1
|
Simpson AV, Hope D. From policy to practice: Measuring success in widening participation. MEDICAL EDUCATION 2024. [PMID: 38767197 DOI: 10.1111/medu.15443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 05/09/2024] [Indexed: 05/22/2024]
Affiliation(s)
- Ashley Victoria Simpson
- NHS Lothian Medical Education Directorate, Edinburgh, UK
- Edinburgh Medical School, Edinburgh, UK
| | | |
Collapse
|
2
|
Ashley L, McDonald I. When the Penny Drops: Understanding how social class influences speciality careers in the UK medical profession. Soc Sci Med 2024; 348:116747. [PMID: 38547804 DOI: 10.1016/j.socscimed.2024.116747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 02/22/2024] [Accepted: 03/01/2024] [Indexed: 04/29/2024]
Abstract
In the UK, the medical profession is socially exclusive and socially stratified as doctors from more advantaged backgrounds are more likely to train for specialities with more competitive entry. However, in research to date the causes and consequences of social stratification have been overlooked. We explore this subject here, drawing on a qualitative study comprising in-depth interviews with 30 medical students and doctors from less advantaged socio-economic backgrounds negotiating medical school and early careers. Using Bourdieu's 'theory of practice' we show how socialisation in the family and at school influences how aspirant medics from less advantaged backgrounds view the world, suggesting some inclination towards more community orientated careers, which may be less competitive. However, these tendencies are encouraged as they lack stocks of social, economic and cultural capital, which are convertible to power and position in the field. While allowing for both choice and constraint our core argument is that speciality outcomes are sometimes inequitable and potentially inefficient, as doctors from more advantaged backgrounds have privileged access to more competitive careers for reasons not solely related to ability or skill. Our main theoretical contribution is to literature in the sociology of medical education where ours is the first study to open-up the 'black box' of causal factors connecting medical students' resources on entering the field of education and training with speciality outcomes, though our findings also have important implications for practitioners, the profession and for patients. We discuss the implications for safe and effective healthcare and how this informs directions for future research.
Collapse
Affiliation(s)
- Louise Ashley
- School of Business and Management, Queen Mary University of London, Mile End Road, London, E1 4NS, UK.
| | - Ian McDonald
- School of Business and Management, Royal Holloway University of London, Egham Hill, Egham, TW1 0EX, UK
| |
Collapse
|
3
|
Steward JM. Response to: "Evaluating the publication practices of medical students: A mixed-methods study". MEDICAL TEACHER 2024; 46:430-431. [PMID: 37962074 DOI: 10.1080/0142159x.2023.2276673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
|
4
|
Nolan HA, Roberts L. Trigger warnings as tools for learning-theorising an evolving cultural concept. MEDICAL EDUCATION 2024; 58:185-195. [PMID: 37528527 DOI: 10.1111/medu.15172] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/20/2023] [Accepted: 07/03/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND While definitions of trigger warnings vary, it is generally accepted that they caution about potential reactions arising from exposure to distressing material. Controversy surrounds use of warnings in education, with concerns noted regarding impacts on academic freedom, "coddling", thereby undermining resilience, reinforcement of traumatised identity and enablement of avoidance. Proponents of warnings position them as accommodations for those affected by trauma, enhancing inclusion, and suggest warnings empower choice and enable informed engagement in learning. A recent meta-analysis of warnings' efficacy demonstrated no effect on affective responses or comprehension. Findings regarding avoidance suggested warnings may increase engagement with material. Synthesis of heterogeneous results relating to context of warning application necessitates cautious interpretation of findings. Furthermore, controlled experimental designs do not reflect complex ecologies of social learning environments. METHODS Evidence relating to warnings in healthcare professions education remains limited. We undertake a narrative review and synthesis of evidence regarding the role and functions of trigger warnings from a range of disciplines, to inform healthcare education practice. We apply this evidence in considering how warnings may act within a range of theoretical frameworks for healthcare professionals educations including andragogy, self-directed learning and, ultimately, transformative learning. Tensions between exposure to emotionally stimulating learning episodes and the necessity of emotion for learning while simultaneously attending to learners' needs and fulfilling educators' responsibilities are explored. We probe gaps and contentions in existing theoretical frameworks for learning, and consider implications of recognised limitations with reference to warnings. We summarise by proposing a conceptual model for the role of warnings that considers wider salient factors for fostering effective learning. DISCUSSION AND CONCLUSIONS Difficulties associated with deriving contextually-relevant evidence and conclusions relating to warnings as an evolving cultural concept are highlighted. We propose warnings as tools to enable critical reflection and emotional literacy, to curate effective learning environments and support humanistic healthcare professional identity formation, within wider trauma-informed pedagogies and educator practice.
