Health Education England (HEE) – widening access to medicine

Project

Work Psychology Group (WPG) partnered with Health Education England (HEE) to evaluate the success of six new UK Medical Schools in widening access to medicine for those from lower socio-economic backgrounds.

Challenge

Medicine has historically been seen as an elitist profession requiring significant investment of time and money from both students and society. Widening access to medicine is a key government objective to encourage a diverse workforce more representative of the society it serves and to address under-doctored areas of the UK.

Research consistently shows that a more diverse healthcare workforce leads to improved population health outcomes (Razack et al., 2015). However, entry into medicine is expensive, highly competitive and relies heavily on prior academic attainment.  This makes it difficult for candidates from underrepresented groups, such as lower socio-economic and more educationally disadvantaged backgrounds, to enter the profession (Cleland & Palma, 2018).

In 2016, six new Medical Schools opened across England as part of the government’s plan to increase the number of medical students by 25% and, ultimately, the number of UK trained doctors. These new schools – Anglia Ruskin, Aston University, Edge Hill University, Lincoln Medical School, Kent & Medway and University of Sunderland – were asked to address widening access and workforce shortages by using more innovative approaches to selection and recruitment.

WPG has extensive experience in the design and evaluation of selection and recruitment processes and in the research and application of interventions targeting equality, diversity and inclusion/widening access.

Approach

WPG undertook initial research to develop an Evaluation Framework to define future evaluation activity against the original aims.  The multi-method approach comprised interviews with senior stakeholders including Deans, HEE, Office for Students, Medical Schools council and an independent expert review. Template analysis was used to analyse the transcripts (King, 1998). This led to the identification of 7 key influencing factors important to support widening access.

The final evaluation framework was structured in two parts.  A Generic Evaluation Framework, for consistent evaluation of the new Medical Schools, enabling comparisons and broader conclusions to be drawn. Also, Individual Evaluation Case Studies, where evaluation activity is specific to locally defined objectives and activities, reflecting their unique context.

For the individual evaluation case studies, qualitative data was collected with key stakeholders using interviews and focus groups.  These focussed on the locally defined objectives/activities being undertaken by each school that reflected their unique context and strengths. Participants included Deans, admissions tutors, teaching staff and senior leaders and medical students from widening access backgrounds.

Throughout this work, WPG engaged in steering group meetings with HEE and the schools to provide updates and share risks and issues. WPG also supported with organising interviews and focus groups and collating the quantitative data to facilitate the evaluation and reduce the burden on schools and students. This enabled a deeper understanding of the unique context and challenges of each school.

Throughout the evaluation, the approach was updated based on findings that emerged in relation to the school’s local context.  Whilst there is largely commonality, challenges regarding educational and socio-economic disadvantage are subtly different in Sunderland compared to Kent or Liverpool, and so on. Importantly, WPG’s ongoing engagement with each of the schools generated discussions around how they could best measure their outcomes against their overarching aim to widen access. This led to adaptations to the way the evaluation framework was applied to ensure that outcomes are meaningful for both the individual schools and wider community.

In addition, WPG consulted Professor Jen Cleland throughout the project. Jennifer is an Occupational and Clinical Psychologist with over 15 years’ expertise in medical education and, in particular, selection and widening access.  Jen is also part of the WPG Science Faculty, an invaluable team of trusted international experts with specialist skills that we can call upon to complement our in-house knowledge.

The stakeholders agreed that success would be the identification of initiatives and approaches that have had a positive impact on widening access to medical education while maintaining required educational standards.

Outcome

The findings suggest that significant innovations have successfully taken place at the new Medical Schools in relation to outreach and attraction, selection and recruitment, and the induction/ongoing support available for widening access students.

Examples are new innovations in selection criteria and the use of contextualised offers which look at a student’s performance in the context of the average performance of their school, adjustments to the weighting and sequencing use of various selection tools (such as situational judgement tests and interviews) and the use of taster/outreach programmes targeting schools that don’t usually send students to medical school.

The work identified 7 key success factors:

• Outreach & attraction
• Selection methods & contextualised offers
• Institutional culture
• Leadership commitment
• Educational initiatives
• Institutional support
• Early educational placements.

Work has been positively received by stakeholders from HEE and the new Medical Schools. Early evidence shows that initial objectives have been met using a thorough Evaluation Framework and robust data collection. The findings identified several approaches and initiatives which have been deemed successful to promote widening access, and it is intended the work will be used to inform policy across Medical Schools (in the UK and internationally).

Sharing these approaches initiates discussion and prompts further thinking around improving selection and assessment approaches and supporting widening access. Not just in medicine but potentially across additional professions.

Acknowledgements

Professor Liz Hughes, Health Education England.

All participants in the study at the six medical schools.