Social Inclusion or Social Engineering? The Politics and Reality of Widening Access to Medicine in the UK

Alexander, Kirsty; Cleland, Jennifer

doi:10.1007/978-3-319-78316-1_7

Cited by 13 publications

(15 citation statements)

References 79 publications

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“…Structural barriers may help explain why applications from those in lower socio‐economic groups have not risen significantly over the last decade despite changes in WA policy and practices, and attitudes. The alignment of medical school systems, education policies, market pressures and other stakeholders is required to address this barrier …”

Section: Discussionmentioning

confidence: 99%

“…The alignment of medical school systems, education policies, market pressures and other stakeholders is required to address this barrier. 73,74 The substantial demographic diversity within the participant group enabled us to include a breadth of views from participants living in very different contexts and cultures and attending different schools. The disproportionate number of female participants may be because girls tend to perform better at high school 75 and are more likely to apply for medicine.…”

Section: Perceived 'Fit' With Medicinementioning

confidence: 99%

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Bridging the cultural divide? Exploring school pupils’ perceptions of medicine

2019

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Context Literature published around a decade ago demonstrated that UK individuals from non‐traditional groups may not consider, or aspire to, medicine because of sociocultural barriers and instead may perceive medicine as ‘not for the likes of me’. Since this time, the UK higher education landscape has undergone significant change, with an increased emphasis on student choice and widening access (WA) initiatives. Consequently, the present study looks anew at the perceptions of medicine held by school pupils from non‐traditional backgrounds to assess whether sociocultural factors remain a major barrier to medicine. Methods Focus groups were conducted with 71 high‐achieving school pupils in their penultimate or final years (aged 16–18 years). Participants attended UK state‐funded schools engaged with medical school WA initiatives. Transcripts were analysed thematically using a data‐driven approach. Themes were then interpreted through the conceptual lens of the ‘reflexive habitus’, an adapted version of Bourdieu's classic concept. Results Participants did not perceive that sociocultural differences would deter them from aspiring to, or pursuing, the career of their choice. Some participants identified their ‘different’ background as a strength to bring to medicine. They reported that intrinsic motivators (personal interest and fulfilment) were most important in their own career choices. When asked what they believed might have motivated current medical students for the career, participants debated the role of extrinsic motivators (high status and income) versus intrinsic ones. ‘Hot knowledge’ (social contacts) from within medicine helped some participants reconcile any clash in perceived values and better imagine themselves in the profession. Conclusions These non‐traditional school pupils from schools engaged with WA initiatives appear to have embraced the belief that medicine is for anyone with the appropriate desire and ability, regardless of background. Furthermore, some pupils reported that some aspects of their ‘difference’ (diversity) could help enrich the workforce and patient care.

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Section: Discussionmentioning

confidence: 99%

Section: Perceived 'Fit' With Medicinementioning

confidence: 99%

Bridging the cultural divide? Exploring school pupils’ perceptions of medicine

2019

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“…It also highlights these teachers' prioritisation of pupils making their own choice of career. We suggest that the expectation for teachers in WA schools to advocate medicine cannot happen in isolation and instead that this requires the support of other stakeholders, policies and systems aligning to provide their pupils with opportunities to develop their capability, as well as better chances of actually achieving a place (Alexander and Cleland 2018;Gorman 2018). Acknowledging and understanding teachers' concerns and working with them to construct better partnerships and a more positive view of the journey to medicine, might be a tangible start (Greany et al 2014).…”

Section: Discussionmentioning

confidence: 97%

“It’s going to be hard you know…” Teachers’ perceived role in widening access to medicine

