Selection to medical school in Great Britain

British Medical Journal, April 3, 1999 by C Michael Steel, David Jackson, David W Sinclair, Stephen R Magee, D A Levison, D Parratt, J M Bland, Sheila M Gore, Chris McManus

There is no frame of reference. Does this phenomenon apply to medical schools only, to the universities as a whole, or to other sectors with high applications per place, such as Oxbridge, old universities, other high demand subjects? The analysis applies only to applicants in medicine. It seems unlikely that staff concerned with admissions to medical schools are universally racially prejudiced while those in other university sectors are not.

We should also admit that everybody is prejudiced, including ourselves. The language of this paper, which refers consistently to the "disadvantage" experienced by applicants from ethnic minorities, prejudges the issue, for example. In every walk of life, we should guard against prejudice, but we should not assume that a difference in success rate is in itself evidence that this is the explanation.

J M Bland Professor of medical statistics St George's Hospital Medical School, London SW17 0QT Email:mbland@sghms.ac.uk

[1] McManus IC. Factors affecting likelihood of applicants being offered a place in medical schools in the United Kingdom in 1996 and 1997: retrospective study [with commentaries by A Esmail and M Demetriou]. BMJ 1998;317:1111-7. (24 October.)

League tables only help if uncertainty is properly looked at

Editor--The article by McManus on selection to medical schools in Britain[1] gives a correlation in the order of 0.5--between a medical school's disadvantaging of ethnic minority applicants in consecutive years--which is not of itself evidence that there is structural racism, as Esmail thinks,[1] or that there are meaningful differences in success rates at in vitro fertilisation clinics.[2] Indeed, having ordered medical schools by their 1997 performance, McManus's figure 3 clearly shows classical regression to the mean[1]; there was a tendency for low disadvantage schools in 1997 to have higher estimated disadvantage in 1996, whereas high ranked disadvantage schools in 1997 tended to have lower estimated disadvantage in 1996.

There may be other empirical evidence of individual medical schools' "structural racism," such as important heterogeneity between medical schools in their disadvantaging of applicants from ethnic minorities, and this may be consistent between calendar years. But such evidence was not presented in McManus's paper. For example, Esmail condemned so-called "persistent offenders" among medical schools.[1] "Persistent offender" might mean: consistency between years of effect size (how greatly a medical school disadvantages ethnic minorities); or of its ranking between years. Esmail ignores the uncertainties in estimating annual disadvantage per medical school,[3] which are shown in McManus's figure 3. That there is overall disadvantaging of ethnic minority applicants is the primary message. Esmail seeks to delve deeper into heterogeneity between schools, but a full analysis on that issue was not given.

League tables do not help if glibly or popularly interpreted, as schools,[4] hospitals, and prisons know to their cost. The new data should be an impetus for change across medical schools. Indictment of individual medical schools goes beyond the published data and underlines the fact that league tables can be more hindrance than help.