Collapse
|
5
|
Nolan HA, Owen K. Medical student experiences of equality, diversity, and inclusion: content analysis of student feedback using Bronfenbrenner's ecological systems theory. BMC MEDICAL EDUCATION 2024; 24:5. [PMID: 38172809 PMCID: PMC10765790 DOI: 10.1186/s12909-023-04986-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Issues relating to equality, diversity, and inclusion (EDI) significantly impact on medical student achievement and wellbeing. Interventions have been introduced at curricular and organisational levels, yet progress in addressing these issues remains limited. Timely evaluation is needed to assess effectiveness of interventions, and to explore issues and interactions in learning environments impacting on student experience. We introduced an anonymous question concerning students' experiences of EDI into routine online student feedback questionnaires, to scope the nature of ongoing issues and develop greater understanding of students' experiences in our programme environment. Ecological systems theory, which conceptualizes learning as a function of complex social interactions, determined by characteristics of individual learners and their environment, provides a framework for understanding. METHODS Free-text responses regarding experiences of EDI gathered over 20 months from all programme years (n = 760) were pooled for analysis, providing a holistic overview of experiences in the learning environment. A counting exercise identified broad categories reported by students. Content analysis of the qualitative dataset was undertaken. Bronfenbrenner's ecological systems theory was applied as a framework to demonstrate interdependencies between respondents' experiences and environments, and associated impacts. RESULTS Three hundred and seventy-six responses were received relating to wide-ranging EDI issues, most frequently gender or ethnicity. Responses mapped onto all areas of the ecological systems model, with frequent links between subsystems, indicating considerable complexity and interdependencies. Interpersonal interactions and associated impacts like exclusion were frequently discussed. Differential experiences of EDI-related issues in medical school compared to clinical settings were reported. Impacts of institutional leadership and wider societal norms were considered by respondents. Respondents discussed their need for awareness of EDI with reference to future professional practice. CONCLUSIONS Implementation of a regular free-text evaluation question allowed data-gathering across cohorts and throughout several stages of the curriculum, illuminating student experience. Connections established demonstrated intersectionality, and how environment and other factors interact, impacting on student experiences. Students experience EDI-related issues on multiple levels within the educational environment, with consequent impacts on learning. Any successful approach towards tackling issues and promoting equity of opportunity for all requires multi-level actions and widespread culture change. Students can offer fresh and distinct perspectives regarding change needed, to complement and diversify perspectives provided by staff and organisational leadership. Student voice should be enabled to shape change.
Collapse
|
6
|
Ravulapalli KC, Arroyave Caicedo NM, Zahra D, Mirza M. Quantitative Analysis of Challenges Encountered by UK Widening Participation Medical Students in Comparison With Their Non-Widening Participation Peers. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2024; 11:23821205241249012. [PMID: 38808124 PMCID: PMC11131392 DOI: 10.1177/23821205241249012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/05/2024] [Indexed: 05/30/2024]
Abstract
OBJECTIVES Few studies have captured the experiences of widening participation (WP) medical students, and none have compared their experiences to their non-WP peers. This study aims to identify which challenges WP students are more likely to face. METHODS A 22-item questionnaire was distributed to medical students across all UK medical schools. Students were asked yes or no questions on whether they faced challenges in finances, socializing, physical and mental health, academic attainment, and COVID19-related teaching changes. RESULTS One-hundred seventy-six medical students from all year groups across the UK responded, with 97 students from a WP background. WP students were significantly more likely to have their personal background impacting their mental health (OR = 2.65, WP = 0.002), more than twice as likely to feel that their job impacted their studies (OR = 2.53, P ≤.05), more likely to feel limited by their financial situation (OR = 2.29, P≤.05) and to receive support from student finance (OR = 2.08, P < .05). CONCLUSION WP students were more likely to face challenges in mental health and finances in medical school compared to their peers. These findings, further informed by qualitative insights can aid in advancing equity in medical training.
