribution to healthcare in the UK and beyond.
Future cohorts of students wishing to enter medical school must be enabled to sit their exams in person, even if this is done distantly, so that this year’s fiasco is not repeated.
Malcolm Reed is the dean at Brighton and Sussex Medical School and co-chair of the Medical Schools Council.
John Atherton is the pro vice chancellor and dean for the faculty of medicine and health sciences in the University of Nottingham and co-chair of the Medical Schools Council.
Katie Petty-Saphon is the chief executive of the Medical Schools Council.
Competing interests: Nothing further to declare.