Hope, David

Simpson, Ashley victoria

English

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     Edinburgh Research Explorer                                      From policy to practice: Measuring success in wideningparticipationCitation for published version:Simpson, AV & Hope, D 2024, 'From policy to practice: Measuring success in widening participation',Medical Education. https://doi.org/10.1111/medu.15443Digital Object Identifier (DOI):10.1111/medu.15443Link:Link to publication record in Edinburgh Research ExplorerDocument Version:Publisher's PDF, also known as Version of recordPublished In:Medical EducationGeneral rightsCopyright for the publications made accessible via the Edinburgh Research Explorer is retained by the author(s)and / or other copyright owners and it is a condition of accessing these publications that users recognise andabide by the legal requirements associated with these rights.Take down policyThe University of Edinburgh has made every reasonable effort to ensure that Edinburgh Research Explorercontent complies with UK legislation. If you believe that the public display of this file breaches copyright pleasecontact openaccess@ed.ac.uk providing details, and we will remove access to the work immediately andinvestigate your claim.Download date: 26. Nov. 2025COMMEN T A R YFrom policy to practice: Measuring success in wideningparticipationAshley Victoria Simpson1,2 | David Hope21NHS Lothian Medical Education Directorate, Edinburgh, UK2Edinburgh Medical School, Edinburgh, UKCorrespondenceAshley Victoria Simpson, NHS Lothian Medical Education Directorate, Edinburgh, UK.Email: ashley.v.simpson@ed.ac.ukImproving diversity within the medical profession is an internationalpriority.1 Nevertheless, some backgrounds remain underrepresentedin medicine.2 In this issue of Medical Education, Cleland et al describethe complexities of translating widening participation policy intopractice.3 Recognising that establishing policy is only the first step,they explore the process of policy enactment, describing differencesbetween institutions and tensions between new medical schoolsand their host universities. Cleland et al conclude that context iscritical to enacting widening participation policy in a substantive andsustainable way. However, they note that tensions exist regarding themeasurement of success. In this commentary, we will explore theindicators of widening participation, discuss how macrolevel policymight be attached to microlevel stakeholders, and consider how todeal with policy failure.As we have previously highlighted, the indicators of wideningparticipation employed in selection processes varies betweeninstitutions.4 Furthermore, as Cleland et al note, the relative weightgiven to indicators also differs. The lack of standardisation makespolicies hard to evaluate on a national level. Variation acrossinstitutions restricts applicants, who may find that their ‘indicator’does not universally entitle them to a contextual admission. Byconsidering a broad range of indicators as being a single category,we homogenise learners from diverse backgrounds who may havedifferent needs. A native applicant from a socio-economicallydeprived or care-experienced background will have differentexperiences to a refugee or asylum seeker.By considering a broad rangeof indicators as being a singlecategory, we homogeniselearners from diversebackgrounds who may havedifferent needs.Cleland et al describe that the universities they studied met policytargets as defined by percentage intake of students. However, it isunclear what indicators of widening participation these students hadand no sub-categorisation was reported. What if, for arguments sake,these institutions recruited large numbers of students from areas ofsocio-economic deprivation, but no refugee or care-experiencedstudents? Yes, intake targets may have been met, but it would beunjust to consider policy successful if a minority population remainexcluded. There are implications for equity by using only a single‘super-category’ of widening participation and not considering moregranular demographic data. Furthermore, some applicants will havemultiple indicators, which are not just additive but multiplicative.Widening participation is not a one-dimensional issue. Policy mustacknowledge the intersectionality of demographic variables if it is toReceived: 9 May 2024 Accepted: 9 May 2024DOI: 10.1111/medu.15443This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in anymedium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.© 2024 The Author(s). Medical Education published by Association for the Study of Medical Education and John Wiley & Sons Ltd.Med Educ. 2024;1–3. wileyonlinelibrary.com/journal/medu 1have a meaningful impact.5 We must also exert caution when usingintake of students as the measure of success. If a university reports a40% intake of widening participation students, and half of these laterwithdraw from programme, this is not success. They may havereached a prescribed policy target, but the rate of non-continuationcannot be overlooked.It would be unjust toconsider policy successful if aminority population remainexcluded.As such, policymakers and medical schools must consider how tomeasure success in a granular way, and how to connect overall policyto areas of medical education delivery. We will briefly discuss therole of admissions, assessment experts, pastoral care, financialservices and programme leadership, giving examples of