Top A-level results are not always necessary for students to succeed in medicine, according to the authors of a paper in this week’s BMJ. Students with average grades, who come from economically and educationally deprived areas, can do well at medical school provided they have extra academic and pastoral support during their first two years.

Becoming a doctor has traditionally been seen as the preserve of the professional middle classes—over three quarters of conventional medical students come from this background. Yet it is now acknowledged that the UK needs more doctors who better represent the diverse social and ethnic population of the country. As such, widening participation initiatives have become an important component of most UK Higher Education Institutions.

The paper, written by the academics behind such an initiative at King’s College London, analyses their success. The Extended Medical Degree Programme (EMDP) began in 2001. Its remit was to enable bright students from low-achieving state schools in Inner London to become doctors. Initially ten extra places were made available for these students each year and the first cohort graduated in 2007. To be accepted students needed to get CCC at A level, rather than the traditional AAB.

Students on the EMDP course are given an extra year of studying—the first two years of the traditional five year degree are spread over three—to allow for more academic and pastoral support.

Most of the students are the first in their family to go to university and come from different backgrounds from the majority of students. To help them adjust, EMDP students are also given extra support including an induction week, student mentors and personalised learning programmes.

Nine out of ten students so far accepted on to the EMDP programme are from ethnic minorities and just under a third (31%) from middle-class families. This compares with 51% and 76% respectively for students from “conventional” backgrounds.

The data shows that, despite the lower entry grades, the exam results of these students have been spread fairly evenly throughout the entire year group of 360–400 students. First time pass rates have generally been slightly lower for EMDP students, however in the clinical years (years 4–6) first time pass rates are identical for both conventional and EMDP students (93%). Of those who opted to do an intercalated BSc, 12% got a first, 76% an upper second and 12% a lower second, compared with 28%, 65% and 7% respectively among conventional students.

Over 200 students are now on this programme and doing well, so the authors say they can safely conclude that “medical students can succeed without AAB at A level” (as long as these results were obtained from a low achieving school) and as a result the widening participation programme is creating “a new type of doctor…[that] better reflects the social diversity of London’s population.”

In an accompanying editorial, Hugh Ip and Chris McManus discuss whether the more diverse population of doctors resulting from the widening participation initiative will better serve a diverse population of patients. They also question if the £190 000 spent each year on the EMDP programme is money well spent.

Source: British Medical Journal