Diversity in wine and medicine

The first question I asked myself when I was appointed Professor of Academic Medicine and Director of (undergraduate) teaching and learning at Trinity College, Dublin, was: Is there an optimum way of selecting medical students? Apparently not. In Ireland, as in many countries, the number of applicants for places in medical schools far exceeds the number available. The selection process in Ireland depends on the number of ‘points’ a candidate obtains in the national ‘leaving certificate’ examination (the socalled CAO system). Although this system has been widely criticised, it provides a degree of fairness and prohibits parents from applying undue pressure to have their children selected for entry. I recollect many phone calls (exclusively from mothers) extolling the family’s contribution to the university and asking me to favour the selection of their offspring. Luckily (for me), I always said there was nothing I could do as it all depended on the grades achieved by the prospective candidate and the contribution of the family to the university was irrelevant. In the UK, selection of medical students depends not only on examination grades but also heavily on an interview with the prospective candidate. While an interview may provide important information, the pressure imposed on the selection board may become overwhelming, especially in a small country (such as Ireland). In France, each academic institution may have different admission criteria, and medical studies are divided into three cycles. The first cycle (PCEM) lasts 2 years. At the end of the first year, there’s a difficult examination which determines who goes into the second year. Usually, only 15–20% of students pass. This method of selection offers an opportunity for many students to enter medical school but after the first year only students who achieve high grades progress to the next year to continue their medical studies. In the USA, there is a mixture of state universities and private medical schools. In 2019, a scandal erupted when a criminal conspiracy was uncovered. This revealed an attempt to influence undergraduate admissions, by parents, at several top American universities. To date >50 people have been charged with bribery, money laundering and document fabrication and several have received prison sentences. I do not know if any medical schools were involved but the scandal certainly tainted the ‘fairness’ and diversity of admissions policies. In a 2021 paper in the New England Journal of Medicine, Morris and et al. report on Diversity of the National Student Body [1]. They found, not surprisingly, that the number of male AfricanAmerican, Hispanic and other racial ethnic group enrollees was well below the percentages of these groups in the national census. Richter et al. writing in the same journal in 2020 point out that women are much less likely to be promoted to higher academic positions than men. The authors offer a number of factors, including an ‘old boy’s club’ mentality which I presume means misogyny [2]. So, diversity is still an issue. Without going through every country, it is clear that there is no universal acceptable system of selecting medical school entrants and that there is diversity in the system of selection. Whatever about diversity in selection is there diversity in the social class or racial background of enrollees? It seems to me from observation that most medical undergraduates come from middleor upperclass backgrounds. In Trinity College, Dublin, an attempt was made to widen the social background of students entering medical school. The Trinity Access Programme (TAP) is an attempt to widen the scope of entrants to medical school. A number of TAP students who entered the school of medicine unfortunately dropped out. This was not only from a combination of ongoing