Why A-level chemistry might not improve diversity in our doctors

Should A-level chemistry be a requirement to study medicine at university?

Why am I even asking this question? It is clear that chemistry underpins the whole of modern medicine. From understanding how DNA arranges itself into a helical shape to the development of new medicines and the chemical basis for neurotransmission, all of medicine requires us to understand how our bodies work at the molecular level. There are many more examples as detailed in my recent article, Why chemistry is essential for studying medicine at university. It is clear chemistry is essential, but is A-level chemistry?

A recent Times article revealed that some UK universities are considering changing their entry requirements to remove the chemistry A-level prerequisite. In the USA there has been a similar call to remove prior science attainment from selection criteria for medical school. I teach science to secondary school level and pharmacology in medicine at the University of Cambridge and, having previously been an admissions tutor for medicine, I’ve been keenly watching this development and the ensuing arguments, particularly because I also have an interest in widening participation.

There is a real need to widen the pool from which our medical students are drawn so doctors are more representative of society as a whole. The question is whether removing the requirement for A-level chemistry will have an impact on students applying from underrepresented groups. Time will tell, but there are parallels with improving diversity within engineering and some universities removing the requirement for A-level physics a few years ago. Since A-level physics is overwhelmingly male dominated, it was thought that removing the A-level physics requirement for engineering and teaching the necessary physics at university instead would improve the gender balance in the intake. While full analysis of this is not yet available, it appears that the backgrounds of applicants are widening. However, it has not had the expected impact on gender balance. A thorough analysis of admissions data before and after these changes will be essential to understand the impact this experiment has had.

If universities relax the A-level chemistry requirement, it will be important to ensure that students who begin medical school without a strong background in chemistry are able to catch up without being overwhelmed. Talking with colleagues in Australia and New Zealand where several universities do not require students to have studied chemistry at school, it is clear that the first year of medicine is extremely challenging for those students. Most medical courses have a large amount of material to cover and usually go through it quite quickly: anyone who is less well prepared is likely to struggle. It is therefore crucial that those who do not have adequate preparation receive support to ensure they are able to keep up.

Aside from the argument around widening participation there is also the question of whether it is desirable to teach the chemistry required at university within the context of medicine rather than at sixth form. While there is a significant amount of relevant content in A-level chemistry, there is also quite a lot that is unrelated. Students who are really interested in medicine rather than chemistry in its own right may well end up being frustrated by irrelevant content at A-level. I have asked medical students whether they needed the chemistry they learned at A-level and many do not recognise how the concepts they learned are applied in medicine. When teaching pharmacology to students who have A or A* at A-level chemistry, I often need to explain some chemistry concepts and show directly how they are applied in medicine to help students consciously make that connection. This suggests that simply getting an A at A-level chemistry is insufficient to ensure students can use the chemistry they’ve learned. Logically, this leads to the conclusion that it might be better just to teach it within the medical course along with all the other aspects of physics, biology and maths that are relevant to medicine.

If the requirement of A-level chemistry for medicine is removed by more medical schools, it is quite likely to have a significant impact on the numbers of students studying it and therefore their teachers. While I’m very sympathetic, having a PGCE in secondary chemistry, I’m finding it very difficult to justify making it a prerequisite.