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

Follow the policy: An actor network theory study of widening participation to medicine in two countries

INTRODUCTION

The slow pace of change in respect of increasing the diversity of medical students suggests powerful actors are reproducing practices to support the status quo. Opening up medicine to embrace diversity thus requires the deconstruction of entrenched processes and practices. The first step in doing so is to understand how the actor-network of widening participation and access to medicine (WP/WA) is constructed. Thus, here we examine how the connections among actors in WP/WA in two different networks are assembled.

METHODS

A comparative case study using documents (n = 7) and interviews with staff and students (n = 45) from two medical schools, one United Kingdom and one Australian, was used. We used Callon's moments of translation (problematisation, interessement/operationalisation, enrolment, mobilisation) to map the network of actors as they are assembled in relation to one another. Our main actant was institutional WP to medicine policy (actor-as-policy).

RESULTS

Our actor-as-policy introduced five other actors: the medical school, medical profession, high schools, applicants and medical school staff. In terms of problematisation, academic excellence holds firm as the obligatory passage point and focal challenge for all actors in both countries. The networks are operationalised via activities such as outreach and admissions policy (e.g., affirmative action is apparent in Australia but not the UK). High schools play (at best) a passive role, but directed by the policy, the medical schools and applicants work hard to achieve WP/WA to medicine. In both contexts, staff are key mobilisers of WP/WA, but with little guidance in how to enact policy. In Australia, policy drivers plus associated entry structures mean the medical profession exerts significant influence.

CONCLUSIONS

Keeping academic excellence as the obligatory passage point to medical school shapes the whole network of WP/WA and perpetuates inequality. Only by addressing this can the network reconfigure.

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.

Institutional choice among medical applicants: a profile paper for The United Kingdom Medical Applicant Cohort Study (UKMACS) prospective longitudinal cohort study

PURPOSE

To generate a large cohort of those in 2019 seriously considering applying to study Medicine, collecting data on a range of socioeconomic and other demographic factors that influence choice of medical schools and to link to other datasets to form a longitudinal study of progress through medical school and careers in medicine.

DESIGN

Cross-sectional questionnaire studies, part of the longitudinal UK Medical Applicant Cohort Study (UKMACS).

SETTING

UK medical school admissions in 2020.

PARTICIPANTS

UK residents aged 16+ and seriously considering applying to study Medicine. The cohort was primarily drawn from those registering in 2019 for the U(K)CAT (University Clinical Aptitude Test (formerly the UK Clinical Aptitude Test)) with additional potential applicants responding to an open call. Participants consented to their data being linked within the UK Medical Education Database.

FINDINGS TO DATE

UKMACS Wave 1 questionnaire respondents consisted of 6391 consenting respondents from across the UK. In 2019, 14 980 of the 17 470 UK-domiciled medicine applicants were first-time applicants. The questionnaires show that many of these applicants have a need for more help and guidance to make informed choices, with less advantaged groups reporting themselves as being at a disadvantage when applying due to limited understanding of information and limited access to guidance to enable informed and effective decision-making.

FUTURE PLANS

To link the cohort with successive Universities and Colleges Admissions Service and other datasets to analyse outcomes of applications and establish national longitudinal evidence to understand how medical choices are made and how they impact on educational, career and workforce outcomes.

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

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.

Drastic times need drastic measures: COVID-19 and widening access to medicine

In response to COVID-19, schools, colleges and universities across the world have closed or shifted to online/remote or blended teaching, learning and assessment. These changed ways of working pose challenges to students and will likely exacerbate existing educational attainment gaps between different societal groups. Our focus is the potential impact of COVID-19 on widening access to medicine. We provide an account of the process, in the form of comparative cases, of applying for medical school for two applicants from differing backgrounds. Three challenges were identified: family circumstances and support (financial security and parental educational support); staying connected (access to educational material, technology and Wifi); getting the grades and meeting other entry criteria (predicting grades and work experience). We propose that medical schools adopt drastic measures to protect widening access including increasing the use of aptitude tests, contextualised admissions, online multiple mini interviews (MMIs), creative outreach and promotion of alternative means of gaining relevant experience.

Getting to know our non-traditional and rejected medical school applicants

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"The biggest barrier was my own self": the role of social comparison in non-traditional students' journey to medicine

INTRODUCTION

Social comparisons strongly influence an individual's concept of self, their aspirations and decisions. This study investigates how non-traditional applicants used social comparison to shape their preferences, beliefs and predictions whilst preparing an application for medical school.

METHODS

Semi-structured interviews were conducted with 12 UK medical students from non-traditional backgrounds to explore their process of 'getting ready' for medical school, and the role social comparison played in their experiences. Thematic analysis was used to inductively develop themes in the data, before findings were interpreted through the 'triadic model' of social comparison.

RESULTS

Findings revealed that participants looked to the opinions of those with similar norms and backgrounds to accept their desire to study medicine. They sought the opinions of 'experts' to affirm a belief in their suitability but lacked confidence until success in crucial examinations 'proved', in their own view, that they had the ability to do medicine. Social comparison to peers who were perceived to be less committed to medicine, and to relatable role models, reassured participants that someone from their background could succeed in medicine.

DISCUSSION

Our findings further understanding about 'how' and 'why' exposure to relevant experts, peers and role models can positively influence application to medicine through the lens of social comparison. We recommend widening access initiatives promote and foster various opportunities for social comparison to help counter non-traditional students' feelings of uncertainty about their ability and prospects, and to reorient their focus away from achieving the required grades before preparing the non-academic aspects of their application.

Medical career expectations of academically talented high school students: a nationwide cross-sectional study in China

BACKGROUND

Academically talented high school students (ATHSSs), an exceptional cohort, are not well studied for their career expectations, especially for those with medical career expectation (MCE). Nowadays, the public perception of the medical profession is changing in China. The purpose of this study was to answer questions about 'is medicine attractive for ATHSSs and 'what factors affect medical career expectations (MCE) for ATHSSs' in China.

METHODS

A total of 16,479 representative ATHSSs in senior three completed a questionnaire and four different academic tests. Frequency statistics showed the proportion of ATHSSs with MCE. Unpaired t-tests were performed to find out the differences in demographics, family background, and academic performance between students with and without MCE. The logit models analysis were applied to explore the potential factors that affected the MCE of this exceptional group of students.

RESULTS

ATHSSs with MCE accounted for 20.6% (ranking 7/18) of the respondents. They were more likely to be female, came from relatively poorer families, lived in a rural area, and performed significantly worse in all academic tests except for mathematics, compared with those without MCE. In addition, the results revealed that gender (β = - 0.436, p < 0.01), region of hometown (β = - 103, p < 0.1), mother's years of schooling (β = - 0.019, p < 0.05), and father's occupational status (β = - 0.005, p < 0.01) contributed significantly to the MCE of academically talented students. Better performance in mathematics affected the MCE of ATHSSs taking the liberal arts and science tests differently.

CONCLUSIONS

We found the medical career is becoming unattractive to academically talented students and the medical career may be losing their aura in China. Students who have medical career expectations are likely to be females and to have a weak family background.