Harsh truths on the clinical journey

Should psychology students from a Black, Asian and Minority Ethnic (BAME), or a low socioeconomic background, consider a career in Clinical Psychology? Are they aware of some of the harsh truths that they will encounter when embarking on this journey? 

It is well known that getting onto the clinical doctorate is tough competition. But exactly how tough is it? For the 2020 entry, only 18% of applicants succeeded in gaining a place on NHS Clinical Psychology training (University of Leeds). Although this is a 3% increase from the 2019 entries, it is still low when compared to the number of applicants. Furthermore, various universities have specific entry requirements, which toughen the competition. For example, Royal Holloway requires students who achieved a 2:1 at their undergraduate degree and have relevant work experience, to  also have a Masters degree and achieved a distinction, have a publication, or excellent A-level results (Royal Holloway). Whereas the University of Birmingham stated in their entry requirements that they do not accept applicants with a 2:2 at undergraduate level, even if they have a Master's or PhD (University of Birmingham). 

So, how do these requirements then reflect on the very small pool of candidates that are accepted onto the doctorate? An article written in The Psychologist highlighted that successful applicants were more likely to be from specific ethnic groups. In the 2018 entry, 16.7% of white applicants were successful, compared to 9.1% of Asian applicants, and 8.6% of Black applicants (The Psychologist). Furthermore, when focusing on socio-economic backgrounds, 20.6% of successful applicants were from the fifth quintile of socioeconomic status (richest), compared to the 9% from the first quintile (poorest). 

This disparity only grew in the 2019 entry. '16.6% of white applicants were successful, 6.8% of Asian, and 9.9% of Black (University of Leeds). Notably 34.8% of successful candidates were from quintile 5, whereas 6.1% were from quintile 1. Though there is currently no demographic data on the 2020 entry, a testimonial from a current clinical doctorate trainee supports what has been seen in previous years, where similarly their cohort is primarily White, with only a few Asian students and two Black students.

Why does this matter? It has been widely researched and acknowledged that individuals from lower socioeconomic backgrounds tend to have lower academic grades compared to peers from higher socioeconomic backgrounds, and this relationship with academic achievement is further confounded by race. A literature review conducted by the Widening Participation Research and Evaluation Unit at the University of Sheffield linked the ethnicity attainment gap to a variety of unique factors. BAME students are more likely to come from families of lower socioeconomic status and regions of low higher education attainment, and as a consequence are more likely to have part-time work during term time, which has been linked to lower attainment as there is less time to spend on studying (University of Sheffield). On top of this, parents of first-generation entrants are less likely to be able to provide advice and guidance on studies, further impacting attainment if schools also offer minimal advice and guidance.

It appears that if you are an individual from an ethnic minority background and your family has low socioeconomic status, the odds may be forever stacked against you. This is felt when applying to higher education courses, including the clinical psychology doctorate. Admissions teams at undergraduate level recognise this, and often provide contextual offers to students from underprivileged backgrounds to support them in attending higher education. However what do these A-level grades based on contextual offers mean for doctorate applications? Would their hard work not be regarded? This further feeds into achieving postgraduate qualifications, as an even smaller proportion of BAME individuals, and those from lower socioeconomic backgrounds, can afford to study a Master's degree and PhDs as these are often linked to having unpaid work experience, and clear career paths are preferred which PhDs do not often confer (The Guardian).

The A-level results controversy in 2020 truly highlighted just how deep this impact runs, where results were initially based on school achievement, creating a postcode lottery which by no means was a reflection of students' ability. Unsurprisingly, the ones affected the most were students from lower socioeconomic backgrounds, and the government eventually made a U-turn after outcry that the algorithm used to predict grades was inherently biased towards upgrading results of students in private schools, and downgrading results of those attending state schools. Although the doctorate entry requirements are not this unfair, it is still reminiscent of little consideration towards how much demographics can affect academic attainment above and beyond a student's ability. It is unfortunate to see that this racial and economical bias is also reflected in psychological careers in general. For example, in 2013, the Health & Social Care Information Centre showed that BAME professionals only make up 9.6% of qualified clinical psychologists in England and Wales (Office of National Statistics, 2018). 

We can no longer ignore how significant and influential the differences in economic status and race, and subsequent resources available, are in impacting grades. This bias, to many, may be a constant and unfortunate reminder of class and racial disparities in our society. 

There is an ongoing drive for more diversity within psychology professions, as it's been recognised by the BPS that a lack of BAME professionals can make it difficult for BAME service users to engage with support, and feel understood and that needs are met (BPS 2015, BPS 2020). Is it therefore not time for doctoral courses to rethink entry requirements? The outlined research has made it clear that the present system is not working. Some of the barriers to diversity are present at the entry level, and one way forward to level the playing field and allow BAME individuals to feel represented in statutory bodies can be to rethink the approach to supporting BAME individuals and those from lower socioeconomic backgrounds in entering the profession. 

- Franca Onyeama and Nadia Yates-Stephenson