Reflections on 10 years of ‘Access to Medicine’

Last week the Extended Medical Degree Programme [EMDP] at King’s College London celebrated its 10th anniversary with a ‘Celebration of Success’ event.  Before becoming an academic geographer, I was centrally involved in the King’s Access to Medicine scheme, of which the extended degree is part, setting up and running the widening participation outreach element of the project from 2001 – 2007.

I want to use this opportunity to congratulate the students who graduated as doctors last week and to celebrate their achievements.  Many of them I supported through the process of applying to medical school and the early years of their studies.  One or two of them are quite exceptional, and I am proud to have helped them towards achieving their aspirations to becoming doctors.

But I also want to use this tenth anniversary as an opportunity to critically reflect on the work of this widening participation scheme.  In doing so, I accept my own complicity in some of the problematic dynamics I want to highlight.

The Access to Medicine project (now called Outreach for Medicine) was originally established to enable talented young people from ‘widening participation backgrounds’ attending non-selective state schools in inner London to train as doctors.  The scheme ran an extensive programme of outreach activities as a means of talent spotting, assisting young people who aspired to become doctors to achieve their ambition, and encouraging talented young scientists to consider careers in medicine (and related health professions).  Those students engaged in the programme who didn’t achieve the grades to enter a conventional medical degree could apply to the six-year Extended Medical Degree Programme, which recruited with lower entrance requirements and provided additional support to students during the pre-clinical phase of their degree.

One of the key motivating factors behind the establishment of the scheme was the recognition that the King’s College School of Medicine (along with its partner NHS Trusts and the other health-related schools in the College) constituted one of the largest providers of medical education and training in Europe, was located in three of the most socially deprived local authorities in Britain, and yet recruited virtually no students to medical degrees from that locality.  The project has changed that for the better – but, even from the start, it needed to recruit from a wider area of London to meet its entrance targets (and has since expanded its provision into Kent and Medway, as well as across all those London Boroughs with low progression rates into higher education). 

I still believe that there is a valid social justice argument for diversifying the demographics of future doctors, and recruiting talented young people from a wider range of ethnicities and social class backgrounds.  Here, the Access to Medicine project has been successful up to a point – the young people trained through the EMDP come from a far broader range of ethnicities than the those recruited to more conventional medical degrees in London.  However, unless the EMDP cohort has changed significantly in the four years since I left the project, King’s have not been particularly successful in recruiting white working class students or young people of Black Caribbean heritage.  This lacuna highlights a complex and problematic class dynamic amongst the students recruited through the scheme – although many do come from low-income households, many also come from highly educated migrant and refugee families, and that confounds a simplistic identification of them as ‘working class’.  Similarly, there were sufficient loopholes in the project’s selection criteria that more than a few students from professional, gentrifiying families have been recruited to the scheme over the years.  So, while it is easy for the project to continue to justify its widening participation credentials according to many of the benchmarking criteria set by HEFCE and the Office for Fair Access, I question how successful the project has been in widening access to medical education in other ways.  It seems to me that the project continues to fail young people from those social groups that are most under-represented in medical schools (and higher education generally).  To some extent, its real success has been in helping to consolidate a Bangladeshi and Nigerian middle class in inner London (and spurring a similar dynamic amongst some numerically smaller minority ethnicities in the capital).  There is not necessarily anything wrong with that per se, but it is not what the project set out to achieve.

In many ways, this situation also reveals some of the problematics of an approach to widening participation that emphasizes raising aspirations as a route to social mobility.  Although, of course, the irony here is that I don’t think the Access to Medicine project really did much to ‘raise’ young people’s aspirations.  Where its success lay was in supporting young people who already aspired to become doctors and enabling them to act on their aspirations and stand a fighting chance of entering medical school.  Again, that’s no bad thing – within the remit of widening participation initiatives, furthering fair access to medical education is important.  But I think, as the very obvious gaps in which social groups have benefitted from the scheme shows, even after ten years of work, Access to Medicine has had less success in recruiting students for whom the aspiration to become a doctor is completely off their radar.  It takes more than a single project (however well-intentioned or resourced) to have that kind of impact on the social and cultural capital of some working class communities.

Although I am not sure I agree with all of their arguments and analysis, readers might be interested in the following to papers from a few years back that examine the work of the Access to Medicine project and the EMDP:

Garlick, PB and Brown, G (2008), “Widening participation in medicine: reflections on the first six years of the Extended Medical Degree Programme (EMDP) at the King’s College London School of Medicine”, British Medical Journal, 336: 1111 – 1113.

Brown, G and Garlick, PB (2007), “Changing Geographies of Access to Medical Education in London”, Health and Place, 13 (2): 520 – 531.

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