A level grades are a blunt instrument

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The report last week that the UK Government is being ‘forced’ to fund more places in English universities to train doctors and dentists as a result of ‘grade inflation’ raises more questions than it answers. At a simplistic level, the problem is easily understood – if pupils get higher grades at A level than would have been the case had they sat exams, then more people will meet the grade-based criteria for entry onto the courses. But if those people are suitable to become doctors and dentists under one system, what is it about sitting exams which would somehow have made them unsuitable? If Pupil X gets an A* when assessed by his or her teachers but ‘only’ a B in an exam, why is the same pupil, with the same knowledge and abilities, doctor material in the first case but not in the second? How do we ‘know’ that pupils with an A* grade obtained in an examination can go on to be successful doctors and dentists, whilst those with a B cannot?

Using grades obtained by an adolescent in his or her last year at school as an absolute determinant of his or her future career prospects seems almost designed to waste a lot of potential talent. Clearly, the grades obtained by pupils at A level tell us something about how much work and effort those pupils have expended, how much knowledge they have accumulated, and how likely they are to apply themselves to their work at university, but they aren’t – and can’t be – as definitive as the way in which they seem to be being used. Exams are in some ways a blunt instrument; they are not an assessment method which suits all, and the circumstances in which a pupil finds him or herself on one particular day may not be representative of that pupil’s general character and approach. And although all of us want those providing our medical care to have the necessary knowledge and expertise, it’s not at all clear that the precise grade obtained in A level Biology is a particularly good indicator of that.

We know that there is a shortage of doctors and dentists in the UK, and that the UK is simply not training enough to meet our needs. We also know that this is a problem which cannot be resolved quickly, given the length of time it takes to train people. But neither is it a recent problem: it is a long-running problem under successive governments, whether Tory or Labour, which share an ideological commitment to competition and markets. What this so-called ‘grade inflation’ underlines is that that shortage is not a result of a lack of people wanting to become doctors and dentists, nor is it a question of their suitability for the role. It is the result of decisions by successive governments to limit the number of places, largely on financial grounds. They have made a deliberate choice to train fewer than we need and recruit people trained outside the UK instead, in the process not only rejecting many of those who want to follow careers as doctors and dentists and have the ability to do so, but also depriving other countries of the benefits of their own investment in training. Any government which was serious about providing proper health care for its citizens would start by looking at how many people it needs to train to provide that care and then provide enough places to meet that need, rather than setting a financially-driven cap on the number of places and filling those places through market-style competition. It is yet another example of a government decision driven by ideology rather than need.