Division of Medical and Dental Education, University of Aberdeen, Aberdeen, UK.
Med Educ. 2015 Jan;49(1):25-35. doi: 10.1111/medu.12502.
Since the 1970s, the UK medical student body has become increasingly diverse in terms of gender, ethnicity and age, but not in socio-economic background. This variance may be linked to large differences in how individual medical schools interpret and put into practice widening participation (WP) policy. However, attempts to theorise what happens when policy enters practice are neglected in medical education. We aimed to explore the dynamics of policy enactment to give a novel perspective on WP practices across UK medical schools.
We used a qualitative design employing individual telephone interviews to elicit views and concerns around WP from admissions deans and admissions staff within UK medical schools. We carried out interviews with representatives from 24 of 32 UK medical schools. Data coding and analysis were initially inductive, using framework analysis. After the themes emerged, we applied a deductive framework to group themes into four contextual dimensions of 'situation', 'professional', 'material' and 'external'.
Our participants held different positions in relation to the interpreting and translating of WP policy, which were influenced by a number of contextual factors including: geographical locality and positioning of the medical school; the expectations of the university and other key stakeholders, and resources. The latter were subtle and referred to resources for medical selection processes rather than for WP per se. The data hinted that the political goal of WP and medical education's goal of producing the best doctors may conflict.
This is the first study to explicitly explore WP policy enactment in medical education. Our analysis is useful for understanding differences in how WP policy is played out in local contexts, and for planning for future policy enactment and research. The messages identified will resonate internationally with all those engaged in efforts to widen participation in medical education.
自 20 世纪 70 年代以来，英国医学生群体在性别、种族和年龄方面变得更加多样化，但在社会经济背景方面并非如此。这种差异可能与个别医学院校在解释和实施扩大参与（WP）政策方面存在的巨大差异有关。然而，在医学教育中，人们忽视了尝试从理论上解释政策实施会发生什么。我们旨在探讨政策实施的动态，为英国医学院校的 WP 实践提供新的视角。
我们采用定性设计，通过个人电话访谈，从英国医学院校的招生院长和招生人员那里征集 WP 相关的观点和关注点。我们对 32 所英国医学院校中的 24 所的代表进行了采访。数据编码和分析最初是归纳性的，使用框架分析。在主题出现后，我们应用了一个演绎框架，将主题分为“情境”、“专业”、“材料”和“外部”四个背景维度。
我们的参与者在 WP 政策的解释和翻译方面处于不同的地位，这受到许多背景因素的影响，包括：医学院的地理位置和定位；大学和其他主要利益相关者的期望，以及资源。后者是微妙的，指的是用于医学选择过程的资源，而不是 WP 本身。这些数据暗示 WP 的政治目标和医学教育培养最佳医生的目标可能存在冲突。
这是第一项明确探讨医学教育中 WP 政策实施的研究。我们的分析有助于理解 WP 政策在当地环境中的不同实施方式，并为未来的政策实施和研究提供规划。所确定的信息将在国际上与所有致力于扩大医学教育参与度的人产生共鸣。
