Widening access to medicine: A realist review

The under-participation of students from disadvantaged population groups in medical education reflects broader complex structural and societal issues, highlighting that widening access (WA) selection pathways into medicine are highly context dependent. While much literature on WA pathways exists, to date this is limited to small, mostly descriptive, single-site studies; hence there is a need for more robust and theory-driven approaches to yield transferable findings. This realist review sought to develop explanatory theory on designing and implementing selection pathways that successfully widen access to medicine and increase cohort diversity.A realist approach to evidence synthesis identified the mechanisms (M) of action underpinning WA interventions for selection into medical school. We examined how these mechanisms triggered outcomes (O) related to increasing cohort diversity within different contexts (C). Our research design was informed by Pawson’s five iterative strategies for realist review: (1) locate existing theories, (2) search for evidence, (3) select articles, (4) extract and organise data and (5) synthesise the evidence and draw conclusions.Of the 6300 studies identified and screened in the main search, 32 met the inclusion criteria. Five types of WA interventions were reported across the 32 papers:(1) Minimising Bias(2) Modifying selection criteria(3) Collaborating with community(4) Preparing applicants for selection and studying medicine(5) Combining College with Medical SchoolOur realist analysis developed and refined 19 context-intervention-mechanism-outcome (CIMO) configurations. Mechanisms were categorised as addressing institutional, situational, or dispositional barriers to selection into medicine. While situational factors were often the impetus for implementing a WA intervention, the interventions themselves were developed with either an institutional or dispositional focus.There are several known situational barriers that influence the decision of individuals from under-represented minority groups just to apply to medical school. The reviewed studies reported on interventions that demonstrated positive gains in increasing applicants, offers and matriculants in several under-represented populations. More research is needed around mitigating barriers earlier in the journey to medical school (pre-application) through to supportive interventions provided once accepted (post-admission, retention, and graduation) to fully diversify the health workforce.This review highlights how institutions all use demographic characteristics to identify under-represented students, but these demographics are usually blunt one-dimensional measures of disadvantage and therefore limited. This review highlights how sociocultural conditions and policy, either external or within an institution, will drive the commitment and resources made available for a WA intervention. Based on the findings of the review reported here, the review team were left wondering if the interventions being applied are genuinely widening access for disadvantaged applicants to medical education

Widening Access to Medicine: A Realist Review

The under-par7cipa7on of students from disadvantaged popula7on groups in medical educa7on reflects broader complex structural and societal issues, highligh7ng that widening access (WA) selec7on pathways into medicine are highly context dependent. While much literature on WA pathways exists, to date this is limited to small, mostly descrip7ve, single-site studies; hence there is a need for more robust and theory-driven approaches to yield transferable findings. This realist review sought to develop explanatory theory on designing and implemen7ng selec7on pathways that successfully widen access to medicine and increase cohort diversity

The Price of Bodies: A Hedonic Pricing Model of Avatar Attributes in a Synthetic World

Cet article explore une nouvelle et unique source d'évaluation sociale: un marché pour des corps. Sur internet, on trouve un grand nombre de mondes synthétiques que les utilisateurs visitent en se servant d'un corps virtuel, le soi-disant avatar. Les avatars ont une valeur réelle puisque les utilisateurs passent du temps à améliorer leur habileté; ces valeurs peuvent être observées directement sur des marchés en ligne. Les données des enchères du monde virtuel d'EverQuest sont utilisées ici pour évaluer un nombre de questions relatives aux valeurs de différentes caractéristiques des avatars. L'analyse hédonique des prix aux enchères suggère que le 'niveau', une mesure inhérente au jeu qui indique la fonctionnalité ou le pouvoir d'un avatar, est de loin la caractéristique la plus importante. D'autres attributs qui exercent une influence significative sur le prix sont le sexe et la classe (p.ex. être un magicien plutôt qu'un guerrier). La différence de prix entre les sujets masculins et féminins est intéressante, puisqu'il n'existe pas de différence dépendant du sexe quant à l'habileté des caractères. La différence de prix doit donc dériver d'une autre préférence des acheteurs qui n'est pas en relation avec le pouvoir ou la fonctionnalité des avatars en tant que tels. Copyright WWZ and Helbing & Lichtenhahn Verlag AG 2004.

Public COAPI Toolkit of Open Access Policy Resources

The Coalition of Open Access Policy Institutions (COAPI, https://sparcopen.org/coapi ) is committed to sharing information and resources to assist in the development and implementation of institutional Open Access (OA) policies. The COAPI Toolkit includes a diverse collection of resources that COAPI members have developed in the course of their OA policy initiatives. These resources are openly accessible and published here under Creative Commons Attribution 4.0 licenses, unless otherwise noted on the resources themselves