Collapse
|
7
|
Ikhlaq H, Agarwal S, Kwok C, Golamgouse H, Derby S, McRae N, Brown MEL, Collin V, Parekh R, Kumar S. Medical students impacted by discrimination: a qualitative study into their experiences of belonging and support systems at medical schools in the UK. BMJ Open 2023; 13:e078314. [PMID: 38154907 PMCID: PMC10759082 DOI: 10.1136/bmjopen-2023-078314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 12/11/2023] [Indexed: 12/30/2023] Open
Abstract
OBJECTIVE To better understand the broader experience of medical students impacted by discrimination and the support systems they engage with. DESIGN Qualitative study using semi-structured interviews. SETTING Four medical schools based in the UK. PARTICIPANTS 17 medical students were recruited using volunteer and snowball sampling: all students self-identified as being impacted by discrimination. RESULTS 5 themes were identified: feelings of isolation, imposter syndrome and exclusion; a lack of representation and positive role modelling; the importance of peer support; issues relating to the accessibility of support; building support networks through shared experiences and attempts to foster a sense of inclusion through peer and institutionally led initiatives. CONCLUSIONS The findings of this study suggest medical schools could do more to recognise the importance of acknowledging the multiple identities at risk of discrimination held by students, perpetuating feelings of isolation and exclusion. Our research highlights the need for practical systemic initiatives to improve the sense of belonging of medical students who are impacted by discrimination. Medical educators and institutions should consider formal and informal provisions, such as creating time and space for students to meet and share experiences, access support and reporting networks, to foster a greater sense of belonging.
Collapse
Affiliation(s)
- Hamza Ikhlaq
- Faculty of Medicine, Imperial College London, London, UK
| | | | | | | | | | | | - Megan E L Brown
- Medical Education Innovation & Research Centre, School of Public Health, Imperial College London, London, UK
| | - Victoria Collin
- Medical Education Innovation & Research Centre, School of Public Health, Imperial College London, London, UK
| | - Ravi Parekh
- Medical Education Innovation & Research Centre, School of Public Health, Imperial College London, London, UK
| | | |
Collapse
|
8
|
Medisauskaite A, Viney R, Rich A, Alexander K, Silkens M, Knight L, Harrison D, Crampton P, Griffin A. Financial difficulty in the medical profession. J R Soc Med 2023:1410768231172151. [PMID: 37217199 DOI: 10.1177/01410768231172151] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Affiliation(s)
- Asta Medisauskaite
- UCL Medical School, University College London, Research Department of Medical Education, London, WC1E 6BT, UK
| | - Rowena Viney
- UCL Medical School, University College London, Research Department of Medical Education, London, WC1E 6BT, UK
| | - Antonia Rich
- UCL Medical School, University College London, Research Department of Medical Education, London, WC1E 6BT, UK
| | - Kirsty Alexander
- UCL Medical School, University College London, Research Department of Medical Education, London, WC1E 6BT, UK
| | - Milou Silkens
- UCL Medical School, University College London, Research Department of Medical Education, London, WC1E 6BT, UK
| | - Laura Knight
- UCL Medical School, University College London, Research Department of Medical Education, London, WC1E 6BT, UK
| | - David Harrison
- UCL Medical School, University College London, Research Department of Medical Education, London, WC1E 6BT, UK
| | - Paul Crampton
- Hull York Medical School, Health Professions Education Unit, York, YO10 5DD, UK
| | - Ann Griffin
- UCL Medical School, University College London, Research Department of Medical Education, London, WC1E 6BT, UK
| |
Collapse
|
9
|
Elmansouri A, Curtis S, Nursaw C, Smith D. How do the post-graduation outcomes of students from gateway courses compare to those from standard entry medicine courses at the same medical schools? BMC MEDICAL EDUCATION 2023; 23:298. [PMID: 37131153 PMCID: PMC10152708 DOI: 10.1186/s12909-023-04179-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 03/20/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND Widening participation (WP) for underrepresented students through six-year gateway courses helps to widen the demographic representation of doctors in the UK. 'Most students from gateway courses graduate, even though many enter with lower grades than standard entry medicine students.' This study aims to compare the graduate outcomes of gateway and SEM cohorts from the same universities. METHODS Data from 2007-13 from the UK Medical Education Database (UKMED) were available for graduates of gateway and SEM courses at three UK medical schools. Outcome measures were passing an entry exam on the first attempt, Annual Review of Competency Progression (ARCP) outcome and being offered a level one training position from the first application. The univariate analysis compared the two groups. Logistic regressions, predicting outcomes by course type, controlled for attainment on completion of medical school. RESULTS Four thousand four hundred forty-five doctors were included in the analysis. There was no difference found in the ARCP outcome between gateway and SEM graduates. Gateway graduates were less likely to pass their first attempt at any membership exam than graduates of SEM courses (39% vs 63%). Gateway graduates were less likely to be offered a level 1 training position on their first application (75% vs 82%). Graduates of gateway courses were more likely to apply to General Practitioner (GP) training programmes than SEM graduates (56% vs 39%). CONCLUSIONS Gateway courses increase the diversity of backgrounds represented within the profession and importantly the number of applications to GP training. However, differences in cohort performance are shown to continue to exist in the postgraduate arena and further research is required to ascertain the reasons for this.
