Category Archives: Reflections

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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After the seminar

I’m pleased to say the ‘Place of Aspirations’ seminar on 14th May went really well. 

The event was attended by just under 20 people, including a trio from Malmo University in Sweden (more about them later…).  Many of the participants were directly involved in the delivery of widening participation projects and this led to some very fruitful discussions that were particularly focused on policy and practice.

Prof. John Storan from Continuum at the University of East London and Sumi Hollingworth from the Institute of Policy Studies in Education at London Metropolitan University both gave fascinating papers that really helped broaden the afternoon’s debates and put my own work within a broader context.

What I found particularly interesting about Sumi’s paper “Choice or Coercion? Policies and initiatives aimed at increasing urban pupils’ engagement and aspirations for post-16 participation was how similar the aspirations were of the young people we have worked with in our respective studies.  Sumi had mostly worked with young people attending six schools across London who were deemed to be at risk of leaving school and not engaging with education, employment or training.  In contrast, the teenagers I worked with in South-East London in 2007 were all relatively high-achieving students who were engaged with their studies. 

 

 

In full flow at the seminar

In full flow at the seminar

The seminar left me with several ideas to think about for the future, including some potential follow-up studies, and I’m sure I’ll post more about some of these over the summer.  But the most exciting conversations of the afternoon were with the delegation from Malmo, who are interested in researching the aspirations of young people in their city.  The potential for an international comparative study is tantalizing, as is the prospect of thinking about educational aspirations in a political culture where the language of  ‘aspiration’ has not saturated policy debates in recent years.

Latest developments

Despite a heavy teaching load this semester, work on this research project seems to be developing well:

  • All the interviews with WP practitioners have been completed and transcribed.  The transcription service I used JHTS (http://www.jhts.co.uk/) provided an excellent and highly efficient service – despite the obligatory small number of amusing mis-transcriptions (I will never quite be able to think the same way about one girls’ school in South London, mentioned by one interviewee, whose name got transcribed as ‘Lower Trade’).  I plan to start a full analysis of this data early in January.
  • I am in the process of arranging focus groups with udnergraduates at universities in London and the East Midlands who participated in widening participation activities whilst at school.  In this neck of the woods I have received an exceptionally high level of interest from students and hope that the interest amongst London students will be similarly high.
  • Finally, I am also working on arranging a focus group with Year 10 school students in the East Midlands who are currently engaged with Aimhigher initiatives, to hear their opinions about aspiration raising activities and how they feel about their ambitions for adult life.  As the project budget is beginning to look quite tight, I have decided not to organise a parallel focus group with school students in London, as I have unpublished data from a recent action research project that can be integrated into this research and serve as a comparison with the the views of teenagers from the East Midlands. 

Interviews: early thoughts

Today I conducted the last of the interviews with Widening Participation practitioners.  Soon the recordings will be sent off to the transcription service; and, once the transcripts return, I can begin the process of fully analysing this phase of the research.  Before then, I have a few observations to share on the interview material, albeit very impressionistic ones.

In total, I have interviewed twelve professionals working in the field of widening participation.  Six of them are based in London, and six in the East Midlands.  Eight of them are currently based in the higher education sector, three work for Aimhigher partnerships, and one works for a learned society.  Of those currently working in higher education, all but one work for mainstream, research-led universities (but two of the group have previous experience of providing WP work in the ‘new university’ sector).  If I get an opportunity to extend this research in the future, I hope to include a more balanced representation of professionals working across the full range of the higher education sector.

The dozen professions I interviewed had varied career routes that led them into widening participation work.  Six had previously worked in university administration in other capacities (either in admissions, student recruitment and related marketing activities, or in welfare advice roles).  Four had previously worked as secondary school teachers; with another having taught in adult education.  One had started her professional life as a careers adviser.  Two of the interviewees had worked as university academics, with one still being primarily employed in this role.  It is my impression that the analysis will reveal some subtle, yet (I think) significant, differences in approach to young people’s aspirations and life choices between those with a background in teaching and careers and those with greater experience of higher education.

