Widening participation

Authors: Abdul Salam 

Publication date:  03 Mar 2010


Abdul Salam recommends boosting your own medical credentials by helping others gain them

The General Medical Council publication The doctor as teacher sets obligations and professional attributes for doctors when teaching junior colleagues and medical students.[1] Most application forms for specialist training posts—like the examples in box 1—ask applicants to provide evidence of teaching, leadership, and communication skills. With thousands of applicants and fierce competition for training posts, it is a struggle to stand out from the crowd.

Box 1: Specialist training application forms 2009

Royal College of Physicians: In this section please provide details of your teaching experience. Please give full details about the type of teaching, your personal contribution and details of any feedback obtained

Royal College of Paediatrics and Child Health: Please give details of your experience of teaching and different teaching methods (including outside medicine).

Getting involved in one of the hundreds of widening participation initiatives across the country enables doctors to demonstrate and develop teaching skills rapidly and effectively. Additionally, by taking part in such activities, doctors can help redress the educational inequality that exists in our society.

Widening participation—shaking up the status quo

“A scandalous initiative seeking to socially engineer society”; “dumbing down”; “penalising high achieving grammar and independent schools”—these are just some of the media criticisms levelled at the government’s Widening Participation in Higher Education programme when it was launched in 1999. Ten years on, although some critics remain, most have been persuaded that the programme is a successful enterprise that ensures the medical profession selects future doctors from an appropriately wide and meritocratic pool of students.

Widening participation initiatives have been crucial in attracting talented students who might otherwise not apply to medicine, and can be defended from any suggestions of lowering standards. According to research commissioned by the Sutton Trust,[2] 60 000 state school pupils who have been among the top 20% of academic performers in their year do not go on to higher education. Pupils from top performing independent schools, on average, also make twice as many applications to leading research universities as students from state comprehensive schools, despite having similar average A level results.[3] Widening participation should, therefore, be thought of as levelling the playing field, allowing less privileged pupils to compete with their counterparts educated at private and grammar schools.

Others have researched the cause of this apparent disparity. In 2004 a survey of 68 students aged 14 to 16 years showed that those from lower socioeconomic backgrounds saw medical school as geared towards “posh” students and did not think they would win a place at such institutions.[4] This could be interpreted as lack of aspiration, although another survey found that at least half of careers and education advice in state schools was inadequate or inappropriate.[5] Only half of 16 to 17 year olds in this study said the support they had received had been helpful, whereas 58% said they would have liked more. The root of the inequality, therefore, is complex and multifactorial.

Do something different

Between 2001 and 2008, the Department for Innovation, Universities and Skills and the Higher Education Funding Council for England allocated £392m funding to universities for widening participation projects.[6] This has increased the number and diversity of opportunities available to doctors.

Mentoring

Hundreds of mentoring projects have been set up across the country; these projects sometimes target students who lack positive role models in their lives. Typically, mentors are paired one to one with students, providing a flexible and reliable source of information and guidance on anything from academia to more general life issues. Mentors meet regularly with their students, ideally four to six times a year, and are often in constant email contact. Several case studies and descriptive papers illustrate the potential benefits generally to both mentees and mentors.[7] Specifically for doctors, mentoring is an excellent way to gain an insight into the mindset of younger people, allowing greater understanding of patients, which may in turn lead to better quality of care.

Summer school

Some universities offer summer school projects, which are often expensive to set up and maintain. Places for students are limited and so competition is intense. Medical summer schools are generally geared towards GCSE students with an interest in pursuing a career in medicine and typically last a week.

The Dick Whittington Summer School at University College London is a non-residential summer school where students gain an insight into medicine as a career. Experienced medical students lead a group of year 11 students through topics such as ethics in medicine, the importance of team working, and interview skills. Students are given a tour of the Whittington Hospital and visit local general practitioner surgeries to see professional working environments. Other doctors give more specific talks—for example, sharing their experiences as junior doctors. Keeping an audience of up to 50 GCSE students engaged and interested can be extremely taxing, and for doctors it is, therefore, an opportunity to develop extensive skills and expertise in lesson planning and teaching methods.

Other initiatives

Sometimes initiatives are developed outside a university’s formal widening participation programme. One such scheme is Target Medicine, which was set up in 2007 by a group of University College London medical students from state school backgrounds. The project aimed to counter some of the barriers that had made their own passage to medicine a difficult one. Target Medicine guides students through the most difficult stages of the application process—particularly gaining work experience, writing personal statements, and preparing for interviews (box 2). It approaches careers coordinators at local colleges and sixth form centres to identify AS level students who have shown an interest in medicine and have the academic potential. Teams of medical students are recruited and formally trained in effective facilitation and mentoring before going to schools at least six times over a year.

