Category Archives: Widening Participation

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.

Request for information: aspirations and student protests

I am working on a short intervention piece for  ACME: An International E-Journal for Critical Geographies  about the successes and failures of recent initiatives to widen participation in higher education, including work on ‘raising’ young people’s aspirations, in relation to the student protests of late last year against the three-fold increase in tuition fees.

I would be interested to hear from any readers who can point me in the direction of examples of student protestors actually talking about their aspirations (for life, for higher education etc) in relation to the protests.  I’ve found some examples from media coverage, but would welcome new leads.

Please leave a comment if you know of anything relevant.

The phenomenology of aspirations

I’ve recently been reading Sara Ahmed’s book The Promise of Happiness and this has set me thinking about the phenomenology of aspirations.  In her book, Sara makes some references to aspiration and social hope, but doesn’t dwell on the effects (and affects) of those social policy interventions that have sought to work on young people’s aspirations in Britain over the last fifteen years.

As I’ve said before, aspiration (at least as it is understood and promoted in recent British social policy) is a particular expression of neoliberal social hope.  Widening participation interventions that seek to raise young people’s aspirations also function to orientate young people’s lives towards particular imagined life courses that are consistent with this expression of neoliberal social hope.  They are designed to instill in young people a wish for, and a commitment to, a future where they go to university, enter professional graduate employment and are able to be socially mobile and economically self-reliant, seeking privatised solutions for their well-being.

In practice, these widening participation interventions also seek to re-orientate young people geographically, in relation to their home neighbourhoods.  To have your aspirations raised is also to have your horizons broadened.  Young people living in the most socially deprived neighbourhoods in the country are encouraged to look beyond the places where they live to imagine how life could be different.  It is not enough to want to go to university, to have their aspirations (truly) raised, a young person is encouraged to aspire to a middle class habitus and dream of moving away to university.  Physical, spatial mobility is closely linked to the social mobility being promoted in these policies.  This is another way of denigrating (white) working class communities.  Young people from these backgrounds are being taught that there is nothing of value in their home communities.  To have one’s aspirations raised is to want to leave friends, family and home behind.  It is hardly surprising that widening participation initiatives have perhaps been least successful amongst those young people deemed most in need of intervention.

And this brings me to my final point (for now).  The effect of these attempted re-orientations differs depending on the relational geographies of the home neighbourhoods in which the young people they target live – how connected they are to other places – and on the life trajectories of individual young people and their families.  Not all socially deprived neighbourhoods, or the people who live in them, are the same.  It is possible to live on a low income, in an area that scores highly on the indices of multiple deprivation, and still have a wide range of connections with different people that extend across social difference and across space.  This is one reason why I think young people from some minority ethnic communities have done relatively well out of widening participation initiatives.  If your family experience is one of transnational migration; if you and your family sustain kinship networks that extend around the globe; or, if you attend a church, mosque or temple that brings you into regular contact with a group of people engaged in a diverse range of livelihoods, jobs and careers, you are likely to be aware that the way you live your life, here and now, is not the only option open to you. 

So, while I am suspicious about the ways in which the imperative for young people to ‘broaden their horizons’ has become enmeshed with the imperative to raise their aspirations for a privatised neoliberal future, I do also see value in having wide horizons.  Conscious experience of what Doreen Massey would call ‘place beyond place’ can serve to widen your horizon.  Wide horizons, although at times unsettling, can reveal new options and possibilities.  I am critical of how widening participation initiatives envisage only one course across that widened horizon; but I am interested in how widening our horizons may also hold the potential for fostering social relations and social hopes that exceed neoliberal aspirations.

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.

Thoughts on social mobility and the Milburn Report

Alan Milburn’s report Unleashing Aspiration: The Final Report of the Panel on Fair Access to the Professions, produced for the Cabinet Office, has received a huge amount of publicity over the last couple of days. 

It’s been personally really rewarding for me to see some of my former students from the Extended Medical Degree Programme, recruited to train as doctors through the Access to Medicine Project at King’s College London so centrally involved in the launch event for the report and featured in so much of the publcity surrounding it.  It was also a pleasant surprise to see a paper I co-authored with Pamela Garlick (http://www.bmj.com/cgi/content/full/336/7653/1111) cited, as evidence in the report.