Collapse
Affiliation(s)
- Ahmad Elmansouri
- Medical Education, Faculty of Medicine, University of Southampton, Southampton, SO17 IBJ, England, UK.
| | - Sally Curtis
- Medical Education, Faculty of Medicine, University of Southampton, Southampton, SO17 IBJ, England, UK
| | - Ceri Nursaw
- Nursaw Associates, Coventry, CV1 2TT, England, UK
| | - Daniel Smith
- General Medical Council, London, NW1 3JN, England, UK
| |
Collapse
|
10
|
Kawecki MM, Newton PM. Widening Access: what do dental school websites signal to prospective students? Br Dent J 2023; 234:106-110. [PMID: 36707583 PMCID: PMC9883153 DOI: 10.1038/s41415-023-5454-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 11/06/2022] [Accepted: 11/08/2022] [Indexed: 01/28/2023]
Abstract
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.
Collapse
Affiliation(s)
- Michal M Kawecki
- Swansea University Medical School, Swansea University, Swansea, SA2 8PP, UK.
| | - Philip M Newton
- Swansea University Medical School, Swansea University, Swansea, SA2 8PP, UK
| |
Collapse
|
11
|
Nolan HA, Roberts L. Medical students' views on the value of trigger warnings in education: A qualitative study. MEDICAL EDUCATION 2022; 56:834-846. [PMID: 35352384 PMCID: PMC9544229 DOI: 10.1111/medu.14803] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/23/2022] [Accepted: 03/26/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Trigger warnings-advance notification of content so recipients may prepare for ensuing distress-feature in discussions in higher education. Students' expectations for warnings in some circumstances are recognised, and some educators and institutions have adopted use. Medical education necessitates engagement with potentially distressing topics. Little is known about medical students' expectations regarding warnings in education. METHODS All students from a 4-year graduate-entry UK medical degree programme were contacted via digital message outlining study details and were openly sampled. Qualitative methodology was chosen to explore participant expectations, experiences and meanings derived from experiences. Students participated in semi-structured interviews exploring perspectives on functions, benefits and drawbacks of trigger warnings in classroom-based medical education. We analysed interview transcripts using thematic analysis. RESULTS Thirteen semi-structured, qualitative interviews were undertaken. Themes in the following areas were identified: (1) students' experiences influence understanding of trauma and trigger warnings, (2) warnings as mediators of learning experiences, (3) professional responsibilities in learning, (4) exposure to content, (5) professional ethos in medical education and (6) how to issue trigger warnings. Students recognised the term 'trigger warning', and that warnings are an accommodation for those affected by trauma. Students' conceptualisation of warnings was influenced by personal experiences and peer interactions both within and outside education. Students expressed both support and concerns about use of warnings and their ability to influence learning, assuming of responsibility and professional development. DISCUSSION Diverse student opinions regarding warnings were identified. Most students suggested that warnings be used prior to topics concerning recognised traumas. Incremental exposure to distressing content was recommended. Students should be supported in managing own vulnerabilities and needs, while also experiencing sufficient formative exposure to develop resilience. Greater understanding of trauma prevalence and impacts and underpinnings of warnings amongst students and educators are recommended to optimise education environments and professional development.
Collapse
|