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Who makes the cut?

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Ellie Decamp on access to medicine

Before I joined the Sutton Trust I was a doctoral student researching the links between Literature and Medical History in the sixteenth and seventeenth centuries – blood, guts, gore and all!

My interest in the field hasn’t dried up and I was happily lecturing on bleeding basins and surgical operating chairs last night at the University of London. Last year I published a book called Civic and Medical Worlds in Early Modern English Literature: Performing Barbery and Surgery.

Back then, you didn’t need to go to university if you wanted to be a surgeon. You trained as an apprentice and would have shared your Company Halls with barbers (who did a lot more than just hair trimming at the time!).

Surgery (Chirurgerie) emerges from the world of the guilds and crafts, and comes from the Greekchiro, meaning hand. Physicians, by comparison, were the university educated, elite practitioners – and they were very dismissive of the less qualified surgeons. There was a distinct sense of hierarchy in this medical world but in spite of their ‘lesser’ training surgeons were phenomenal pioneers who overturned much outdated thinking.

Skip forward several hundred years and of course lots more has changed: you expect to be anaesthetised before a scalpel is put to your skin, you don’t go to the barber to have your teeth pulled, and you wouldn’t accept human remains as part of your doctor’s prescription.

But the idea of a medical elite is still profoundly felt, and now some would suggest that making it as a top surgeon is perhaps the most competitive and challenging medical route of all.

Obviously we want those who attend to our ailing, damaged bodies to be highly trained, expert practitioners. But access to medical school is increasingly the preserve of individuals from the most privileged backgrounds.

According to Sutton Trust research, nearly two thirds (61%) of top doctors were educated at independent schools (and only 16% of top doctors come through from comprehensives).

Medicine was part of the debate at our social mobility APPG inquiry into access to leading professions with access to work experience and exposure to good science teaching from a younger age being some of the issues discussed.

Health Education England is supporting our Pathways to Medicine programme at Imperial College and York-Hull Medical Schools over the next few years to help talented young people (16-18 year olds) from low and moderate incomes to access the profession. And we’re delighted that a new funder is giving us the opportunity to open the programme at another medical school later this year so that we can support more students.

The medical world needs erudition and talent, but it also needs innovators, the tech-savvy, those with grit and sticking-power in a tough NHS climate, and those whose bedside manner appeals to patients from all walks of life.

If we are just selecting our doctors and surgeons from a small pool, we simply limit the great benefits to the medical profession of cognitive and social diversity.