local policyconsiderations.Policymakers and medicalschools must consider how tomeasure success in agranular way.Admissions teams routinely consider their approach to selection,including deviations from standard academic entry requirements oruplifting pre-application aptitude test scores (e.g. UCAT) for wideningparticipation students. It is relatively straightforward to set a recruit-ment target and adjust entry requirements. Yet, admission to medicalschool is not the endpoint of widening participation6 and recruits faceadditional challenges transitioning to tertiary education, with differen-tial attainment in examinations7 and higher non-continuation rates.8Assessment experts should monitor attainment gaps throughoutmedical school and interrogate the causes of such gaps. Pastoral careservices, such as counselling and mentoring, are essential. Wellbeingstaff may require additional training to allow them to deliverculturally-sensitive support for students from disadvantaged or minor-ity groups, and the uptake rates of services should be measured.Financial issues among widening participation students are relevant tothose within finance departments, who may need to assist via bursa-ries or hardship funds. Ensuring financial support is available is anobvious policy target. Finally, programme leaders should take owner-ship of the overall policy and lead change. Widening participationstudents experience less growth in social capital and develop fewerconnections while at university,9 and policy targets for leaders mightcentre around building a welcoming and inclusive environment. Theseare examples, and many others are applicable.So far, we have considered policy in terms of success. In the lit-erature, there has been little discussion about how deal with failure.If recruitment targets are not met, or financial support is inadequate,how should failure be remedied and who should be held account-able? As the newly expanded cohorts of widening participationstudents progress through medical education, some objectives willprobably go unmet. Clear policy goals, tied to pre-agreed measuresof success, carefully evaluated through the implementation phase,will offer the best chance to identify what went wrong and how tofix it.Widening participation has been a priority for at least the lasttwo decades. Now, we are moving into a phase where we mustmonitor the effectiveness of policy at every level within medicaleducation, building towards a future in which there are morewidening participation medical students and doctors than everbefore. By carefully considering how to enact policy and measuresuccess (or failure) now, we will increase the chances of success inthe future.We are moving into a phasewhere we must monitor theeffectiveness of policy atevery level within medicaleducation.AUTHOR CONTRIBUTIONSAshley V. Simpson: Conceptualization; writing—original draft;writing—review and editing. David Hope: Conceptualization; writing—original draft; writing—review and editing.ORCIDAshley Victoria Simpson https://orcid.org/0009-0002-4747-525XDavid Hope https://orcid.org/0000-0001-6623-2857REFERENCES1. Salmi S. (2018). All around the world – Higher education equitypolicies across the globe – Lumina Foundation. 2018. AccessedJanuary 19, 2024. https://scholarshipsforchange.issuelab.org/resources/37341/37341.pdf2. Patterson F, Roberts C, Hanson MD, et al. 2018 Ottawa consensusstatement: selection and recruitment to the healthcare professions.Med Teach. 2018;40(11):1091-1101. doi:10.1080/0142159X.2018.14985893. Cleland J, Buxton J, Hughes L, Patterson F. Translating governmentpolicy into practice: how new UK medical schools enact wideningparticipation. Medical Education. 2024. doi:10.1111/medu.154034. Simpson AV, Hope D. When I say … widening participation. Med Educ.2024;1-2. doi:10.1111/medu.153722 COMMENTARY 13652923, 0, Downloaded from https://asmepublications.onlinelibrary.wiley.com/doi/10.1111/medu.15443 by Test, Wiley Online Library on [24/05/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License5. MSC. (2014). Selecting for excellence. Outreach Guidance. https://www.medschools.ac.uk/media/1205/msc-a-journey-to-medicine-outreach-guidance.pdf6. Sartania N. Admission to medical school is not the endpoint ofwidening participation. Open Scholarship of Teaching and Learning.2023;2(3):3. doi:10.56230/osotl.617. Hope D, Dewar A, Hothersall EJ, Leach JP, Cameron I, Jaap A.Measuring differential attainment: a longitudinal analysis ofassessment results for 1512 medical students at four Scottish medicalschools. BMJ Open. 2021;11(9):Article 9. doi:10.1136/bmjopen-2020-0460568. Krstic C, Krstic L, Tulloch A, Agius S, Warren A, Doody GA. Theexperience of widening participation students in undergraduatemedical education in the UK: a qualitative systematic review. MedTeach. 2021;(9):1053. doi:10.1080/0142159X.2021.19089769. Friend KL. The creation of social networks: social capital and theexperiences of widening participation students at three elite institu-tions in the US, England, and Scotland. Pedagogy, Culture & Society.2021;29(3):359-377. doi:10.1080/14681366.2020.1735496How to cite this article: Simpson AV, Hope D. From policy topractice: Measuring success in widening participation. MedEduc. 2024;1‐3. doi:10.1111/medu.15443COMMENTARY 3 13652923, 0, Downloaded from https://asmepublications.onlinelibrary.wiley.com/doi/10.1111/medu.15443 by Test, Wiley Online Library on [24/05/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License

