The ‘Selecting for Excellence (SfE)’ project (SEEG, 2014) confirmed the very poor representation of young people from socially and educationally disadvantaged backgrounds in medical school and the medical profession in the UK; indeed, around 80% come from managerial and professional backgrounds. In addition, circa 80% of medical applicants come from only 20% of UK secondary schools and colleges, and roughly half of schools and colleges have no medical applicants at all (Garrud, 2014). Accordingly, the SfE recommendations included considerable focus on outreach as well as the equity of selection processes and support for widening participation students at university. A subsequent report from the UK Medical Schools Council (Nursaw, 2016) showed that a substantial number of schools and colleges miss out on engagement with medical schools (indeed, higher education in general): it is likely that there is considerable overlap with those whose students do not apply to medicine.

In addition to this difficulty of access to medical school, nationally there has been growing concern about the shortage of qualified doctors choosing to train in general (family) practice (GP) (e.g. Mathews-King, 2015) against figures that model the need for a 50% increase in GP workforce by 2020 (RCGP, 2016). In several recent years significant proportions of doctors completing their foundation training (a 2-year post-qualification internship) chose not to apply for specialist training, and those figures suggest we may see critical shortages in other areas than GP as well (e.g. psychiatry, emergency medicine) (BMA, 2017). In the East Midlands region in 2015 only 69% of GP training places were filled – the lowest in the UK (HEE, 2015) – prompting particular concern about the long-term viability of primary care in this area. One response to this developing crisis in GP recruitment was a report commissioned by Health Education England (HEE) (Wass et al, 2016) that identified multiple underlying factors, and recommended a multi-pronged approach to raising awareness of, and promoting positive attitudes towards GP. The present paper reports a widening access project targeting young people in secondary education with the objective or raising awareness and aspiration for careers in primary care.

The approach is based on sociological understanding of the barriers to aspiration and participation in medicine. Bourdieu (e.g. Bourdieu, 1986) has emphasized the role of social networks in producing and reproducing inequality; his work suggests that it is worth considering how one may develop the educational and social capital of young people from disadvantaged backgrounds. The approach described here is based on Archer’s work focussing on ‘science capital’ (e.g. Archer et al, 2015) – a concept embodying knowledge, attitudes, networks, and behaviour related to science. In the present case, this is deployed to enhance knowledge about and attitudes towards health careers.

The objectives were:-

• To engage young people from disadvantaged backgrounds and schools with below average levels of attainment;
• To increase aspirations around health careers in primary care, and training as a doctor in particular;
• To develop a positive, informed and realistic view of general practice;
• To engage health professionals working in primary care as ambassadors.

The project used an interactive web-based system – “I’m a Medic, Get me out of here” https://Imamedic.uk  – to support live webchats between groups/classes of schoolchildren and a panel of primary care health professionals, with three events from June 2017 to March 2018. This followed the established model of “I’m a Scientist” (Pontin, 2011). The website also supported asynchronous questions and answers during the 2-week events. Towards the end of each event all the participating children had the opportunity to vote for the practitioner they wanted to win a prize of £500 to spend on further outreach projects.

Schools were recruited in East Midlands region via networks from the universities of Nottingham and Leicester widening participation units and Mangorolla, the community interest company who run the “I am a…” websites, using flyers, newsletters, email, etc. The project was also advertised to teachers in the region via existing lists and Twitter. They were invited to book one or more live chats for groups of students in years 9-12 (approx. ages 13-17 years). Teachers were sent a pack comprising suggested preparation and follow-up activities for their students, technical instructions, and a number of careers booklets (e.g. HEE, 2018) and resources (e.g. links to MSC, 2017). In all 34 from a regional target list of 76 schools applied to take part. The distribution can be seen in Figure 1 below.

Figure 1: Map of participating schools in East Midlands Map data ©2018 Google

Healthcare professionals in primary care were recruited from a wide variety of networks including alumni, Local Medical Committees, the Royal College of General Practitioners, and Health Education England: East Midlands, and via social media. A total of seventy practitioners applied to take part and 22 were selected to make up panels of 6, 7 and 8 for the three events in June 2017, November 2017, and March 2018, respectively. They represented a broad range of roles including: qualified GPs, trainee GPs, practice nurses, practice managers, an advanced clinical practitioner and a medical student. Details can be found in the general practice zone reports (Mangorolla, 2018a, 2018b).

Tables 1 and 2 below summarise school and student participation across the three events. They demonstrate that a high proportion of students from the participating schools engaged with the online platform.

Just under 900 pupils took part, raising a substantial number of questions that, after moderation to remove duplication, received answers on average from three practitioners. The majority – circa four fifths – of students were active on the site making use of the asynchronous ASK function as well as the live CHATs. Voting for the most useful professional was also popular.

