Institute of Education in Medical and Dental Sciences, University of Aberdeen, Aberdeen, UK.
Curtin University, Perth, WA, Australia.
Med Educ. 2021 Jul;55(7):825-839. doi: 10.1111/medu.14442. Epub 2021 Jan 21.
Globally, people with the academic and personal attributes to successfully study medicine experience disadvantages associated with sociodemographic factors. Governments have attempted to address this issue via macrolevel policies aimed at widening participation (WP) to medicine. These policies differ by country, suggesting much can be learned from examining and comparing international policy discourses of WP. Our question was: How are discourses of WP to higher and medical education positioned in the UK and Australia?
A systematic search strategy was guided by five a priori themes inspired by United Nations Sustainability Goals (2015). Seventeen policy documents (UK n = 9, Australia n = 8) published between 2008 and 2018 were identified. Analysis involved two over-arching, iterative stages: a document analysis then a Foucauldian critical discourse analysis, the latter with the aim of unveiling the power dynamics at play within policy-related discourses.
Discourses of social mobility and individual responsibility within a meritocracy are still paramount in the UK. In contrast, the dominant discourse in Australia is social accountability in achieving equity and workforce diversity, prioritising affirmative action and community values. Similarities between the two countries in terms of WP policy and policy levers have changed over time, linked to the divergence of internal drivers for societal change. Both nations recognise tensions inherent in striving to achieve both local and global goals, but Australia appears to prioritise community values in working towards 'nation building' whereas in the UK the focus on individuality and meritocracy at times seems at odds with achieving parity for disadvantaged individuals.
WP policies and practices are situated and contextual so caution must be taken when extrapolating lessons from one context to another. The history of a country and the nature of marginalisation in that country must be scrutinised when trying to understand what drives WP policy.
在全球范围内，具有成功学习医学的学术和个人属性的人都经历了与社会人口因素相关的劣势。各国政府试图通过旨在扩大医学专业参与度的宏观政策来解决这一问题。这些政策因国家而异，这表明可以通过研究和比较国际医学专业参与度政策话语来学习很多东西。我们的问题是：英国和澳大利亚如何定位高等教育和医学教育的参与度政策话语？
一个系统的搜索策略由五个先验主题指导，这些主题是受联合国可持续发展目标（2015 年）启发而来。2008 年至 2018 年间共确定了 17 份政策文件（英国 n=9，澳大利亚 n=8）。分析包括两个总体的迭代阶段：文件分析和福柯式批判话语分析，后者旨在揭示政策相关话语中发挥作用的权力动态。
在英国，社会流动和精英制度下的个人责任的话语仍然至关重要。相比之下，澳大利亚的主导话语是在实现公平和劳动力多样性方面的社会问责制，优先考虑平权行动和社区价值。两国在 WP 政策和政策手段方面的相似之处随着时间的推移而发生了变化，这与社会变革的内部驱动力的分歧有关。这两个国家都认识到在努力实现本地和全球目标方面存在内在的紧张关系，但澳大利亚似乎在追求“国家建设”时更重视社区价值观，而在英国，关注个人和精英制度有时似乎与实现弱势群体平等背道而驰。
WP 政策和实践是有背景和语境的，因此在将一个国家的经验推广到另一个国家时必须谨慎。在试图理解是什么推动 WP 政策时，必须仔细审查一个国家的历史和该国的边缘化性质。
