A new degree could provide a cure for medical elitism

Most students who graduate this summer will have to make do with parents' pride and polite applause. Three King's College London (KCL) medics, who graduated last Friday under the gothic arches of Southwark Cathedral, are getting a little more attention, winning plaudits from the great and the good, among them Prime Minister Gordon Brown and Desmond Tutu.

The three graduates of KCL's extended medical degree are the first wave of a small revolution in medical training that some hope may at last provide an answer to accusations of prejudice and elitism in medicine and across higher education.

Last week the Sutton Trust reported that only 17 per cent of top medics went to comprehensives, the same percentage as 20 years ago. It is easy to see why. In 2003, according to the British Medical Association, nine out of 10 medical students were middle class, middle-class applicants had twice the chance of being accepted as their working-class peers, and whites had nearly twice the chance of getting into medical school as blacks.

In 2001 KCL decided to do something about those figures. They designed a six-year medical degree – it is usually five – open to pupils from non-selective state schools in 10 inner-London boroughs with below-average exam results and rates of progression into higher education.

Instead of demanding the usual high grades and impressive extracurricular credentials, applicants are judged on school reports, interviews and mental agility tests. Most offers are three Cs at A-level, but one student was admitted with CDD. He is now in the top 15 per cent of all KCL medical students in his year.

"We're not trying to take academically inferior students," says Dr Pamela Garlick, the course director at KCL. "We're taking students who would have got three As or four As if they had been to a high-achieving school. We're taking people who are exactly the same academically as the conventional students."

Students on the scheme must do the same exams and must pass to the same standard as other students. The extra year is spent on extra subject teaching, mostly better biology, as well as academic English and study skills. The course, funded by the Higher Education Funding Council for England (HEFCE), started with nine students. There are now nearly 200 students on the programme, with KCL recruiting 50 students each year.

Many universities and medical schools have access programmes, with visits to local schools and offers of work experience. The belief is that able children are not realising their potential because of low expectations. However, for many children in inner city and rural comprehensives low expectations are realistic. Last year only 13 per cent of the students with the three As usually required to study medicine came from working-class backgrounds.

"When we set up the project even the most motivated and bright kids in those schools were never going to pull off the grades that would get them into a conventional medicine course," says Gavin Brown, Access to Medicine project manager at KCL.

The programme has given these young people a chance to study medicine and helped raised expectations and grades, says Dr Brown. Not only are the more recent applicants getting better A-levels, but other pupils at the targeted schools are achieving the grades necessary to gain entry to conventional medicine courses.

The new medical degree seems to be reaching those who need it most. Although applicants are not means tested, almost all qualify for means-tested bursaries under the new rules, with 60 per cent of last year's intake from households with an income under £18,000 qualifying for full grants.

"It's given us a wonderful opportunity," says Stella Adesoye, one of the medics who graduated last week. Dr Adesoye had always dreamed of becoming a doctor but received no offers when she applied for medical school. "This course is a testament to the fact that there are people out there who aren't the stereotypical textbook doctor, but who have the potential to go on and do well on the degree and as doctors," she says.

Taking Adesoye and the other students on was a bold and undoubtedly well-intentioned step by KCL. Was it a wise one? Only three of the nine students taken on to the programme six years ago graduated on Friday. One has spent an extra year getting a BSc, but four are repeating a year after failing exams, and one dropped out altogether.

The numbers repeating a year, at least in the first intake, are higher than usual, but that, argues Dr Garlick, simply reflects more complex and less stable home lives than academic ability. During the course one of the original nine, she says, suddenly found himself the sole breadwinner for his family.

The university points to a 90 per cent overall retention rate on the course, a little less than the norm on the conventional course, to demonstrate its success. And the students, say professors, catch up fast. Even in the first three years the top 10 per cent of the extended medical degree students are in the top 15 per cent of their year.

Are other universities going to follow suit? Some already have. The KCL model of looking beyond A-level grades to other tests of ability has been taken up by Southampton University, which in 2002 launched a means-tested six-year medicine degree. Retention on Southampton's course is around 80 per cent. The University of East Anglia's medical school starts a similar course in September. It has also spread to other subject areas. At Southampton an access programme is available in engineering, and the university is considering applying it to law.

One problem for universities considering following suit is money. "It does cost," says Dr Chris Stephens, director of education at Southampton's school of medicine. "These students require a lot of support." And some medical students are suspicious of what they see as positive discrimination. "It can be controversial," says Emily Rigby, chair of the BMA's medical students committee. "There is a concern that if this became the usual way to get into medical school, it would be unfair on students who work very hard and achieve the grades. It's a very fine balance."

But many in the profession welcomes the prospect of a more diverse medical community. A medical community that better reflects society, says Rigby, will be better able to serve it.

It is a diverse community that has so far proved elusive. Professors at KCL believe that their course may be the answer. "You can do a whole load of work going in to schools and raising aspirations," says Dr Brown at KCL. "But if universities don't make changes to their admissions criteria and potentially also to their curriculum they're only doing half the job."