There’s no advantage at all to having 4 A-levels over 3. Medical schools will only look at your top 3 grades so only take a 4th subject if you’re really interested in it and you’re sure that having the extra subject won’t pull down the rest of your grades. AAA is better than AABB as most medical schools have a requirement of minimum 3 As.
Same goes for taking an additional AS subject and an EPQ. Some universities give a lower offer to students who have undertaken an EPQ, but this often excludes Medicine. I can’t think of any medical school that does lower the grade on the basis of the EPQ, but you might want to have a read of the application criteria on each university’s website properly to make sure for the ones you’re interested in. The only real benefit to doing an EPQ is the research skills and that you might be able to mention it in your PS or interview – I however didn’t use my EPQ at all at any point in my application.
I wrote a blog post, right after I finished applying for Medicine and submitted my EPQ about how much it benefits you, you might want to read it: Should you do the EPQ?
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