“There should be no rich, no poor, no strong, no weak”……”Equality is the great thing, equality is everything” – Steerpike (Peake 1946, p291)

“Things out to be fair, I suppose. But I don’t know anything about it.” – Fuchsia (Peake 1946, p291)

Widening participation (WP) has been a major policy strand in the UK since 1997. It has prompted various activities within Medical Schools who are trying to increase the proportion of students admitted from underrepresented groups. Medical Schools have sought to justify WP on the grounds of improving healthcare, but the external pressure is to fulfil a social justice agenda by being an engine for social mobility.

A systematic review was used to find the relevant literature. Pre-identified keywords were used to search 6 databases and 4 journals. 53 relevant documents remained after the application of the inclusion/exclusion criteria.

A thematic analysis was used to identify key descriptive themes from which analytical themes could be drawn. 

Key Themes

Key themes identified:

1.    The socio-demographic composition of the clinician workforce should reflect the patient population.

2.    Medical Schools should provide equal access to ensure social justice.

3.    Medical Schools are socially accountable and should provide representation and culturally sensitive healthcare.

4.    Concerns about gaps in the research to justify WP.

5.    Concerns about the targeting of WP and the definition of disadvantage.

An argument for WP? School is not a place for leaning but a place to experience the diversity of minds by See-ming Lee Licensed under CC BY 2.0

Analysis

The provision of culturally sensitive healthcare via a representative clinician population was the primary justification, however there was no substantial evidence for this in the UK context. This justification aligns with the telos of the Medical School, but until it is proven the WP agenda has to rely on other justifications, such as enhancing social mobility. Justice in admissions should not merely be about providing equal opportunity but should also be about identifying those who are best suited to a career in Medicine rather than trying to provide an approximate proportional representation. This questions the definition of social justice is when it comes to admissions.

The question of justifying WP needs to be answered by showing how WP provides public benefits and enables the identification, selection and admission of those who are best suited to a career in Medicine and will thereby improve the healthcare service. This allows Medical Schools to be socially accountable in their activities.