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In 1979, fewer than a quarter of Cambridge undergraduates were women: now nearly half are. But while greater sex equality has been achieved in entry, the university has been concerned for some time about differences between men's and women's exam performance. Undergraduate women at Cambridge - and Oxford - consistently underachieve relative to men in the percentage of first-class marks attained, in contrast to more similar levels of achievement by both sexes at other UK higher education institutions.

Attempts to understand these differences have been inconclusive. They have focused on the possible impact of Cambridge and Oxford colleges becoming mixed, of women being selected through interviews in which male interviewers predominate, of the potential role of pre-menstrual symptoms when most exams are taken over only a week or so and of sex differences in exam styles and expectations.

Now, in one of the largest research projects of its kind completed in the UK, a study commissioned by Cambridge University into the social and psychological welbeing of its students has considered other explanations. For the first time, it has examined differences in course choice, together with entry qualifications and individual student personal dispositions and circumstances in looking at the issue.

The research was conducted by a group working in the Institute of Public Health in Cambridge and supported by King's, St John's and Trinity colleges on behalf of the executive of the University Counselling Service. It invited a 25 per cent random sample of all 4,800 students starting Cambridge courses in the 1995 academic year to participate and more than 800 did, providing information annually until completing their courses up to four years later. It concludes that although the sex difference in academic attainment is pronounced, with the men who participated awarded 60 per cent more first-class marks than the women, half of this difference is due simply to differences in academic course choice.

Final exam results vary markedly by subject studied and by faculty. For example, about one in four Cambridge undergraduates following science faculty courses is awarded first-class marks in final examinations in contrast to about one in seven in arts. And about 65 per cent of women choose arts faculty-based degree subjects, compared with just 40 per cent of men. Proportions of firsts awarded by individual degree subjects vary even more starkly. Again, it is the subjects favoured by women that tend to attract fewer firsts.

The study reveals marked variation in the award of first-class marks by qualifications on entry. It found students with high grades at either AS level or Cambridge Sixth Term Examination Papers were four times as likely to obtain firsts as those who did not achieve three A grades at A level (where at least three A levels were taken). While there were differences in entry qualifications by gender in this study (about a quarter of men in contrast to a sixth of women had entry qualifications at these highest levels) this only explained about 10 per cent of the difference in exam performance between men and women once course choice had been taken into account.

Inevitably, this knowledge contributes to dilemmas facing individual Cambridge colleges about widening access, not only for women but also perhaps for applicants from relatively disadvantaged backgrounds.

Finally, the study found social and psychological factors come into play. While there was a clear suggestion that the rate of episodes of depression and anxiety peaked at times coinciding with university examinations, the overall extent to which students report these conditions was found to be broadly equivalent to that of the general population. But the study discovered more than twice as many women as men report their degree courses to be extremely stressful. About 10 per cent of students each year reported seeking help for social or psychological problems from GPs, counselling or other support services, with women seeking help at about twice the rate of men - findings that are typical of university counselling services elsewhere in the UK. Those students reporting considerable social problems during their final year were much less likely to achieve a first in finals than those without such problems.

Cambridge has one of the lowest dropout rates of all publicly funded universities and colleges in the UK with less than 2 per cent of undergraduates aged under 21 failing to continue after their first year, compared with about 11 per cent in English higher education institutions overall. The current situation where about two-thirds of students who achieve three A grades at A level are from state schools but only about half of offers of places at Cambridge and Oxford go to state school students continues to stimulate efforts to widen access.

It is possible that more students may be encouraged to apply to Cambridge if they reflect on the relative rarity with which students discontinue their courses and on their likelihood of achieving good degrees - about 20 per cent of Cambridge undergraduates obtained firsts and up to 60 per cent upper seconds, compared with 8 per cent and 42 per cent respectively across all UK higher education institutions last year.

The annual round of applications for university entry will begin again shortly, and Cambridge (and Oxford) will continue to do their best to widen access, aided by organisations such as the Sutton Trust and the Target Schools Scheme. But the past two decades have been a time of unprecedented change. About one third of young people now enter higher education and participation by ethnic minorities and by women (now studying for a first degree in about equal proportions) has increased. While these figures suggest overall equality of access for previously under-represented groups, they disguise wide variations according to the subject areas chosen, whether students are studying full or part time and whether they are enrolled in pre or post-1992 universities.

This Cambridge study should aid a more informed debate of the extent and nature of students' psychological health and social problems, of their demand for support services and of sex differences in high academic attainment and provide insights for staff responsible for student welfare nationwide.

Paul Surtees is a Medical Research Council senior scientist at the Institute of Public Health, University of Cambridge. Further details of the report Student Mental Health, Use of Services and Academic Attainment by P. G. Surtees, N. W. J. Wainwright and P. D. P. Pharoah may be obtained from the Press and Publications Office, University of Cambridge.