The Target Medicine curriculum incorporates various opportunities for doctors to become involved. For example, a clinicians’ “speed dating event” gives doctors who have volunteered a limited time to “sell” their specialty to Target Medicine students, before they meet another clinician. Arguably the highlight of the year, the event exposes students to aspects of medicine they may never have considered, from cardiology to obstetrics and gynaecology. As well as giving doctors the opportunity to develop communication skills, such projects offer excellent opportunities for gaining experience of delivering large group presentations. Students at this stage are often most curious and inquisitive, and doctors have to think on their feet to meet the changing demands of each student group.

Target Medicine now operates in nine colleges and sixth form centres in London, recruiting nearly 50 medical students as trained facilitators. Target Medicine’s achievements were formally recognised by University College London Medical School in 2008 when it granted special study component status to the programme. Medical students are now rewarded with academic credit for devoting their time and effort to the project. Target Medicine’s founders believe the project can be used as a model to recreate its structure and material elsewhere in the country.

Box 2: About Target Medicine

“Target medicine helped me achieve more than I ever thought I could. I am really not what you would call a typical medical student. I was the first person in my family to ever even consider going to university, let alone become a doctor. When I was in secondary school, I wasn’t aware of the stiff competition or standards that I had to meet if I wanted to go on to study medicine. When I got to college, it hit me for the first time that my grades alone were not going to get me to where I wanted to be.

“Meeting doctors at the group sessions inspired me to persist with my exams and coursework when I was flagging. The advice and support were invaluable to me, and I believe wholeheartedly that I wouldn’t have made it to medical school without it.”

—Student, Target Medicine 2008

“Planning for a short presentation to groups of 16 year old students was a lot harder than I thought. Engaging and making my area of expertise interesting, interactive, and relevant for the students required careful planning and preparation. Inspiring young people and encouraging them to reach their full potential has been one of the most rewarding experiences in my medical career so far.”

—Paediatric senior house officer, volunteer for Target Medicine 2009

Summary

The government’s Widening Participation programme initially caused anxiety within the medical establishment, with commentators fearing that the prestige and quality of medicine would be reduced. What widening participation projects have achieved is far more radical. They have turned medicine into a career open to able and hard working students from any background. If the medical profession wants to continue to command the respect and prestige it values and, indeed, deserves, it must establish itself as a profession that reflects the diverse community it serves. After all, illness and medical need do not discriminate on the grounds of class or education. As a doctor, getting involved in widening participation projects is not simply a way to enhance one’s career, it is a valuable and unique opportunity for personal growth and fulfilment.

Further information

Mentoring

  • The Mentoring and Befriending Foundation ( [Link] ) has useful information on mentoring programmes across the country

  • Contact your local college or sixth form centre to find out how to join existing programmes

  • Mentors generally have formal training before starting work with young people

Summer schools

  • The Dick Whittington Summer School is always looking for enthusiastic volunteers: [Link]

  • St George’s, University of London, runs a range of summer schools: [Link]

Competing interests: A Salam helped to set up Target Medicine.

References

  1. General Medical Council. The doctor as teacher  . [Link] . 
  2. The Sutton Trust. Wasted talent. Attrition rates of high achieving pupils between school and university  . 2008. [Link] .
  3. The Sutton Trust and Department for Business Innovation and Skills. Applications, offers and admissions to research led universities  . 2009. [Link] . 
  4. Greenhalgh T, Seyan K, Boynton P. “Not a university type”: focus group study of social class, ethnic, and sex differences in school pupils’ perceptions about medical school. BMJ   2004;328:1508-9.
  5. The Sutton Trust. Half of university advice and guidance in schools is inadequate  . 2008. [Link] .
  6. House of Commons Public Accounts Committee. Widening Participation in Higher Education  . 2009. [Link] . 
  7. Teherian K, Shekarchian M. Mentoring for doctors. Do its benefits outweigh its disadvantages? Medical Teacher  2008;30(4): e95-e99.

Abdul Salam senior house officer and cofounder of Target Medicine Basildon and Thurrock University Hospital

 a.salam@ucl.ac.uk

Cite this as BMJ Careers ; doi: