Widening access to medicine, is it working?

Carolyn Blundell — School of Medicine, University of Southampton, UK

Introduction

 In 2003, 64% of medical and dental school entrants in the UK came from higher managerial and professional backgrounds. This is four times higher than the proportion of the working population with this background 1. The likelihood of an applicant being accepted to medical school generally declines with socio-economic background.

The result is a medical profession that does not  meet The Council of Heads of Medical Schools’ Statement of principles’ that 2 ‘the social, cultural and ethnic backgrounds of medical graduates should reflect broadly the diversity of those they are called upon to serve’

The UK government has made clear its commitment to widening participation in HE  and the health professions 3.       

‘We need to make more progress in widening access to medicine… Most of the present intake into our medical schools comes from a relatively small section of our society.

Rt. Hon John Hutton MP, Minister of State (Health) speech to the Council of Heads of Medical Schools, Sept.2004.

Aims of the study

At Southampton Medical School we have developed a nationally acclaimed4,5 widening access (WA) route into medicine that specifically targets young people in low socioeconomic groups. This is an interim review of  this initiative as part of a longitudinal study of WA students’ progress and achievement from admission to graduation.

Can such a widening access programme be successful without compromising standards ?

The aims of the study are :

1. To assess whether the initiative’s success criteria are being met in terms of student progression and achievement.

2. To evaluate, whether despite marked differences in entry grades and backgrounds the levels of achievement of the widening access cohort are comparable to the whole BM5 cohort.

Description of the study

One of the barriers to a place at medical school for disadvantaged groups is the high academic score required for entry.We have designed a route, see Fig 1, that enables such students (those who have been identified with the potential to succeed), to enter a six year programme, BM6 ( rather than the traditional five year, BM5) with a much lower entry score. Providing BM6 students pass the additional year, Year 0, they join the main BM5 group in Year 1.

The programme provides not only a strong academic platform for progression but health care work experience and confidence building.

The BM6 programme has  been running for three years. The first cohort are currently in Year 2 BM5 and the second cohort in Year 1 BM5. For the purposes of this study only data from the first two cohorts will be studied with the focus on Cohort 1.

•         Comparison of mean entry scores , academic performance and progression for  BM6 Cohorts 1 & 2 & the relevant BM5 cohorts they joined

•         Relationship of BM6 performance in Year 0 to performance in Years 1 and 2 using the Spearman rank correlation coefficient

 Findings to date

Entry scores

•         Mean academic scores,using UCAS tariffs were calculated for students holding AS & A2 qualifications indicating that BM6 students had scores between 37 -40% lower than their BM5 colleagues.

•          In addition graduates made up between 7 - 20% of BM5 entrants whereas there were none within BM6.

Progression

•         The BM6 programme’s success criteria for progression has been met by both BM6 Cohorts 1 & 2

•         BM6 students progression rate from Year 1 to Year 2 slightly exceeds that for BM5 students.

Academic performance of BM6 Cohort 1 compared to whole BM5 cohort

•         All BM6 students successfully passed their Primary examinations at the end of Year 1, though one student passed following a resit.

•          For all results the mean performance of the BM6 cohort was slightly below the mean performance of the whole cohort, between 5 - 5.5 % lower and the distribution skewed to the left.

( eg end of Year 1 mean marks – 67.5% for whole cohort and 62.9% for BM6 cohort ).

•         No BM6 students were within the highest scoring, top 15% of the whole cohort.

Relationship of Year 0 performance to performance in

Years 1 & 2

•         There was a significant correlation ( p = 0.001) between individual student performance for BM6 Cohort 1, Year 0 science units, and their Year 1 and Year 2 examination performance.

Key lessons learned so far and next steps

·        The Widening Access programme is so far meeting its criteria for success in terms of student progression

·        Despite considerably lower entry scores BM6, widening access students perform well within the whole BM5 student cohort and  standards are not being compromised.

·        The mean academic performance for the BM6 cohort is however approximately 5% below that of the whole cohort and BM6 students do not feature in the highest achieving student group , the top 15%.

·        There is a significant correlation between Year 0 performance in specific ( science) units and Year 1 & 2 performance for BM6 students.

·        Previous academic performance has been reported as being a good, but not perfect, predictor of achievement in medical training, this study neither confirms nor disputes this.

·        BM6 students’ progression and achievement will continue to be monitored to graduation. So far BM6 cohort 2 performance is similar to cohort 1.

·        The experience of BM6 students is being evaluated via focus groups and questionnaires to identify key issues for Year 0 curriculum review.

Questions

What role does confidence building, support mechanisms, and socialisation into the university and profession play in widening access students’ success, compared to upgrading students’ knowledge and understanding alone?

Can this be assessed ?

Literature cited

 1.        Board of Medical Education, British Medical Association. The demography of medical schools : A discussion report.London: BMA.2004.

 2.        Council of Heads of Medical Schools. Medical education and research : CHMS statement of principles,                 www.chms.ac.uk/key prin.html ( accessed 24th Nov.2004)

3.         Department of Education& Skills.Widening participation in HE.London.HMSO.2003.

4.         Universities UK Social class & participation : good practice in widening access to HE. London. Universities UK 2002.

5.         Department of Health. Medical Schools : delivering the doctors of the future. London DoH 2004.