I found it interesting, but not completely surprising, that almost all of these professionals – to my recollection, with only one exception – were keen to claim a ‘widening participation’ background for themselves.  Personal experience of being the first in family to attend higher education appears to be an important motivating factor for many working in this field.  Certainly, while Government ministers have tended to advocate widening participation in terms of the economic advantage it can offer individuals and the nation state, widening participation practitioners seem more likely to understand the importance of their work in terms of social justice and an equalities agenda.

All of the interviews have contained rich descriptions and explanations of how the places where young people grow up (and attend school) shape their aspirations and ambitions for adult life.  Although there are some commonalities in the evidence provided by WP practitioners working in London and the East Midlands, I also anticipate that a full analysis will indicate some significant variations between these two regions.  In part, this might be a measure of the complexity and diversity of the populations in inner London.  It may be that future research, comparing practice in more regional settings will reveal whether their is indeed a high degree of regional variation in the issues affecting young people, or whether this is a case of London’s exceptionalism.

What is perhaps hardest to gauge without thorough analysis of the interview transcript is how WP practitioners conceptualise young people’s ‘aspirations’.  Although all of the professionals had a clear conception of how they were trying to enable young people to make informed choices about their futures, and to expose them to new possibilities as part of that process, several of them found it quite difficult to explain what ‘aspirations’ actually are and how they can be ‘raised’ in practice.  Nevertheless, even those professionals who found it difficult to define the concept of ‘raising aspirations’ could identify those moments when they felt their interventions had made a real and lasting impact on individual young people, and identified the kinds of events and activities that they believed to be most effective in altering how young people thought about what might be possible in their lives.  Tied to this, I think many of the interviews contain really rich  explorations of the multiple ways in which ‘aspirations’ are bound up with a range of other emotions; and, how these are experienced through and in relation to place.

I’m looking forward to getting to grips with a full analysis of these interviews in the near future.

Progress

There are three strands to this project:

  1. an analysis of policy documents, widening participation promotional material, and ministerial speeches examining how young people’s aspirations are discussed in relation to place, and how spatial metaphors are employed;
  2. interviews with widening participation practitioners to examine how policy is put into practice, to understand how these educational professionals conceive of the work they do, and their beliefs about young people’s aspirations;
  3. a small number of focus group workshops with young people from ‘widening participation’ backgrounds (both current school students and undergraduates who have participated in widening participation activities) to consider what it feels like to participate in these events, and the effect they have had in shaping young people’s ambitions for adult life.

Over the summer, I gathered a huge number of policy documents, promotional material and the texts of ministerial speeches, amongst other related documentation.  I presented some very preliminary thoughts on this analysis as a paper at the recent RGS-IBG conference, which seemed to go down well.  When I submitted my abstract for the paper way backat the start of the year (well before the grant was actually confirmed) I clearly thought I would have been able to progress the analysis further over the summer.  As it was, the tight deadline forced me to crack on with the project and to begin a process of interative analysis from the beginning.   I’ll post some of those preliminary thoughts on what I’ve read in these documents in the near future, but the main analysis still remains to be done during the autumn. 

In recent weeks I’ve interviewed nearly a dozen widening participation practitioners who either work in inner London or the East Midlands (and, in one case, a person who currently runs a project that operates nationally).  Earlier today I carried out what will probably be the penultimate interview, with a senior widening participation manager based in the East Midlands.  There is one more interview in the East Midlands already in the diary, and I am still trying to arrange an interview in London with someone I collaborated with on a number of events and activities when I used to run the Access to Medicine Project.  But, as time goes on, I am beginning to realise that there is a limit to how long I can delay sending the interview soundtracks off for transciption while I wait for that interview to be scheduled.  Again, I’ll post some initial reflections and observations on the interviews before too long.

Which really just leaves the focus groups with young people to organise.  I think I have now settled on a couple of schools in inner London and Leicester to approach for their involvement in this phase of the work.  I just need to make contact to see if it will be viable.  Luckily, arranging focus groups with current undergraduates should be less of a challenge.  I had, originally, hoped to organise focus groups with young people from the NEET (not in education, employment or training) cohort in both cities, but as I received a smaller grant that I applied for, and those focus groups could prove very time consuming to arrange, they will have to wait for a future project.

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.