Perceptions, discourses and values: Exploring how key stakeholders construct, negotiate and enact widening access to medical school

‘Widening access’ (WA) policies are designed to increase the participation of underrepresented groups into Higher Education generally, and specifically into professions such as medicine. The interpretation, negotiation and enactment of WA policies is determined by key stakeholders, including medical schools, school teachers and potential applicants. In the UK, measurable progress in WA to medicine has been low. This thesis argues this may partly be due to stakeholders’ conflicting values, ideologies and interests. The thesis thus aims to explore, analyse and better understand the complex motivations, perceptions and values underlying key stakeholders’ behaviour in WA to medicine. Data includes medical school websites, interviews with high school teachers and focus groups with pupils. Analytical methods are qualitative (critical discourse analysis; thematic analysis) and are enriched by discursive and sociological theories (Foucault, Sen, Bernstein and Bourdieu). Analysis focuses on the pathways of mutual influence and communication between key stakeholders. Findings indicate that UK medical schools predominantly situate WA within ideas of social mobility for the individual rather than benefit to the workforce. Medical school webpages frame WA as a ‘requirement’, a ‘value’, or a ‘service’ and communicate distinct impressions of institutional stance to other stakeholders. High school teachers perceive medical school applications as ‘risky’ and this appears to limit their ability to engage as greater advocates for WA. Pupils in WA high schools perceive medicine as increasingly culturally inclusive and negotiate cultural differences through reference to role models in the profession. High academic entry requirements within a context of substantial educational inequality may now be the largest perceived ‘barrier’ to medicine. Overall, this thesis identifies the reasons underlying stakeholders’ behaviour and evaluates whether these may be helping/hindering WA to medicine. It demonstrates the benefit of including diverse stakeholder’s voices in WA research and provides practical recommendations for future research, policy and practice