Changing geographies of access to medical education in London

Abstract

This paper highlights the need for health geographers to consider the social and cultural geographies of who gets to train as a doctor. The paper presents a case study of a scheme intended to widen access to medical education for working class students from inner London. This work examines the role of local education markets and cultures of education in shaping the aspirations and achievements of potential future doctors. It employs ethnographic data to consider how ‘non-traditional’ learners acclimatise to medical school. Our findings indicate that the students who succeed best are those who can see themselves as belonging within the education system, regardless of their social and cultural background.

Introduction

Over the decades, medical geographers have produced a considerable body of work that demonstrates the spatial differences in the incidence of disease, and inequalities in access to healthcare and health outcomes (Gatrell, 2002; Parr, 2004). More recently, geographers of health have theorised the relationship between the local environment, localised health beliefs and people's experience of illness and well-being (Mitchell et al., 2000; Parr et al., 2004). There has been very little, if any, work published on the geographies of where future doctors come from and the spatial inequalities of who has access to the appropriate training.

This is perhaps not surprising, because human geographers have not, until recently, invested much intellectual energy into the study of geographies of education (Johnston et al., 2005; Taylor, 2001, Taylor, 2002). Indeed, at the risk of being accused of policing disciplinary boundaries, much of the most sophisticated work on education that has been published in geographical journals over recent years has come from scholars who have spent most of their careers outside Geography departments (Butler and Robson, 2003).

In response to on-going criticism and concern, both from within and outside the profession (McManus, 1998), about the continuing over-representation of students from professional social classes and particular ethnicities amongst the student body in UK medical schools, the Council of Heads of Medical schools (CHMS) has committed itself to a statement of principles, that includes the following:

The purpose of a medical education is to graduate individuals well-fitted to meet the present and future needs of society for medical care […] The social, cultural and ethnic backgrounds of medical graduates should reflect broadly the diversity of those they are called upon to serve (Council of Heads of Medical Schools, 1998).

Between 1997 and 2004 the number of medical school places increased by over 50% (over 2000 new places). Four new medical schools were created in Devon and Cornwall, Yorkshire and Humberside, East Anglia, and Sussex (Department of Health, 2004). Most UK medical schools are engaged in widening participation outreach work with state schools in their locality, but the volume and intensity of these initiatives vary considerably. King's College London and the University of Southampton have led the way in offering 6-year medical degree programmes to young people from non-traditional backgrounds. The University of Sheffield and St George's, University of London have also been engaged in innovative outreach work over many years (Universities UK and SCOP, 2002, Universities UK and SCOP, 2005).

The authors of this paper have, since 2001, been involved in the development and delivery of an innovative widening participation project, based in the King's College London School of Medicine that aims to encourage and enable students attending state schools in 10 inner London boroughs to train as doctors. By virtue of the demographics of the boroughs concerned, the students that have been recruited over this period have a class profile that is significantly different from that of most student doctors and come from a diverse range of ethnicities that are more representative of their age group in inner London compared to the students that the school has traditionally recruited.

The aim of this paper is not so much to highlight our achievements to date—that paper is destined to appear elsewhere—but to explore themes that we believe are of importance if we are to understand the changes in policy development that are needed to reverse the inequalities in access to medical training in the UK. Although the questions we pose are particularly relevant to the field of medical education, they have a wider application to the geographic study of local education markets, widening participation to higher education more generally (including to Geography departments) and broader issues of class (re)production and social mobility, particularly as they pertain to the intersections of class and ethnicity.

We will explore three themes that we believe are of potential importance to this emerging research agenda. First, there is the study of local education markets and localised cultures of education, examining how these markets are differentiated by class and ethnicity. Secondly, there is a consideration of the limits of choice for young people and their parents in relation to the education market and finally we consider the spatialities of learner identities. How do students mediate their identity as students with other aspects of their lives? And, to what extent are these performances site-specific?

Before examining these issues in some detail, we will briefly review ethnicity, class and gender as they pertain both to medical education in the UK and, more specifically, medical education at King's College.