• I C McManus, P Richards, B C Winder, K A Sproston, and V Styles.
• St Mary's Hospital Medical School, Imperial College of Science, Technology and Medicine, London.
• BMJ. 1995 Feb 25; 310 (6978): 496-500.

ObjectiveTo assess whether people from ethnic minority groups are less likely to be accepted at British medical schools, and to explore the mechanisms of disadvantage.DesignProspective study of a national cohort of medical school applicants.SettingAll 28 medical schools in the United Kingdom.Subjects6901 subjects who had applied through the Universities' Central Council on Admissions in 1990 to study medicine.Main Outcome MeasuresOffers and acceptance at medical school by ethnic group.ResultsApplicants from ethnic minority groups constituted 26.3% of those applying to medical school. They were less likely to be accepted, partly because they were less well qualified and applied later. Nevertheless, taking educational and some other predictors into account, applicants from ethnic minority groups were 1.46 times (95% confidence interval 1.19 to 1.74) less likely to be accepted. Having a European surname predicted acceptance better than ethnic origin itself, implying direct discrimination rather than disadvantage secondary to other possible differences between white and non-white applicants. Applicants from ethnic minority groups fared significantly less well in 12 of the 28 British medical schools. Analysis of the selection process suggests that medical schools make fewer offers to such applicants than to others with equivalent estimated A level grades.ConclusionsPeople from ethnic minority groups applying to medical school are disadvantaged, principally because ethnic origin is assessed from a candidate's surname; the disadvantage has diminished since 1986. For subjects applying before A level the mechanism is that less credit is given to referees' estimates of A level grades. Selection would be fairer if (a) application forms were anonymous; (b) forms did not include estimates of A level grades; and (c) selection took place after A level results are known.

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