Category Archives: Practice

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.

Cameron and Caribbean students at Oxford

In the last few days there has been a lot of media coverage about David Cameron’s ‘gaffe‘ about the number of Black British students at Oxford University.  The Prime Minister claimed that Oxford had only recruited one Black British student in 2009.  The University have countered this by claiming that they actually recruited “at least 26” Black British students that year.

There is, of course, much that can and should be said about the failure of 15 years (plus) of widening participation initiatives to alter the unequal access to elite universities by students from certain ethnicities in the UK.  The fact that for so long there were more Black British students of Caribbean heritage enrolled at London Metropolitan University than all of the Russell Group institutions put together speaks volumes.  Similarly, there is the ghettoization within certain subject areas of those Black Caribbean students lucky enough to be admitted to these elite universities – for many years almost all of the Caribbean heritage students enrolled at Kings College London were studying nursing.

But my interest in this story lies elsewhere.  Why does David Cameron care so much about the number of Black Caribbean students admitted to Oxford.  It is possible, of course, that he is embarrassed and shamefaced by the admissions practices of his alma mater, but I think it is more than that.  I suggest that Cameron’s concern here has political motivation – it helps him to articulate and justify the Coalition Government’s favoured discourse of ‘fairness’ in education.  As last week’s Opening Doors, Breaking Barriers strategy document on social mobility states:

Fairness is a fundamental value of the Coalition Government.  A fair society is an open society. A society in which everyone is free to flourish and rise. Where birth is never destiny. (pg 3).

 The promotion of fairness by the Coalition allows them to distinguish their education policies from those of New Labour, whilst effectively pursuing more of the same (only more intensively).  Fifteen years of aspiration-raising interventions and outreach activities by universities have not increased the number of Black Caribbean students and a new round of aspiration-raising interventions sponsored by business will do no better.  These young people’s aspirations are not the problem – racist recruitment practices by universities and a school system that consistently fails Black Caribbean students, amongst others, are.

Emerging themes and findings

Now that I have had a chance to analyse much of the date collected through the various components of this research project, I am developing a clearer idea of the key themes that have emerged through this research.  For now, I want to flag up three of the main strands of my analysis.

  1. Aspirations-talk and scale: there are clear differences in the tone of the language used by ministers (and in official Government publications) depending on the scale in relation to which they are discussing young people’s aspirations.  When young people’s aspirations are mobilised to talk about the potential for developing and maintaining the global competitiveness of the British economy in the decades to come, the language tends to be optimistic and highly ‘aspirational’ (if that’s not a tautology).  In contrast, more and more, when ministers talk about the aspirations of young people themselves (especially when they are deemed not to be high enough to meet the needs of the national economy), the tone is far more one of regulation and control.
  2. Orienting young people’s aspirations.  There are two thread to this set of findings: the first relates to the different spatial metaphors enroled to talk about young people’s aspirations – whether the role of widening participation is to ‘raise aspirations’ or to ‘broaden [young people’s] horizons’.  The use of these two metaphors by ministers and Government agencies has varied over time, and to some degree between different bodies.  My findings suggest that these metaphors matter and they shape widening participation practitioners’ understandings of their work and the form that their professional practice takes.  The second thread here relates to the issues [discussed above, in relation to the recent Cabinet Office findings] about the extend to which young people’s orientation to the wider world shapes their aspirations and ambitions for adult life – and what the consequences of this might be for widening participation practice.
  3. Emotional geographies of young people’s ambitions.  This strand of my work draws on an understanding of ‘aspiration’ (and ‘ambition’) as an emotional sensation, that is deeply entangled with a range of other emotions and affective states.  This analysis approaches young people’s ambitions (and the barriers to their realisation) as often being intimately linked to place (or a desire to escape certain places). Finally, this aspect of my analysis considers the various ways in which widening participation practice seeks to provoke particular emotional experiences for young people – whether that is through attempting to increase their confidence, self-esteem and resilience, or creating ‘wow!’ moments during widening participation events and interventions.

Over the coming weeks, I’ll share more thoughts about each of these issues.

Thinking ahead

After Easter 2009, by which time most of my analysis for this project should have been completed, I am interested in finding means of disseminating my thoughts and findings to widening participation practitioners and relevant policy-makers.  If you know of any events coming up next summer, or have thoughts about how and where I might disseminate these findings, please drop me a line or leave a comment on this blog.

Personal reflections

It’s worth saying, from the start, and for those of you who don’t know this, that I have some ‘history’ in this field.  Before I became a lecturer, last year, I had worked as a university administrator since 1992. 

For most of that time, I worked in, and ran, university Admissions Offices, processing student’s UCAS applications.  The main two universities where I did this work both had a strong commitment, at the time, to recruiting students from the ethnically diverse, and socially deprived London boroughs where they were based. 

More recently, from 2001 until (almost exactly) a year ago, I ran a large, and successful, widening participation project – the Access to Medicine Project – based in the School of Medicine at King’s College London.  Although my job there was operationally focused, I did create some space to carry out a few small action research projects.  The Place of Aspirations research that I’m currently working on builds upon that work, and many of the research questions that motivate it are inspired by critical reflections upon my own work as a widening participation practitioner and my observations of how many of the other projects I worked alongside had changed over time.

I’m not yet sure how my professional experience (and those earlier small action research projects) will feed into the analysis of the Place of Aspirations research.  But some of the widening participation practitioners I have been interviewing for this research are people I have known and worked alongside for many years. We have a lot of shared experience and common points of reference, and it has been a challenge at times to ensure that, in the interviews, we do not talk local jargon at each other, as shorthand for fuller explanations of what we each think about the topic at hand.

Why ‘the place of aspirations’?

I originally set up this blog as a space in which to share my thoughts, as they emerge, about a small research project I was working on at the time.  The project was called ‘The Place of Aspirations: emotional geographies of young people’s ambitions for their adult lives‘.  It was funded by a Small Research Grant from the Royal Geographical Society (with IBG).

The main objectives of this project were:

  • to analyse how policy discourses about young people’s ‘aspirations’ explicitly or implicity relate to space and place
  • to examine how aspiration and ambition are expressed as spatial practices. 
  • to explore what other emotions and affects attach themselves to thinking about (and doing) ‘aspiration’

The project involved a critical evaluation of the policy documents driving widening participation policy (and related interventions in young people’s lives) in a UK context; as well as interviews with widening participation practitioners working in local education sectors in inner London and the East Midlands.  A small number of focus group workshops were carried out with current undergraduates, who had participated in ‘aspiration raising’ activities organised by their schools, universities and local Aimhigher partnerships.

The research sought to broaden understandings of the emotional consequences of widening partcipation policy interventions.  As a result, this work contributes to, and extends, theoretical debates at the intersections of geographies of education, geographies of childhood, and emotional/affective geographies.  In carrying out this project, I explored how these discrete research agendas could be pushed further theoretically, in dialogue with each other, whilst also producing findings that could contribute to policy development and widening participation practice.

Although the RGS small grant officially ended in 2009, I continue to write and think about these issues.  This blog charts the development of my ideas in this area.