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Medical school aptitude tests ‘inherently biased’, study finds

By Lilian Anekwe

Aptitude tests designed to increase diversity and fairness and widen access to medical schools for women and less advantaged students are failing because they have ‘inherent gender and socioeconomic bias', a BMJ study has found.

The analysis concluded that the UK Clinical Aptitude Test (UKCAT), a key element of the admissions process at all of the UK's medical and dental schools, is biased in favour of male applicants and those from private schools.

The finding will reopen the debate about whether the medical profession is a ‘closed shop' to female students and those from less privileged backgrounds.

A Pulse investigation in August found a growing divide in the chances of state school applicants being accepted onto medical courses compared with their privately educated counterparts, findings mirrored in report by the BMA and the Government's Panel on Fair Access to the Professions.

The UKCAT was introduced in 2006 in an effort to open up medical schools to students from all backgrounds, by selecting students on the basis of identified aptitude rather academic achievement, which is dependent on both the type of school students attend and other socio-economic factors.

The UKCAT was also seen as a more discerning way of discriminating between a growing pool of students who achieved top grades at A level.

But a comparison of the first cohort of students' performance at A level and on the UKCAT found that although there was a modest correlation between A level and UKCAT scores, there was an 'inherent favourable bias to men, and students from a higher socioeconomic class, or independent or grammar schools'.

The study looked at nearly 10,000 applicants to 23 UK medical and dental schools in 2006 who achieved three pass grades at A level. Researchers found four independent predictors of overall success at or above the 30th centile.

Candidates in this high-scoring group were 51% more likely to be male and more than twice as likely to be white than those below the 30th centile.

Students who scored highly were also 34% more likely to be from a professional or managerial family background than those who achieved lower scores, and 91% more likely to have gone to an independent or grammar school.

Professor David James, director of medical education at the University of Nottingham Medical School, led the study and concluded: ‘The introduction of an additional new selection tool is reasonable only if this improves the selection process. This finding, and the inherent socioeconomic bias, leads us to be cautious about the use of the UKCAT and the value of any one specific sub-test within an admissions policy.'

The BMJ study found medical school aptitude tests are 'inherently biased' The BMJ study found medical school aptitude tests are 'inherently biased'