‘”Not a university type”: focus group study of social class, ethnic, and sex differences in school pupils’ perceptions about medical school’

By Trisha Greenhalgh, Kieran Seyan and Petra Boynton

In British Medical Journal. 2004. Article is available here.

The authors seek to highlight the views of 14-16 year olds to understand why young people from particular socioeconomic backgrounds are more, or less, likely to apply to study medicine at university.

Six schools in London contributed to the research, with 68 total students participating in focus group discussions. Teachers were asked to identify either Year 10 or Year 11 students who were predicted to achieve highly in GCSE subjects related to medicine, and who had showed interest in applying to medical courses. The schools involved reflected a variety of socioeconomic background factors.

Students were encouraged to discuss their perceptions of a successful applicant to medical school. They also considered what concerns people may have when considering applying to study medicine. The discussions aimed to highlight the views and aspirations of young people regarding their futures. The responses within the focus groups were transcribed and coded afterwards.

The results show few differences among pupils based on ethnicity and gender, but notable differences between socioeconomic status – defined through the occupation of the head of household. Pupils from higher socioeconomic backgrounds were aware of intrinsic benefits to studying medicine, such as personal achievement and fulfilment. Such pupils saw a medical career as one career option among other high-status opportunities and were likely to have researched the necessary pathways and developed a strategy to succeed. Alternately, pupils from lower socio economic groups were unaware of the plan required to apply for medicine and perceived the application process as competitive and demanding. Results showed anxiety about success: inner city pupils believed that they had a 1 in 10 chance of acceptance, when in actuality it is 2 in 3. Students from lower socioeconomic backgrounds believed that more affluent students from advantaged backgrounds would have stronger applications. Independent school students were confident they would gain a place in medical schools.

All young people reported similar characteristics of people studying medicine: ‘intelligent’, ‘hardworking’, ‘dedicated’, ‘tough’, ‘interested in people’, ‘caring’, ‘enthusiastic’, ‘ambitious’, and ‘able to cope with pressure’. All of the interviewed students showed limited knowledge concerning what the reality of a medical degree entails and medicine as a profession. Similarly, the financial burden of studying medicine at university was noted as a barrier across all groups – yet richer students would not base their decision to apply on money. Across the different focus groups the students expressed desires to acquire access to more information from outside sources on what happens in medical degrees and how to apply. Specifically, the advice of recent graduates would be favoured in the opportunity of providing authentic guidance and job shadowing was considered a useful possibility for gaining insights.

The results of this study find that widening participation strategies need to more equitably address socio-economic factors influencing decisions to study medicine, more so than gender and ethnicity. The authors suggest that working class culture, self-esteem and identity are not in line with traditional academic perceptions and aspirations and so interventions to address imbalances should more creatively address disadvantages.