From policy to practice: Measuring success in widening participation

     Edinburgh Research Explorer                                      From policy to practice: Measuring success in wideningparticipationCitation for published version:Simpson, AV & Hope, D 2024, 'From policy to practice: Measuring success in widening participation',Medical Education. https://doi.org/10.1111/medu.15443Digital Object Identifier (DOI):10.1111/medu.15443Link:Link to publication record in Edinburgh Research ExplorerDocument Version:Publisher's PDF, also known as Version of recordPublished In:Medical EducationGeneral rightsCopyright for the publications made accessible via the Edinburgh Research Explorer is retained by the author(s)and / or other copyright owners and it is a condition of accessing these publications that users recognise andabide by the legal requirements associated with these rights.Take down policyThe University of Edinburgh has made every reasonable effort to ensure that Edinburgh Research Explorercontent complies with UK legislation. If you believe that the public display of this file breaches copyright pleasecontact openaccess@ed.ac.uk providing details, and we will remove access to the work immediately andinvestigate your claim.Download date: 06. Aug. 2024COMMEN T A R YFrom policy to practice: Measuring success in wideningparticipationAshley Victoria Simpson1,2 | David Hope21NHS Lothian Medical Education Directorate, Edinburgh, UK2Edinburgh Medical School, Edinburgh, UKCorrespondenceAshley Victoria Simpson, NHS Lothian Medical Education Directorate, Edinburgh, UK.Email: ashley.v.simpson@ed.ac.ukImproving diversity within the medical profession is an internationalpriority.1 Nevertheless, some backgrounds remain underrepresentedin medicine.2 In this issue of Medical Education, Cleland et al describethe complexities of translating widening participation policy intopractice.3 Recognising that establishing policy is only the first step,they explore the process of policy enactment, describing differencesbetween institutions and tensions between new medical schoolsand their host universities. Cleland et al conclude that context iscritical to enacting widening participation policy in a substantive andsustainable way. However, they note that tensions exist regarding themeasurement of success. In this commentary, we will explore theindicators of widening participation, discuss how macrolevel policymight be attached to microlevel stakeholders, and consider how todeal with policy failure.As we have previously highlighted, the indicators of wideningparticipation employed in selection processes varies betweeninstitutions.4 Furthermore, as Cleland et al note, the relative weightgiven to indicators also differs. The lack of standardisation makespolicies hard to evaluate on a national level. Variation acrossinstitutions restricts applicants, who may find that their ‘indicator’does not universally entitle them to a contextual admission. Byconsidering a broad range of indicators as being a single category,we homogenise learners from diverse backgrounds who may havedifferent needs. A native applicant from a socio-economicallydeprived or care-experienced background will have differentexperiences to a refugee or asylum seeker.By considering a broad rangeof indicators as being a singlecategory, we homogeniselearners from diversebackgrounds who may havedifferent needs.Cleland et al describe that the universities they studied met policytargets as defined by percentage intake of students. However, it isunclear what indicators of widening participation these students hadand no sub-categorisation was reported. What if, for arguments sake,these institutions recruited large numbers of students from areas ofsocio-economic deprivation, but no refugee or care-experiencedstudents? Yes, intake targets may have been met, but it would beunjust to consider policy successful if a minority population remainexcluded. There are implications for equity by using only a single‘super-category’ of widening participation and not considering moregranular demographic data. Furthermore, some applicants will havemultiple indicators, which are not just additive but multiplicative.Widening participation is not a one-dimensional issue. Policy mustacknowledge the intersectionality of demographic variables if it is toReceived: 9 May 2024 Accepted: 9 May 2024DOI: 10.1111/medu.15443This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in anymedium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.© 2024 The Author(s). Medical Education published by Association for the Study of Medical Education and John Wiley & Sons Ltd.Med Educ. 2024;1–3. wileyonlinelibrary.com/journal/medu 1have a meaningful impact.5 We must also exert caution when usingintake of students as the measure of success. If a university reports a40% intake of widening participation students, and half of these laterwithdraw from programme, this is not success. They may havereached a prescribed policy target, but the rate of non-continuationcannot be overlooked.It would be unjust toconsider policy successful if aminority population remainexcluded.As such, policymakers and medical schools must consider how tomeasure success in a granular way, and how to connect overall policyto areas of medical education delivery. We will briefly discuss therole of admissions, assessment experts, pastoral care, financialservices and programme leadership, giving examples of local policyconsiderations.Policymakers and medicalschools must consider how tomeasure success in agranular