Nana Sartania

Healthcare workforce shortages and inequities in access to medical education remain persistent global challenges. Expanding participation in health professions education has become a central strategy for strengthening healthcare systems and improving population health outcomes. This perspective applies the Holistic Ecosystem Model (HES) as its central analytical framework to examine outreach initiatives across the United States, the United Kingdom, Australia, and Singapore. The HES conceptualizes pathways into medicine as dynamic systems shaped by four interacting layers: the learner pathway, educational structures, institutional systems, and community and policy environments. Viewing outreach through this ecosystem lens reveals why piecemeal interventions so often fall short–and what more coordinated, systemic strategies might achieve.

Background: Widening participation in medicine is a key societal priority. To improve representation of non-traditional applicants, UK medical schools use contextual admissions, although definitions of under-represented groups vary across institutions. This study examined the educational and training trajectories of one such group— mature non-graduates . We aimed to determine whether their progression was comparable to that of school-leavers and graduate entrants, whether they progressed through medical school non-inferiorly, and whether they were equally likely to secure postgraduate training posts. Methods: Data on UK medical students and resident doctors (2007–2015) were extracted from the UK Medical Education Database (UKMED). Undergraduate performance (Educational Performance Measure (EPM), Prescribing Safety Assessment (PSA), Foundation Programme Situational Judgement Test (FP-SJT) and postgraduate performance (Membership of the Royal College of Physicians, MRCP and MRCGP Applied Knowledge Test, MRCGP AKT), Annual Review of Competency Progression (ARCP), and obtaining an offer for a Level 1 training post) were compared across the three groups using multivariate statistical analyses, including Kruskal–Wallis tests where appropriate. Results: Across all measures of undergraduate academic attainment (EPM, PSA and FP-SJT) and postgraduate examination performance (MRCP Part 1, Part 2 and PACES), mature non-graduates performed less well than school-leavers or graduates. They were more frequently released from training (ARCP Outcome 4) and received higher numbers of Developmental ARCP outcomes. Mature non-graduates were also less likely to receive an offer for competitive specialty training on their first application; however, the likelihood of them applying exclusively to General Practice did not differ from that of school-leavers or graduates. Conclusions: Although performance differences persist for a subset of widening-participation candidates named here as mature non-graduates, they still progress through training, obtain Certificates of Completion of Training, and contribute to the medical workforce. Further research is needed to examine how their life experience and non-traditional educational trajectories influence their long-term practice.

Understanding widening participation is subjective and is shaped in many ways by the setting in which you are working. Reasons for under-representation in different fields and professions need to be identified in order to strive for equity in opportunities. In the first chapter, members of the National Medical Schools Widening Participation Forum have collaborated to reach an understanding of what we currently believe Widening Participation means for Medicine today.

In this final chapter, we look over the key themes across the book, to draw a conclusive overview of the role of Widening Participation during the life cycle of the medical student from primary school to practice.

With increasing numbers of students from widening participation backgrounds now studying medicine, the next challenge for medical schools is to ensure that these students are supported in their transition to university and medical school and have access to the same opportunities as everyone else. The chapter discusses current practice and strategies the schools employ to help the students from widening participation background overcome the barriers in accessing the university and progressing on the course. We discuss social dynamics between different student groups and offer practical measures to nurture confidence to combat ‘imposter syndrome’.

Scholarly papers addressing widening access and participation in medicine have mushroomed in the last decade or so, but the focus has predominantly been on the first part of the equation: access. The time has come to consolidate the gains in widening access and develop the latter half of the equation and ensure equitable participation of students from non-traditional backgrounds. Academic discussions about class and social mobility concentrate on understanding the factors that determine (or limit) people’s upward trajectory and how class origins still play a strong role in it. This paper builds on a critical evaluation of the published literature on the topic to discuss the barriers (perceived or real) that students from widening participation backgrounds experience on their journey from admissions to progression through to medical training and into the workforce. It is discussed what tangible measures can be taken to break the cycle of social reproduction and help students from disadvantaged backgrounds successfully enter the medical professions.

Background: In the transition from academic to clinical learning, the development of clinical reasoning skills and teamwork is essential, but not easily achieved by didactic teaching only. Case-based learning (CBL) was designed to stimulate discussions of genuine clinical cases and diagnoses but in our initial format (CBL’10) remained predominantly tutor-driven rather than student-directed. However, interactive teaching methods stimulate deep learning and consolidate taught material, and we therefore introduced a more collaborative CBL (cCBL), featuring a structured format with discussions in small breakout groups. This aimed to increase student participation and improve learning outcomes. Method: A survey with open and closed questions was distributed among 149 students and 36 tutors that had participated in sessions of both CBL formats. A statistical analysis compared exam scores of topics taught via CBL’10 and cCBL. Results: Students and tutors both evaluated the switch to cCBL positively, reporting that it increased student participation and enhanced consolidation and integration of the wider subject area. They also reported that the cCBL sessions increased constructive discussion and stimulated deep learning. Moreover, tutors found the more structured cCBL sessions easier to facilitate. Analysis of exam results showed that summative assessment scores of subjects switched to cCBL significantly increased compared to previous years, whereas scores of subjects that remained taught as CBL’10 did not change. Conclusions: Compared to our initial, tutor-led CBL format, cCBL resulted in improved educational outcomes, leading to increased participation, confidence, discussion and higher exam scores.

MedEdPublish (ISSN 2312–7996) is a highly visible, open access, specialist practitioner e-journal that enables academics, teachers, clinicians, researchers and students to publish their experiences, views and research findings relating to teaching, learning and assessment in medical and health professions education. An innovative and key feature of MedEdPublish is that the peer review process begins following publication.

This article was migrated. The article was marked as recommended. Widening Participation (WP) for medical school entry has been politically encouraged to ensure access and participation for underrepresented groups that are rarely able to gain access to this high demand profession. Those who reside in the 20% most deprived postcodes in Scotland (SIMD20, Scottish Index of Multiple Deprivation) are much less likely to apply for medical school entry and even less likely to succeed. The National outreach programme of Scotland (Reach) aims to rectify the existing situation by encouraging and supporting students from working class backgrounds to apply to high demand courses, including medicine, and has achieved great success in helping pupils from low progression secondary schools to gain a place in Glasgow Medical School. However, some of the Reach students have similar demographics as the rest of the medical school class and arguably do not genuinely belong in the target group. To address this, a second flag, based on SIMD20/40 residence, was employed. Applying more than one WP flag however - while substantially improving the accurate targeting of this programme and helping those who truly are multiply deprived - reduces the Reach-eligible applicant pool to the point of undermining the high WP targets imposed on Universities. But using only a single criterion of SIMD20/40 residence or school progression rate would inappropriately benefit some pupils that are actually not genuinely disadvantaged. Ideally, individualised indicators such as eligibility for Free School Meals, receipt of an Educational Maintenance Allowance and/or a UKCAT bursary, would complement residential data and school progression rates. This paper reflects on the evolution of the admissions practices at Glasgow Medical School that are designed to meet the targets and create a medical workforce reflecting the population it serves.