Alexander

Nicholson

Cleland

2020

Adv in Health Sci Educ

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Medical schools worldwide undertake widening access (WA) initiatives (e.g. pipeline, outreach and academic enrichment programmes) to support pupils from high schools which do not traditionally send high numbers of applicants to medicine. UK literature indicates that pupils in these schools feel that their teachers are ill-equipped, cautious or even discouraging towards their aspiration and/or application to medicine. This study aimed to explore teachers' perspectives and practices to include their voice in discussions and consider how medical schools might best engage with them to facilitate WA. Interviews were conducted with high school teachers in three UK regions, working in schools targeted by WA initiatives. Data were analysed thematically using template analysis, using a largely data-driven approach. Findings showed that although medicine was largely seen as a prestigious and worthwhile career, teachers held reservations about advocating this above other choices. Teachers saw it as their role to encourage pupils to educate themselves about medicine, but to ultimately allow pupils to make their own decisions. Their attitudes were influenced by material constraints in their schools, and the perception of daunting, long and emotionally difficult admissions requirements, with low chances of success. Medical schools may wish to work with teachers to understand their hesitations and help them develop the mindset required to advocate a challenging and unfamiliar career, emphasising that this encouragement can further the shared goal of empowering and preparing pupils to feel capable of choosing medicine. Reciprocally, medical schools should ensure pupils have fair opportunities for access, should they choose to apply.

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“…The fairy-tale endings of the initial texts evoke the social mobility discourse, which reflects that a university education breaks ‘the transmission of disadvantage from one generation to the next’ (p.231), 44 and is commonly promoted as the main purpose and benefit of widening participation in medicine in the UK. 19 45 46 While HE does enable social mobility for many students, 45 47 when presented alongside a deficit discourse, the social mobility narrative can reinforce perceptions that by attending university, under-represented students move from being ‘not good enough’ to being ‘more like the advantaged’ (p.11) 46 and in alignment with middle class values. 18 48 The university is cast as the gracious patron who grants these students a golden opportunity to achieve ‘better jobs’ and to ‘better myself’ (p.564).…”

Section: Discussionmentioning

confidence: 98%

Challenging the deficit discourse in medical schools through reverse mentoring—using discourse analysis to explore staff perceptions of under-represented medical students

et al. 2021

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IntroductionDespite the increasing diversity of UK medical students, students from low-socioeconomic backgrounds, some minority groups and members of communities with protected identities remain under-represented in medicine. In trying to ascertain why this under-representation persists, literature focuses on the barriers and challenges faced by under-represented students as opposed to the institution’s responsibility to remove or mitigate these obstacles. One UK University created a reverse mentoring scheme enabling students to mentor senior members of the medical faculty to help them understand the perspectives and experiences of students from minority backgrounds. This paper explores whether changes in staff perceptions of under-represented students resulted from engaging with reverse mentoring.MethodsThis qualitative study explored the impact of the reverse mentoring scheme. Staff mentees were required to write a narrative text about the Higher Education journey of an under-represented medical student before and after the reverse mentoring intervention. These texts were compared using discourse analysis to identify shifts in language use that demonstrated a change in perceptions.ResultsThe key themes from five senior staff members indicate a positive change in staff characterisation of the students and an acceptance of institutional responsibility for challenges faced. Initial texts revealed a superficial understanding of the student journey that focused on individual deficit but had fairy tale endings depicting the medical school as benevolent. The follow-up texts revealed a deeper understanding reflected by the portrayal of students as capable agents and containing pragmatic endings acknowledging the responsibility of the medical school.ConclusionThese findings highlight how removed senior staff can be from the reality of the student experience and that engaging with reverse mentoring helps to raise awareness and challenges the students face. This suggests a route for constructive change in medical schools and endorses the benefits of facilitating open discussion around educational inequity.

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Social Inclusion or Social Engineering? The Politics and Reality of Widening Access to Medicine in the UK

Cited by 13 publications

References 79 publications

Bridging the cultural divide? Exploring school pupils’ perceptions of medicine

Bridging the cultural divide? Exploring school pupils’ perceptions of medicine

“It’s going to be hard you know…” Teachers’ perceived role in widening access to medicine

Challenging the deficit discourse in medical schools through reverse mentoring—using discourse analysis to explore staff perceptions of under-represented medical students

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