A-level grades and medical school admission.

Over the past decade there has been a rapid increase in the Alevel grades required for admission to British medical schools. This has worried those concerned in selecting and preparing potential students. The explanations put forward for this sudden increase in grade requirements are speculative and usually take one of three forms: there has been an inflation of A-level grades, and an A grade has become devalued; there has been an increased demand for medical school places, perhaps due to a worsening economic climate, and hence medical schools can afford to select only the best students; and there has been a structural change in the method of selecting medical students. This structural change may be due to a policy in some medical schools not to interview candidates but instead to set high Alevel requirements, thus allowing the A-level examiners to do the actual work of selection and simultaneously pushing up entrance requirements; to an increasing tendency to offer conditional places before students have taken A levels; and to a tendency to take a higher proportion of candidates without A levels in biological subjects. I have examined available statistics to attempt to distinguish these hypotheses. I have assumed-for convenience and in the absence of more adequate statistics-that students in general take A levels at the age of 17 and enter university at 18. Figure 1 (top) shows the basic phenomenon to be explained. Between 1969 and 1980 there was a rapid increase in the proportion of entrants to medical school with 13 or more A-level points from three A levels (the system of calculation gives five points for an A grade, four for a B, etc; few students enter medical school with only two A levels). In particular, the rise was sharp for men entering between 1969 and 1975, though the same effect was apparent for women. For the period 1976 to 1980 requirements were steady; over the same period, the only one for which data are available, the qualifications of applicants rejected were also stable. For comparison (fig 1 (bottom)) the A-level grades of successful and unsuccessful applicants for all university places have been stable for more than a decade. Has there been inflation in the value of an A-level grade? Figure 2 (top) shows the proportions of students taking science A levels who gain particular grades. These proportions are remarkably constant, and I suspect that the examiners arrange the system so that this will be the case. Over the period of this constancy in grade proportions, however, there was a large increase in the number of entries for A-level exams, particularly among women (fig 2 (centre)), though the increase was relatively less for science subjects. The position is complicated further by variation in the size of the eligible population of the correct age (17) for taking the exams (fig 3) due to large fluctuations in the postwar birth rate. So when we examine A-levei entrants (assuming: on average, three subjects per person) as a proportion of the eligible population (fig 2 (bottom)) it is clear that since 1970 the percentage of men taking A levels has been constant, and, particularlv for science subjects, there has been almost no systematic change in either sex. Hence the proportions in fig 2 (top) are applied to populations of roughly equal ability, and inflation should be of little consequence, assuming that there has been no large-scale shift of pupils of higher ability from non-science to science subjects. Furthermore, any inflation of A-level grades has been relatively gradual and hence is unlikely to have accounted for the sudden dramatic shift shown in figure 1 (top).