Private schooling and admission to medicine: a case study using matched samples and causal mediation analysis

BACKGROUND Are applicants from private schools advantaged in gaining entry to degrees in medicine? This is of international significance and there is continuing research in a range of nations including the USA, the UK, other English-speaking nations and EU countries. Our purpose is to seek causal explanations using a quantitative approach. METHODS We took as a case study admission to medicine in the UK and drew samples of those who attended private schools and those who did not, with sample members matched on background characteristics. Unlike other studies in the area, causal mediation analysis was applied to resolve private-school influence into direct and indirect effects. In so doing, we sought a benchmark, using data for 2004, against which the effectiveness of policies adopted over the past decade can be assessed. RESULTS Private schooling improved admission likelihood. This did not occur indirectly via the effect of school type on academic performance; but arose directly from attending private schools. A sensitivity analysis suggests this finding is unlikely to be eliminated by the influence of an unobserved variable. CONCLUSIONS Academic excellence is not a certain pathway into medicine at university; yet applying with good grades after attending private school is more certain. The results of our paper differ from those in an earlier observational study and find support in a later study. Consideration of sources of difference from the earlier observational study suggest the causal approach offers substantial benefits and the consequences in the causal study for gender, ethnicity, socio-economic classification and region of residence provide a benchmark for assessing policy in future research.