Perceptions, discourses and values: Exploring how key stakeholders construct, negotiate and enact widening access to medical school

‘Widening access’ (WA) policies are designed to increase the participation of underrepresented groups into Higher Education generally, and specifically into professions such as medicine. The interpretation, negotiation and enactment of WA policies is determined by key stakeholders, including medical schools, school teachers and potential applicants. In the UK, measurable progress in WA to medicine has been low. This thesis argues this may partly be due to stakeholders’ conflicting values, ideologies and interests. The thesis thus aims to explore, analyse and better understand the complex motivations, perceptions and values underlying key stakeholders’ behaviour in WA to medicine. Data includes medical school websites, interviews with high school teachers and focus groups with pupils. Analytical methods are qualitative (critical discourse analysis; thematic analysis) and are enriched by discursive and sociological theories (Foucault, Sen, Bernstein and Bourdieu). Analysis focuses on the pathways of mutual influence and communication between key stakeholders. Findings indicate that UK medical schools predominantly situate WA within ideas of social mobility for the individual rather than benefit to the workforce. Medical school webpages frame WA as a ‘requirement’, a ‘value’, or a ‘service’ and communicate distinct impressions of institutional stance to other stakeholders. High school teachers perceive medical school applications as ‘risky’ and this appears to limit their ability to engage as greater advocates for WA. Pupils in WA high schools perceive medicine as increasingly culturally inclusive and negotiate cultural differences through reference to role models in the profession. High academic entry requirements within a context of substantial educational inequality may now be the largest perceived ‘barrier’ to medicine. Overall, this thesis identifies the reasons underlying stakeholders’ behaviour and evaluates whether these may be helping/hindering WA to medicine. It demonstrates the benefit of including diverse stakeholder’s voices in WA research and provides practical recommendations for future research, policy and practice

No ends, no means, just education: a kinaesthetic approach to thinking otherwise

In this thesis I offer an alternative to the hyper–individualistic, hyper-performative means-end dynamic that dominates contemporary educational practice. I foreground dimensions of experience that possibilise an approach that is neither instrumentatlised nor instrumentalising; an approach I term (a) (more) just education. The thesis opens with an analysis of how the reduction of education to use-value is both dependent on, and perpetuating of, a conception of subjectivity that overlooks the facticity of embodied life. The prevalence of dualist assumptions in both liberal and critical educational thinking and the persistence of these assumptions despite explicit attempts to think otherwise is mapped out and I draw a link between these assumptions and the privilege accorded to displays of understanding. Alongside this analysis I propose that the seemingly all-pervasive Cartesian legacy might be circumvented by approaching the question of subjectivity from a kinaesthetic perspective. This kinaesthetic approach is outlined with reference to the somatic dance practice of Skinner Releasing Technique (SRT). The practice of SRT offers up three ‘kinaesthetic provocations’ that invite re-thinking both the dynamics of education and the dynamics of justice. Throughout the thesis I explore an interplay between these provocations and the work of Derrida and Deleuze/Deleuze and Guattari; and through this interplay I unsettle the dualisms of self and other, self and world, and self and work. By approaching the shaping of subjectivity from a bodily, kinaesthetic perspective I submit the bodies called teachers and students, the bodies of practice called teaching and learning, the bodies of knowledge called curricula and the ideal body called justice to processes of deterritorialisation. Untethering education from its ends in this way affords the possibility of approaching education as an experience of passage. I argue that an emphasis on passage offers up educational consequences that are shared in rather than shared out and that therefore escape the grip of performative categorising trends. Through this account the role of the educator becomes one of affirmation, rather than validation, and I conclude the thesis by examining the particular sensitivities that this demands

Opening up the black box of a Gateway to Medicine programme : a realist evaluation

Acknowledgements We would like to thank all our study participants for their valuable input into the study and all those who set up and supported the programme. In particular, thank you to Professor Rona Patey, Professor Stephen Davies, Dr Wendy Dollery, Anna Johnston, Dr Christine Kay, Professor Colin Lumsden, Dr Pietro Marini, Dr Sally Middleton, Sarah Miller, Gwen Smith, Laura Young. In addition, we would like to thank Pat Maclennan for all administrative support and Scottish Government for granting the funding. Funding The programme and work was supported by Scottish Goverment.Peer reviewedPublisher PD