A wide range of questions were asked covering the work of different team members, how they chose to become practitioners, their training, and difficult questions about funding, ethics, health policy and politics, as well as the challenging aspects of working in healthcare. Figure 2 below illustrates the proportions and types of question collated over the 1-year study.

Figure 2: Question types and proportions

For coding see: https://about.imascientist.org.uk/2017/student-question-coding/

Figure 3 gives a depiction of the common terms that came up in questions.

Figure 3: Common terms arising in questions

Feedback took multiple forms, including pre- and post-event surveys of participating students, teachers, and health practitioners, and interviews with a purposive sample of teachers and professionals after the conclusion of the third event. Table 3 below summarises the student feedback.

As can be seen, there was a positive shift in responses towards jobs using science, being a doctor, and jobs in healthcare (not a doctor).

Teacher feedback on the use of this platform to engage students was very positive, all saying they would recommend “I’m a Medic” to a colleague and all, bar one, that they would take part again; for 85% the project met their expectations entirely or in most aspects. Their views of the impact on student learning is shown in Table 4 below.

Several features are of note: the success of this approach in engaging students and giving them confidence in asking questions. There was also evidence that they gained awareness of the NHS, about the work of GPs, and about potential careers in healthcare.

Mixed feedback about participating in the venture from the last panel of practitioners is shown in Table 5 below.

Of the panel, most practitioners reported improvement in their understanding of how school students view them, their interest in public engagement, their skill at communicating their work, their enthusiasm and appreciation of their work and its value, but a proportion still stated little had changed. One practitioner had reduced interest in public engagement afterwards.

The outcomes are discussed below with respect to the initial objectives:-

• To engage young people from disadvantaged backgrounds and schools with below average levels of attainment;

The project was successful in engaging a large number of students from secondary schools in East Midlands with lower average levels of attainment; around half of the regional schools targeted took part. This does raise the question of why half of schools did not apply and reasons responsible for a lack of engagement. Logistic constraints may be a contributory factor, but perceived lack of pupil interest or aspiration might also have been influential. In future, the UK government requirements that each secondary school/college meet eight benchmarks in their careers guidance (Careers & Enterprise Co., 2018) may aid participation in learning about health careers through virtual fora such as “I’m a Medic”.

• To increase aspirations around health careers in primary care, and training as a doctor in particular;

There was evidence that following participation in “I’m a Medic”, some students had increased interest in scientific careers in general and were more inclined to consider a career in healthcare as a doctor or in another role, but this was not true for all. Nevertheless, it is arguable that effective careers information should enable young people to see better how well their qualities and interests match those needed in particular jobs and sectors; hence from any school class, one should expect that some gain by realising that, perhaps, this is not for them.

• To develop a positive, informed and realistic view of general practice;

Development of a better informed picture of primary care was a clear outcome. To what extent students took away a realistic and/or a positive view was, however, not directly measured. One can assume that practitioners who took part were likely to be more positive about their work and careers than those who didn’t; similarly, professional integrity, may have helped convey a realistic picture. More detailed testing of attitudes after the events may be beneficial to gain confidence about how well this objective was met.

• To engage health professionals working in primary care as ambassadors.

Recruitment of health professionals was successful with over 70 applying to take part, and 22 subsequently forming the panels. Their feedback suggested that most would remain engaged (i.e. in “I’m a Medic” or healthcare outreach), and that they gained from their involvement in “I’m a Medic”. One principal issue, however, was the time commitment required to take part in live web-chats. Many were working in full-time roles and found it a challenge to schedule their clinical work to fit with live chats during school hours. As the one-year project proceeded an attempt to accommodate this was made by increasing the number on a panel from 6 to 7 and then to recruit teams of health practitioners – e.g. a group performing a similar role, only one of whom would be expected to contribute to any specific web-chat. Both these manoeuvres helped, but did not entirely solve the problem: as such, this will need to be addressed further in future events if the venture is to be sustainable.

Outreach in higher education comprises different types of opportunity and modes of engagement. Many require geographic accessibility – a manageable travel time between university and school, for example – to take part in discovery days, master classes, and evening events. Virtual approaches offer one method to overcome that barrier. The particular form used for “I’m a Medic” (“I’m a Scientist”, “I’m an Engineer”, etc.)  has a number of further advantages: it facilitates a personal conversation between the professional and the student, it gives control to the student over what is discussed, and it encourages all the students to ask questions, even the shy and less articulate. The results of this project demonstrate that this approach can be effective in engaging large numbers of schools and students in finding out about work and careers in health care.