Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
Work Psychology Group, Derby, UK.
Med Educ. 2024 Oct;58(10):1247-1256. doi: 10.1111/medu.15403. Epub 2024 May 10.
Increasing the diversity of medical students, or widening participation (WP), is critical for social justice and healthcare delivery, and many governments are setting policies to encourage WP. However, establishing policy is only the first step in an educational change process: we also need to know "how" policy is enacted or how medical schools interpret and put into practice WP policy. Addressing this gap, the aim of this study was to examine policy enactment in six new UK medical schools with an explicit WP mandate.
This qualitative study, underpinned by social constructivism, used semi-structured interviews to explore the experiences of key actors (6 Deans and 14 Admissions staff) of putting policy into practice when setting up a new medical school. Data coding and analysis were initially inductive, using thematic analysis. We then applied Ball's theory of policy enactment to organise the data into four contextual dimensions of 'situation', 'professional', 'material' and 'external'.
On the surface, there were many similarities across the six schools in terms of the four dimensions. However, how these dimensions interacted illuminated tensions and differences. For example, some schools found themselves increasingly subjected to local and extra-local rule systems, including pressure to follow host university norms and hosts struggling to accept that medical schools are heavily regulated. There were also tensions between the new medical schools and the medical education "establishment", including lack of power and being judged by overly narrow outcomes.
Different contexts seem to influence the enactment of WP to medicine in different places, even in the same country, even in medical schools established at the same time. That policy enactment is a complex, non-linear process of enactment is important to acknowledge: context is critical. Our findings will inform future policies and practices that aim to increase WP in medicine.
增加医学生的多样性，即扩大参与（WP），对于社会正义和医疗服务的提供至关重要，许多政府都在制定政策以鼓励 WP。然而，制定政策只是教育变革过程的第一步：我们还需要了解“如何”实施政策，或者医学院校如何解释和实施 WP 政策。为了弥补这一差距，本研究旨在考察具有明确 WP 授权的六所新的英国医学院校的政策实施情况。
本定性研究以社会建构主义为基础，采用半结构化访谈法，探讨了在新医学院校成立过程中，实施政策时主要参与者（6 位院长和 14 位招生人员）的经验。数据编码和分析最初是归纳性的，使用主题分析。然后，我们应用 Ball 的政策实施理论，将数据组织成“情境”、“专业”、“物质”和“外部”四个背景维度。
从表面上看，六所学校在四个维度上有许多相似之处。然而，这些维度的相互作用揭示了紧张关系和差异。例如，一些学校发现自己越来越受到当地和外部规则系统的约束，包括遵循主办大学规范的压力，以及主办方难以接受医学院受严格监管的事实。新医学院校与医学教育“传统”之间也存在紧张关系，包括缺乏权力和被过于狭隘的结果所评判。
不同的背景似乎会以不同的方式影响 WP 在不同地方的医学实施，即使在同一国家，甚至在同时成立的医学院校也是如此。政策实施是一个复杂的、非线性的实施过程，这一点很重要：背景是关键。我们的研究结果将为未来旨在增加医学 WP 的政策和实践提供信息。
