"It's going to be hard you know…" Teachers' perceived role in widening access to medicine

Preparing for medical school selection: Exploring the complexity of disadvantage through applicant narratives

Background

Despite a growing drive to improve diversity in medical schools, those from state schools and less-advantaged sociodemographic backgrounds remain underrepresented. We explore applicants' approaches to preparing for medical school selection, considering the complexity of sociodemographic disadvantage in this highly competitive process.

Methods

Narrative interviews were undertaken with applicants to a United Kingdom medical school, exploring experiences of preparation for selection (n = 23). Participants were purposively sampled based on involvement in widening participation schemes, school background, gender, and ethnicity. Transcribed data were analyzed using Labov and Waletzky's analytic framework. Bourdieu's concepts of cultural capital and habitus provided a lens to constraints faced and variable experiences. This informed a consideration of the ways applicants approached and navigated their preparation, in the face of various constraints.

Results

Constraints to resources and support were often apparent for those from state nonselective (SNS) schools. These applicants and those beginning their preparation later (12-18 months before application) appeared particularly vulnerable to myths and misunderstandings about the application process and appeared less confident and less discerning in their navigation of preparation. Some of the applicants, particularly those from independent and state selective schools, appeared confident and competent in navigating the complexities of the application process, while others (often from SNS schools) were more frequently lost or stressed by the process.

Discussion

Those who lack particular preparatory tools or resources (materially, culturally, or perceptually) must "make do" as they prepare for medical school selection, In doing so, they may risk a haphazard, ill-informed or ill-equipped approach. Constraints to opportunities, more typically experienced by those from SNS schools, appeared to motivate the process of bricolage for a number of the applicants. Perversely, medical schools have introduced nonacademic requirements to level the playing field of disadvantage, yet applicants in this group appear to experience challenges as they prepare for selection.

Widening Access: what do dental school websites signal to prospective students?

Introduction Widening Access (WA) policies aim to ensure that a professional workforce reflects the community that it serves by facilitating the admission of applicants from under-represented demographics. WA has not been extensively studied in UK dental education. Website discourses are an important element in students' higher education choices and have the potential to engage those who might be under-represented.Methods Critical discourse analysis was used to investigate contents of the 16 UK dental school webpages in relation to WA, based on a previous study within medical education. Data were contextualised through identification of drivers and levers, as well as warrants of WA.Results Discourses emphasising social mobility, and the resultant advancement within social hierarchy of an individual, dominated the narrative rationalising WA as an initiative. WA was depicted as a mechanism to support applicants of high academic ability and exhibiting commitment to studying dentistry but who were unable to show their true potential due to their underprivileged backgrounds. This presentation portrayed dental schools as generous establishments, selectively granting career-advancement opportunities to disadvantaged students. Discourses on the benefits of WA for patient care and workforce diversification were largely absent.Conclusions Discourses representing WA on websites of UK dental schools are limited and do not portray applicants from deprived backgrounds or under-represented groups as individuals bringing unique positive benefits to dentistry and patient care. We encourage dental schools to consider alternate messages for attracting applicants from under-represented demographics.

Opening up the black box of a Gateway to Medicine programme: a realist evaluation

OBJECTIVES

A Gateway to Medicine programme, developed in partnership between a further and higher education setting and implemented to increase the socioeconomic diversity of medicine, was examined to identify precisely what works within the programme and why.

DESIGN

This study employed realist evaluation principles and was undertaken in three phases: document analysis and qualitative focus groups with widening access (WA) programme architects; focus groups and interviews with staff and students; generation of an idea of what works.

SETTING

Participants were recruited from a further/higher education setting and were either enrolled or involved in the delivery of a Gateway to Medicine programme.

PARTICIPANTS

Twelve staff were interviewed either individually (n=3) or in one of three group interviews. Nine focus groups (ranging from 5 to 18 participants in each focus group) were carried out with Gateway students from three consecutive cohorts at 2-3 points in their Gateway programme year.

RESULTS

Data were generated to determine what 'works' in the Gateway programme. Turning a realist lens on the data identified six inter-relating mechanisms which helped students see medicine as attainable and achievable and prepared them for the transition to medical school. These were academic confidence (M1); developing professional identity (M2); financial support/security (M3); supportive relationships with staff (M4) and peers (M5); and establishing a sense of belonging as a university student (M6).

CONCLUSIONS

By unpacking the 'black box' of a Gateway programme through realist evaluation, we have shown that such programmes are not solely about providing knowledge and skills but are rather much more complex in respect to how they work. Further work is needed to further test the mechanisms identified in our study in other contexts for theory development and to identify predictors of effectiveness in terms of students' preparedness to transition.