Opening doors and minds: a path for widening access
Abstract: By collaboratively linking multiple activities organised by the Outreach Office, academic staff and medical students, an annual cohort of approximately 20 participants from non-traditional backgrounds was provided with sustained support in preparing for applying to medical school. The limited data available from follow-up suggests that this approach may have helped overcome the social disadvantage facing these applicants.
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Cited by 8 publications
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Background: Widening access initiatives to medical school (WAMS) have had mixed success. One reason may be the competing interests of different stakeholder groups involved. The aim of this scoping review was to explore stakeholder perspectives of widening access initiatives to medical school in the UK. Methods: Scoping review, including the use of data sources from published literature from 1998 to 2018, CINAHL, Applied Social Sciences Index and Abstracts, ProQuest Education Collection, PsychINFO, PubMed, key journals and citation tracking. Results: The review focused on the 12 papers which comprise 11 studies and can be categorised into: 8 studies on Widening Access initiatives done in the UK, 2 studies on stakeholder perspectives only and 1 generic review on âbest practicesâ in WAMS. The 4 main areas targeted by the WAMS initiatives in this review include: outreach, selection, transition, retention and completion. They also display several key features which could have contributed to their success and sustainability, namely: committed personnel and resources, selection of suitable WAMS applicants, focused sessions based on needs of students, led and delivered by a combination of staff and medical students, utilisation of technology and social media and data collection and feedback. The stakeholders identified are as follows: students, parents, school teachers, medical schoolsâ admissions deans, WAMS facilitators, policy makers, hospital management and the public. Their interests and perspectives have been tabulated. Conclusions: WAMS in the UK have come a long way since their inception, but much remains to be done in achieving their desired results more broadly. As more resources are being allocated to WAMS around the country, a more thorough exploration of stakeholder perspectives and interests may be helpful in understanding how these programmes work.
Background: Widening access initiatives to medical school (WAMS) have had mixed success. One reason may be the competing interests of different stakeholder groups involved. The aim of this scoping review was to explore stakeholder perspectives of widening access initiatives to medical school in the UK. Methods: Scoping review, including the use of data sources from published literature from 1998 to 2018, CINAHL, Applied Social Sciences Index and Abstracts, ProQuest Education Collection, PsychINFO, PubMed, key journals and citation tracking. Results: The review focused on the 12 papers which comprise 11 studies and can be categorised into: 8 studies on Widening Access initiatives done in the UK, 2 studies on stakeholder perspectives only and 1 generic review on âbest practicesâ in WAMS. The 4 main areas targeted by the WAMS initiatives in this review include: outreach, selection, transition, retention and completion. They also display several key features which could have contributed to their success and sustainability, namely: committed personnel and resources, selection of suitable WAMS applicants, focused sessions based on needs of students, led and delivered by a combination of staff and medical students, utilisation of technology and social media and data collection and feedback. The stakeholders identified are as follows: students, parents, school teachers, medical schoolsâ admissions deans, WAMS facilitators, policy makers, hospital management and the public. Their interests and perspectives have been tabulated. Conclusions: WAMS in the UK have come a long way since their inception, but much remains to be done in achieving their desired results more broadly. As more resources are being allocated to WAMS around the country, a more thorough exploration of stakeholder perspectives and interests may be helpful in understanding how these programmes work.
Impact of summer programmes on the outcomes of disadvantaged or âat riskâ young people: A systematic review
Review Rationale and ContextMany intervention studies of summer programmes examine their impact on employment and education outcomes, however there is growing interest in their effect on young people's offending outcomes. Evidence on summer employment programmes shows promise on this but has not yet been synthesised. This report fills this evidence gap through a systematic review and metaâanalysis, covering summer education and summer employment programmes as their contexts and mechanisms are often similar.Research ObjectiveThe objective is to provide evidence on the extent to which summer programmes impact the outcomes of disadvantaged or âat riskâ young people.MethodsThe review employs mixed methods: we synthesise quantitative information estimating the impact of summer programme allocation/participation across the outcome domains through metaâanalysis using the randomâeffects model; and we synthesise qualitative information relating to contexts, features, mechanisms and implementation issues through thematic synthesis. Literature searches were largely conducted in January 2023. Databases searched include: Scopus; PsychInfo; ERIC; the YFFâEGM; EEF's and TASO's toolkits; RAND's summer programmes evidence review; key academic journals; and Google Scholar. The review employed PICOSS eligibility criteria: the population was disadvantaged or âat riskâ young people aged 10â25; interventions were either summer education or employment programmes; a valid comparison group that did not experience a summer programme was required; studies had to estimate the summer programme's impact on violence and offending, education, employment, socioâemotional and/or health outcomes; eligible study designs were experimental and quasiâexperimental; eligible settings were highâincome countries. Other eligibility criteria included publication in English, between 2012 and 2022. Process/qualitative evaluations associated with eligible impact studies or of UKâbased interventions were also included; the latter given the interests of the sponsors. We used standard methodological procedures expected by The Campbell Collaboration. The search identified 68 eligible studies; with 41 eligible for metaâanalysis. Fortyânine studies evaluated 36 summer education programmes, and 19 studies evaluated six summer employment programmes. The number of participants within these studies