Coyle Maeve, Bullen Jonathan, Poobalan Amudha, Sandover Sally, Cleland Jennifer
Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
EnAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia.
Med Educ. 2024 Mar;58(3):288-298. doi: 10.1111/medu.15178. Epub 2023 Aug 7.
The slow pace of change in respect of increasing the diversity of medical students suggests powerful actors are reproducing practices to support the status quo. Opening up medicine to embrace diversity thus requires the deconstruction of entrenched processes and practices. The first step in doing so is to understand how the actor-network of widening participation and access to medicine (WP/WA) is constructed. Thus, here we examine how the connections among actors in WP/WA in two different networks are assembled.
A comparative case study using documents (n = 7) and interviews with staff and students (n = 45) from two medical schools, one United Kingdom and one Australian, was used. We used Callon's moments of translation (problematisation, interessement/operationalisation, enrolment, mobilisation) to map the network of actors as they are assembled in relation to one another. Our main actant was institutional WP to medicine policy (actor-as-policy).
Our actor-as-policy introduced five other actors: the medical school, medical profession, high schools, applicants and medical school staff. In terms of problematisation, academic excellence holds firm as the obligatory passage point and focal challenge for all actors in both countries. The networks are operationalised via activities such as outreach and admissions policy (e.g., affirmative action is apparent in Australia but not the UK). High schools play (at best) a passive role, but directed by the policy, the medical schools and applicants work hard to achieve WP/WA to medicine. In both contexts, staff are key mobilisers of WP/WA, but with little guidance in how to enact policy. In Australia, policy drivers plus associated entry structures mean the medical profession exerts significant influence.
Keeping academic excellence as the obligatory passage point to medical school shapes the whole network of WP/WA and perpetuates inequality. Only by addressing this can the network reconfigure.
在增加医学生多样性方面，变革步伐缓慢，这表明有强大的行为主体在复制相关做法以维持现状。因此，要使医学接纳多样性，就需要解构根深蒂固的流程和做法。这样做的第一步是了解扩大医学参与度和准入机会（WP/WA）的行为者网络是如何构建的。因此，我们在此研究两个不同网络中WP/WA行为者之间的联系是如何形成的。
采用比较案例研究法，使用来自一所英国医学院和一所澳大利亚医学院的文件（n = 7）以及对教职员工和学生的访谈（n = 45）。我们运用卡隆的翻译时刻（问题化、利益关联/操作化、招募、动员）来描绘行为者网络，展示它们彼此之间的关联。我们的主要行动者是医学领域的机构WP政策（政策行为者）。
我们的政策行为者引入了另外五个行为者：医学院、医学专业、高中、申请者和医学院教职员工。在问题化方面，学术卓越作为两个国家所有行为者的必经之路和核心挑战，地位稳固。这些网络通过外展活动和招生政策等得以运作（例如，澳大利亚有平权行动，而英国没有）。高中（最多）扮演被动角色，但在政策引导下，医学院和申请者努力实现医学领域的WP/WA。在两种情况下，教职员工都是WP/WA的关键推动者，但在如何执行政策方面几乎没有指导。在澳大利亚，政策驱动因素加上相关的入学结构意味着医学专业发挥着重大影响。
将学术卓越作为进入医学院的必经之路塑造了整个WP/WA网络，并使不平等长期存在。只有解决这一问题，网络才能重新配置。
