Navigating success: A mixed-methods case study exploring the progression experiences of medical students on a Gateway programme

Abstract

When compared to their peers, medical students from widening participation (WP) backgrounds are less likely to apply for a medical degree or be offered a place, and those who are selected are less likely to complete their studies. Gateway programmes specifically recruit students from WP backgrounds but there is little known about the experiences of these students. This thesis adds to an evidence base improving understanding of the factors that affect the progression and success of students from WP backgrounds in medicine. This thesis presents a mixed methods case study, situated within a pragmatic philosophical worldview, of Gateway programme students (GPSs) at one UK medical school. It explores the experiences of these students as it answers the question ‘How do medical students on a well-established Gateway programme progress through medical school?’. Retrospective cohort level data was used to assess cohort demographics and compare progression rates and assessment performance of 148 Gateway programme and 757 standard entry students. Phenomenographic and thematic analyses of semi-structured interviews with twenty-two GPSs and recent graduates explored student conceptions of success, and how participants navigated their medical school journey. On average, GPSs were older, more ethnically diverse, and from more deprived areas than standard entry students. GPSs progressed at lower rates through points of transition, but no one type of assessment was responsible. Seven percent fewer GPSs graduated into the medical workforce compared to standard entry students. GPS conceptions of success at medical school changed as they progressed through medical school into independent practice. Passing exams developed into being a good doctor, with many more expressing a unique personal achievement as their personal measure of success. These varying conceptions are at odds with the constructions most often used by educational institutions. The overarching experience of GPSs was one of paradox. Benefits of belonging to a ‘family’ of GPSs contrasted with a variable sense of belonging to the medical school as a whole. Recognition of the benefits of extra-curricular involvement contrasted with a choice limited by perceived risk to progression from competing priorities, medical school culture, and financial pressures. Peaks and troughs of confidence, identity formation, and self-efficacy beliefs broadly mirrored points of transition and were affected by the attitude of significant adults and peers, and assessment results and feedback. Medical schools should be applauded for their commitment to WP initiatives. However, further maximising the success of students entering via Gateway programmes will require institutions to examine their environments carefully and critically. Social, cultural, and financial barriers to success must be identified, and steps taken to remove or reduce them to enable further progress in providing an equitable experience for all students.

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