Well-being and attainment in Scottish education: a capabilities approach

The aim of fostering well-being has become central to Scottish educational policy, in part because of a need to address the impact of inequalities of income, wealth, power and inclusion. But, dominated by a human capital picture of the enterprising, entrepreneurial individual whose well-being is tied to particular socio-economic outcomes desired by the Scottish government focused on developing a competitive economy, current approaches to well-being in Scottish education policy primarily reflect a conception of well-being as approximating a skill to be developed for the benefit of the economy. This dissertation presents an alternative conception of well-being in education, based on the capabilities approach, mainly as articulated by Martha Nussbaum. It points to the benefits of drawing upon a capabilities approach for re-conceptualising well-being in education understood as fostering human development - rather than human capital - in which autonomy and dignity play a significant role in developing well-being and, ultimately, in human flourishing. Drawing upon the tools of philosophical inquiry that provide an important clarificatory role in the use of concepts, their implications, and justification in education policy, this dissertation serves as a critique of the current well-being policy agenda in Scottish education. It contributes to the study of well-being as a prominent aim of education in Scotland by examining the relationship between well-being and Scotland’s raising attainment agenda in secondary schools, exploring the policies and practices underpinning these two overlapping and, often, competing aims with a view to illuminating and tempering the most damaging, while retaining a qualified place for attainment in education for well-being

Medical school selection is a sociohistorical embedded activity:A comparison of five countries

Introduction: The medical school selection literature comes mostly from a few countries in the Global North and offers little opportunity to consider different ways of thinking and doing. Our aim, therefore, was to critically consider selection practices and their sociohistorical influences in our respective countries (Brazil, China, Singapore, South Africa and the UK), including how any perceived inequalities are addressed. Methods: This paper summarises many constructive dialogues grounded in the idea of he er butong (和而不同) (harmony with diversity), learning about and from each other. Results: Some practices were similar across the five countries, but there were differences in precise practices, attitudes and sociohistorical influences thereon. For example, in Brazil, South Africa and the UK, there is public and political acknowledgement that attainment is linked to systemic and social factors such as socio-economic status and/or race. Selecting for medical school solely on prior attainment is recognised as unfair to less privileged societal groups. Conversely, selection via examination performance is seen as fair and promoting equality in China and Singapore, although the historical context underpinning this value differs across the two countries. The five countries differ in respect of their actions towards addressing inequality. Quotas are used to ensure the representation of certain groups in Brazil and regional representation in China. Quotas are illegal in the UK, and South Africa does not impose them, leading to the use of various, compensatory ‘workarounds’ to address inequality. Singapore does not take action to address inequality because all people are considered equal constitutionally. Discussion: In conclusion, medical school selection practices are firmly embedded in history, values, societal expectations and stakeholder beliefs, which vary by context. More comparisons, working from the position of acknowledging and respecting differences, would extend knowledge further and enable consideration of what permits and hinders change in different contexts.</p

Cross-sectional exploration of the impact of the Dr Bawa-Garba case on doctors’ professional behaviours and attitudes towards the regulator

OBJECTIVE: This paper examines the impact on doctors’ attitudes towards the General Medical Council (GMC) and on professional behaviours (reflective practice and raising concerns) following the Dr Bawa-Garba case. DESIGN: A cross-sectional survey designed using the theoretical lens of the theory of planned behaviour (TPB) was administered from September 2017 to February 2019. By chance, this coincided with critical events in the Dr Bawa-Garba case. SETTING: Primary and secondary care settings across a broad geographical spread in England. PARTICIPANTS: 474 doctors. OUTCOME MEASURES: Attitudes towards the GMC and two professional behaviours in TPB dimensions. RESULTS: Attitudes towards the GMC became more negative during the period that the Medical Practitioners Tribunal Service and GMC suspended and subsequently erased Dr Bawa-Garba from the medical register. Specifically, confidence that doctors are well regulated by the GMC and that the GMC’s disciplinary procedures produce fair outcomes was rated more negatively. After this period, overall attitudes start to recover and soon returned close to baseline; however, confidence in how the GMC regulates doctors and their disciplinary procedures improved but still remained below baseline. There was no change in doctors’ attitudes or intention to reflect or raise concerns. CONCLUSIONS: The lack of change in doctors’ attitudes towards the GMC’s guidance, the approachability of the regulator, defensive practice and professional behaviours as a response to the Dr Bawa-Garba case demonstrates the resilient and indelible nature of medical professionalism. At the time, professional bodies reported that repairing doctors’ trust and confidence would take time and a significant effort to restore. However, this study suggests that attitudes are more fluid. Despite the high-profile nature of this case and concerns articulated by medical bodies regarding its impact on trust, the actual decline in doctors’ overall attitudes towards the GMC was relatively short lived and had no measurable impact on professionalism