I’m looking forward to making the time to read the report in full over the next few days, and no doubt I’ll be posting further thoughts once that done.  But, for now, here are some very preliminary reactions to the report and it’s recommendations:

  1. This report recognises the limits of widening participation initiatives over the last twelve years in significantly improving the life chances of young people from working class families.  Certainly, widening participation initiatives have helped widen and increase participation in higher education generally.  But, despite some small scale exemplar projects around the country, widening participation has largely failed to achieve fair access to elite universities and the professions. 
  2. The report acknowledges that the chances of working class young people getting into the upper echalons of several professions are getting worse, not better.  Of course, despite many potentially useful recommendations around educational process and the provision of appropriate careers advice, the report fails to challenge the power of the middle classes to control education as a means to safe-guard and reproduce their privilege.
  3. Although the report contains a whole chapter on ‘raising aspirations’, its title (Unleashing Aspirations) really indicates something of a shift in a way this Government thinks about young people’s aspirations.  The implication is that many young people from all social classes have high aspirations for themselves.  They don’t need their aspirations ‘raised’, they need support realising them, and that entails action to tackle deep-seated structural inequalities in society.
  4. Too many of the report’s recommendations rest on the assumption that the best way to tackle these inequalities is to enable working class teenagers to participate in the type of activities that many of their middle class peers take for granted (e.g. join the Combined Cadet Force to learn how to be a team player) and become more ‘like us’, rather than asking more fundamental questions about the reproduction of privilege, and the social value of generalising the aspirational, middle class cultures promoted here.

Overall, I find myself quite conflicted in my reactions to this report.  I value the social justice argument that it is important to enable all young people to achieve the best that they can, no matter what their social background.  But I also recognise that many of the recommendations in this report (and the ways in which it envisages them being enacted) both re-privilege middle class cultures andstrengthen the neo-liberal forms of governance and educational provision that have exacerbated these growing social inequalities over the last two decades.  I am left asking more fundamental questions about a division of labour that privileges professional careers over other forms of work – and these, in turn, prompt me to think quite critically about the contradictions of ‘social mobility’.

Cabinet Office think more spatially about aspirations

I recently discovered a briefing presentation from the Cabinet Office (published in January 2009), Aspiration and attainment amongst young people in deprived communities, which begins to add a new level of spatial sophistication to the Government’s analysis of how place impacts on young people’s aspirations.  The key findings from this report state:

Communities matter. Young people in certain types of neighbourhood are less likely to develop ambitious, achievable aspirations.  These neighbourhoods tend to have high levels of deprivation. (pg 2)

Nothing new or surprising there.  However, the next sentence takes the analysis in an interesting new direction:

However deprived communities are not all the same.  Young people in some very deprived communities have high aspirations (pg 2)

The Cabinet Office team have used MOSAIC geodemographic classifications to analyse the progression rates to higher education from different postcodes that figure highly on the Index of Multiple Deprivation.  They recognise that deprived inner city neighbourhoods with high concentrations of (certain) minority ethnic groups have significantly higher progression rates than many predominantly white working class neighbourhoods that have been blighted by deindustrialisation over the last 30 years.  They recognise that dense social networks may offer valuable mutual support in some circumstances but can lead to an isolated and insular local culture that mitigates against high aspirations for young people growing up in those areas.

This research has clearly fed into the development of the Government’s latest policy initiative to address young people’s aspirations at a community level.  The Inspiring Communities  programme was also announced in January and will be formally launched in the summer.

Interestingly, the socially deprived MOSAIC categories that the Cabinet Office identify as producing young people with high aspirations (Counter-Cultural Mix, Metro Multiculture, and South Asian Industry) are precisely the same types of neighbourhood that Pamela Garlick and I found large numbers of medical students from ‘widening participation backgrounds’ had been recruited from in our 2007 paper ‘Changing Geographies of Access to Medical Education’ published in Health & Place.

Despite these similarities, I think there is a danger of over-relying on geodemographics.  More work needs to be done to analyse what it is about the attitudes of these young people and their families that makes a difference.  The Cabinet Office identify that many deprived white working class communities tend to be isolated and inward-looking.  In this respect, I think they might be on to something – that the stance of a young person (and, by extension, that of their family and social network) in relation to the world may be crucial.  If you have an outward-looking orientation, looking to what Doreen Massey has called ‘place beyond place’, then you are more likely to have extensive social networks to draw on for support and inspiration, and you are more likely to be able to see opportunities for yourself beyond those that are immediately to hand in your locality.

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.