ranged from less than 100 to nearly 300,000. The PICOSS criteria affects the external applicability of the body of evidence â allowances made regarding study design to prioritise evidence on UKâbased interventions limits our ability to assess impact for some interventions. The risk of bias assessment categorised approximately 75% of the impact evaluations as low quality, due to attrition, losses to follow up, interventions having low takeâup rates, or where allocation might introduce selection bias. As such, intentionâtoâtreat analyses are prioritised. The quality assessment rated 93% of qualitative studies as low quality often due to not employing rigorous qualitative methodologies. These results highlight the need to improve the evidence.Results and ConclusionsQuantitative synthesis The quantitative synthesis examined impact estimates across 34 outcomes, through metaâanalysis (22) or in narrative form (12). We summarise below the findings where metaâanalysis was possible, along with the researchers' judgement of the security of the findings (high, moderate or low). This was based on the number and studyâdesign quality of studies evaluating the outcome; the consistency of findings; the similarity in specific outcome measures used; and any other specific issues which might affect our confidence in the summary findings.Below we summarise the findings from the metaâanalyses conducted to assess the impact of allocation to/participation in summer education and employment programmes (findings in relation to other outcomes are also discussed in the main body, but due to the low number of studies evaluating these, metaâanalysis was not performed). We only cover the pooled results for the two programme types where there are not clear differences in findings between summer education and summer employment programmes, so as to avoid potentially attributing any impact to both summer programme types when this is not the case. We list the outcome measure, the average effect size type (i.e., whether a standardised mean difference (SMD) or log odds ratio), which programme type the finding is in relation to and then the average effect size along with its 95% confidence interval and the interpretation of the finding, that is, whether there appears to be a significant impact and in which direction (positive or negative, clarifying instances where a negative impact is beneficial). In some instances there may be a discrepancy between the 95% confidence interval and whether we determine there to be a significant impact, which will be due to the specifics of the process for constructing the effect sizes used in the metaâanalysis. We then list the I2 statistic and the pâvalue from the homogeneity test as indications of the presence of heterogeneity. As the sample size used in the analysis are often small and the homogeneity test is known to be underâpowered with small sample sizes, it may not detect statistically significant heterogeneity when it is in fact present. As such, a 90% confidence level threshold should generally be used when interpreting this with regard to the metaâanalyses below. The presence of effect size heterogeneity affects the extent to which the average effects size is applicable to all interventions of that summer programme type. We also provide an assessment of the relative confidence we have in the generalisability of the overall finding (low, moderate or high) â some of the overall findings are based on a small sample of studies, the studies evaluating the outcome may be of low quality, there may be wide variation in findings among the studies evaluating the outcome, or there may be specific aspects of the impact estimates included or the effect sizes constructed that affect the generalisability of the headline finding. These issues are detailed in full in the main body of the review. Engagement with/participation in/enjoyment of education (SMD): Secondary education attendance (SMD): Passing tests (log OR): Reading test scores (SMD): English test scores (SMD): Mathematics test scores (SMD): Overall test scores (SMD): All test scores (SMD): Negative behavioural outcomes (log OR): Progression to HE (log OR): Complete HE (log OR): Entry to employment, shortâterm (log OR): Likelihood of having a criminal justice outcome (log OR): Likelihood of having a drugârelated criminal justice outcome (log OR): Likelihood of having a violenceârelated criminal justice outcome (log OR): Likelihood of having a propertyârelated criminal justice outcome (log OR): Number of criminal justice outcomes, during programme (SMD): Number of criminal justice outcomes, postâprogramme (SMD): Number of drugârelated criminal justice outcomes, postâprogramme (SMD): Number of violenceârelated criminal justice outcomes, postâprogramme (SMD): Number of propertyârelated criminal justice outcomes, postâprogramme (SMD):We reâexpress instances of significant impact by programme type where we have moderate or high confidence in the security of findings by translating this to a form used by one of the studies, to aid understanding of the findings. Allocation to a summer education programme results in approximately 60% of individuals moving from never reading for fun to doing so once or twice a month (engagement in/participation in/enjoyment of education), and an increase in the English Grade Point Average of 0.08. Participation in a summer education programme results in an increase in overall Grade Point Average of 0.14 and increases the likelihood of completing higher education by 1.5 times. Signs are positive for the effectiveness of summer education programmes in achieving some of the education outcomes considered (particularly on test scores (when pooled across types), completion of higher education and STEMârelated higher education outcomes), but the evidence on which overall findings are based is often weak. Summer employment programmes appear to have a limited impact on employment outcomes, if anything, a negative impact on the likelihood of entering employment outside of employment related to the programme. The evidence base for impacts of summer employment programmes on young people's violence and offending type outcomes is currently limited â where impact is detected this largely results in substantial reductions in criminal justice outcomes, but the variation in findings across and within studies affects our ability to make any overarching assertions with confidence. In understanding the effectiveness of summer programmes, the order of outcomes also requires consideration â entries into education from a summer employment programme might be beneficial if this leads towards better quality employment in the future and a reduced propensity of criminal justice outcomes.Qualitative SynthesisVarious shared features among different summer education programmes emerged from the review, allowing