‘Disadvantage and the “capacity to aspire” to medical school’

Erica Southgate, Brian Kelly, & Ian Symonds

In Medical Education (2015), 49(1), pp.73-83.

The article is available here.

This article considers the aspirations of Australian high school students considering careers within medicine. Conducted in 2015, social mobility within medical careers has notably declined as young people from low socio-economic backgrounds are underrepresented, especially in comparison to representation among other university undergraduate courses. The authors aim to address a gap within the literature concerning how socio-economic status (SES) combines with other social categories of difference to influence career aspirations within medicine.

Gender, race, class, age, geography, disability and sexuality interact when impacting the aspirations of young people. Appadurai’s theory of “aspiration as a capacity” suggests that aspirations are formed within a social context and therefore those from lower SES backgrounds are less likely to access resources useful for navigating towards career goals. The authors here aimed to identify barriers and enablers facing academically able high school students by analysing Socio-Economic Status (SES), status as being the first in family to attend university (FIF) and geographical location.

The research focused on the Bachelor of Medicine at the University of Newcastle, Australia, where only 10-13% of the annual enrolment is made up of low SES students. Five high schools contributed to the study, with 33 total students involved in focus groups and 5 one-on-one interviews with career advisors. Conversations drew on topics surrounding the school community, attitudes to school, subject selection, career and post-school education plans, thoughts about a medical career, enablers and barriers to a medical career, and ideas for university initiatives for students considering medicine. Four clear themes emerged after coding the qualitative data: ‘on being smart enough to be a doctor’, ‘attainment and school level factors’, ‘on being able to handle the job’ and ‘work experience’.

All of the students, across socio-economic backgrounds, recognised the need for doctors to be extremely smart and the importance of subject selection in school to inform university applications. Of the students interviewed, 6 expressed an interest in applying to medical courses – of these, 4 were of FIF status, 3 fell into low SES categories, 2 in the lower-middle and 1 in the upper-middle class. Students expressed uncertainty about the process of medical university applications and career advisors agreed that the application procedure was the biggest barrier facing students. Many students had experiences of career expositions and university day visits, but had been provided with inadequate information concerning admissions. Students from lower-SES and FIF students, were much more reliant upon the advice of teachers and careers advisors in guiding them through these processes.

Within the Australian setting it is recognised that geographic location of a young person’s home can influence the school they attend and thus education curriculum that they receive. Four out of the five schools in this sample focused upon vocational education, with only one following an academic curriculum. Schools focusing upon technical and vocational pathways traditionally harvest student desire to pursue trade experience, which leads to students choosing employment opportunities over continued education in school. It may not be possible for such schools to teach all academic subjects, specifically those required for medical applications, as student enrolment may be low. Careers advisors view Gifted and Talented programmes, aimed at capturing talent within lower SES groups, as ineffective in increasing student attainment levels enough for entry onto medicine courses. Conversely, within the academically focused school studied there was a strong focus on delivering attainment scores high enough to pursue undergraduate study. There is evidence that students of low SES background can accrue benefits from attending school with students of high SES background, by raising their aspirations.

Students across all SES backgrounds expressed confidence that they were academically ‘smart enough’ to pursue university education. However, among low SES student groups there was a concern that they may be unable to handle emotional aspects of a career in medicine and worry about securing employment at completion of the course. Across all socio-economic backgrounds, most students did not personally know a doctor and impressions of a medical career largely originated from popular culture.

Students expressed a desire for what sociologists label ‘hot’ knowledge regarding medical careers: opportunities to speak to doctors directly and gather realistic information about what the job would entail. Work experience aims to deliver genuinely useful information on careers that may be socially distant for students. Whilst low SES students communicated a large desire to obtain work experience, they noted that gaining experiences within health professions is rarely available. However, students from higher SES background were able to draw upon their social networks to secure opportunities. Career advisors commented on the difficult nature of their roles within schools that largely serve lower SES groups – they often have to cater for students in precarious situations (e.g. those who need employment opportunities to escape dangerous home lives) and so academically able students may receive less attention.

Student voices from this research suggest that students of all SES and FIF background have positive aspirations towards university education and medical careers. However, findings highlight that the aspirations of lower SES and FIF status students may be constrained by limited opportunities that are available to them. They are often less likely to have access to parental guidance and so rely upon teachers and careers advisors who themselves have massive demands upon their time. Schools within their area may also be geared toward vocational pathways and unable to offer support for academic university applications. Furthermore, they are less likely to have access to work experience placements, which are necessary to acquire ‘hot’ knowledge in order to formulate appropriate career plans. As all of these factors combine, such students are less likely than those from higher SES backgrounds to achieve grades high enough to enter medical undergraduate schools. The authors recommend that the medical profession should embrace social diversity by delivering equitable courses, which begin with relaxing the academic requirements for entry to make them more accessible for students of all socio-economic backgrounds.