way.Admissions teams routinely consider their approach to selection,including deviations from standard academic entry requirements oruplifting pre-application aptitude test scores (e.g. UCAT) for wideningparticipation students. It is relatively straightforward to set a recruit-ment target and adjust entry requirements. Yet, admission to medicalschool is not the endpoint of widening participation6 and recruits faceadditional challenges transitioning to tertiary education, with differen-tial attainment in examinations7 and higher non-continuation rates.8Assessment experts should monitor attainment gaps throughoutmedical school and interrogate the causes of such gaps. Pastoral careservices, such as counselling and mentoring, are essential. Wellbeingstaff may require additional training to allow them to deliverculturally-sensitive support for students from disadvantaged or minor-ity groups, and the uptake rates of services should be measured.Financial issues among widening participation students are relevant tothose within finance departments, who may need to assist via bursa-ries or hardship funds. Ensuring financial support is available is anobvious policy target. Finally, programme leaders should take owner-ship of the overall policy and lead change. Widening participationstudents experience less growth in social capital and develop fewerconnections while at university,9 and policy targets for leaders mightcentre around building a welcoming and inclusive environment. Theseare examples, and many others are applicable.So far, we have considered policy in terms of success. In the lit-erature, there has been little discussion about how deal with failure.If recruitment targets are not met, or financial support is inadequate,how should failure be remedied and who should be held account-able? As the newly expanded cohorts of widening participationstudents progress through medical education, some objectives willprobably go unmet. Clear policy goals, tied to pre-agreed measuresof success, carefully evaluated through the implementation phase,will offer the best chance to identify what went wrong and how tofix it.Widening participation has been a priority for at least the lasttwo decades. Now, we are moving into a phase where we mustmonitor the effectiveness of policy at every level within medicaleducation, building towards a future in which there are morewidening participation medical students and doctors than everbefore. By carefully considering how to enact policy and measuresuccess (or failure) now, we will increase the chances of success inthe future.We are moving into a phasewhere we must monitor theeffectiveness of policy atevery level within medicaleducation.AUTHOR CONTRIBUTIONSAshley V. Simpson: Conceptualization; writing—original draft;writing—review and editing. David Hope: Conceptualization; writing—original draft; writing—review and editing.ORCIDAshley Victoria Simpson https://orcid.org/0009-0002-4747-525XDavid Hope https://orcid.org/0000-0001-6623-2857REFERENCES1. Salmi S. (2018). All around the world – Higher education equitypolicies across the globe – Lumina Foundation. 2018. AccessedJanuary 19, 2024. https://scholarshipsforchange.issuelab.org/resources/37341/37341.pdf2. Patterson F, Roberts C, Hanson MD, et al. 2018 Ottawa consensusstatement: selection and recruitment to the healthcare professions.Med Teach. 2018;40(11):1091-1101. doi:10.1080/0142159X.2018.14985893. Cleland J, Buxton J, Hughes L, Patterson F. Translating governmentpolicy into practice: how new UK medical schools enact wideningparticipation. Medical Education. 2024. doi:10.1111/medu.154034. Simpson AV, Hope D. When I say … widening participation. Med Educ.2024;1-2. doi:10.1111/medu.153722 COMMENTARY 13652923, 0, Downloaded from https://asmepublications.onlinelibrary.wiley.com/doi/10.1111/medu.15443 by Test, Wiley Online Library on [24/05/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License5. MSC. (2014). Selecting for excellence. Outreach Guidance. https://www.medschools.ac.uk/media/1205/msc-a-journey-to-medicine-outreach-guidance.pdf6. Sartania N. Admission to medical school is not the endpoint ofwidening participation. Open Scholarship of Teaching and Learning.2023;2(3):3. doi:10.56230/osotl.617. Hope D, Dewar A, Hothersall EJ, Leach JP, Cameron I, Jaap A.Measuring differential attainment: a longitudinal analysis ofassessment results for 1512 medical students at four Scottish medicalschools. BMJ Open. 2021;11(9):Article 9. doi:10.1136/bmjopen-2020-0460568. Krstic C, Krstic L, Tulloch A, Agius S, Warren A, Doody GA. Theexperience of widening participation students in undergraduatemedical education in the UK: a qualitative systematic review. MedTeach. 2021;(9):1053. doi:10.1080/0142159X.2021.19089769. Friend KL. The creation of social networks: social capital and theexperiences of widening participation students at three elite institu-tions in the US, England, and Scotland. Pedagogy, Culture & Society.2021;29(3):359-377. doi:10.1080/14681366.2020.1735496How to cite this article: Simpson AV, Hope D. From policy topractice: Measuring success in widening participation. MedEduc. 2024;1‐3. doi:10.1111/medu.15443COMMENTARY 3 13652923, 0, Downloaded from https://asmepublications.onlinelibrary.wiley.com/doi/10.1111/medu.15443 by Test, Wiley Online Library on [24/05/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License

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From policy to practice: Measuring success in widening participation

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