us to cluster specific types of these interventions which then aided the structuring of the thematic synthesis. The three distinct clusters for summer education programmes were: catchâup programmes addressing attainment gaps, raising aspirations programmes inspiring young people to pursue the next stage of their education or career, and transition support programmes facilitating smooth transitions between educational levels. Depending on their aim, summer education programme tend to provide a combination of: additional instruction on core subjects (e.g., English, mathematics); academic classes including to enhance specialist subject knowledge (e.g., STEMârelated); homework help; coaching and mentoring; arts and recreation electives; and social and enrichment activities. Summer employment programmes provide paid work placements or subsidised jobs typically in entryâlevel roles mostly in the third and public sectors, with some summer employment programmes also providing placements in the private sector. They usually include components of preâwork training and employability skills, coaching and mentoring. There are a number of mechanisms which act as facilitators or barriers to engagement in summer programmes. These include tailoring the summer programme to each young person and individualised attention; the presence of wellâprepared staff who provide effective academic/workplace and socioâemotional support; incentives of a monetary (e.g., stipends and wages) or nonâmonetary (e.g., free transport and meals) nature; recruitment strategies, which are effective at identifying, targeting and engaging participants who can most benefit from the intervention; partnerships, with key actors who can help facilitate referrals and recruitment, such as schools, community action and workforce development agencies; format, including providing social activities and opportunities to support the formation of connections with peers; integration into the workplace, through preâplacement engagement, such as through orientation days, preâwork skills training, job fairs, and interactions with employers ahead of the beginning of the summer programme; and skill acquisition, such as improvements in social skills. In terms of the causal processes which lead from engagement in a summer programme to outcomes, these include: skill acquisition, including academic, social, emotional, and life skills; positive relationships with peers, including with older students as mentors in summer education programmes; personalised and positive relationships with staff; location, including accessibility and creating familiar environments; creating connections between the summer education programme and the students' learning at home to maintain continuity and reinforce learning; and providing purposeful and meaningful work through summer employment programmes (potentially facilitated through the provision of financial and/or nonâfinancial incentives), which makes participants more likely to see the importance of education in achieving their life goals and this leads to raised aspirations. It is important to note that no single element of a summer programme can be identified as generating the causal process for impact, and impact results rather from a combination of elements. Finally, we investigated strengths and weaknesses in summer programmes at both the design and implementation stages. In summer education programmes, design strengths include interactive and alternative learning modes; iterative and progressive content building; incorporating confidence building activities; careful lesson planning; and teacher support which is tailored to each student. Design weaknesses include insufficient funding or poor funding governance (e.g., delays to funding); limited reach of the target population; and inadequate allocation of teacher and pupil groups (i.e., misalignment between the education stage of the pupils and the content taught by staff). Implementation strengths include clear programme delivery guidance and good governance; high quality academic instruction; mentoring support; and strong partnerships. Implementation weaknesses include insufficient planning and lead in time; recruitment challenges; and variability in teaching quality. In summer employment programmes, design strengths include use of employer orientation materials and supervisor handbooks; careful consideration of programme staff roles; a wide range of job opportunities; and building a network of engaged employers. Design weaknesses are uncertainty over funding and budget agreements; variation in delivery and quality of training between providers; challenges in recruitment of employers; and caseload size and management. Implementation strengths include effective job matching; supportive relationships with supervisors; preâwork training; and mitigating attrition (e.g., striving to increase take up of the intervention among the treatment group). Implementation weaknesses are insufficient monitors for the number of participants, and challenges around employer availability.
Medical schools worldwide undertake widening access (WA) initiatives (e.g. pipeline, outreach and academic enrichment programmes) to support pupils from high schools which do not traditionally send high numbers of applicants to medicine. UK literature indicates that pupils in these schools feel that their teachers are ill-equipped, cautious or even discouraging towards their aspiration and/or application to medicine. This study aimed to explore teachers' perspectives and practices to include their voice in discussions and consider how medical schools might best engage with them to facilitate WA. Interviews were conducted with high school teachers in three UK regions, working in schools targeted by WA initiatives. Data were analysed thematically using template analysis, using a largely data-driven approach. Findings showed that although medicine was largely seen as a prestigious and worthwhile career, teachers held reservations about advocating this above other choices. Teachers saw it as their role to encourage pupils to educate themselves about medicine, but to ultimately allow pupils to make their own decisions. Their attitudes were influenced by material constraints in their schools, and the perception of daunting, long and emotionally difficult admissions requirements, with low chances of success. Medical schools may wish to work with teachers to understand their hesitations and help them develop the mindset required to advocate a challenging and unfamiliar career, emphasising that this encouragement can further the shared goal of empowering and preparing pupils to feel capable of choosing medicine. Reciprocally, medical schools should ensure pupils have fair opportunities for access, should they choose to apply.
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