Patients benefit from a diverse healthcare workforce. Doctors, particularly those from disadvantaged and minoritised backgrounds, play a crucial role in advocating for what is best for their patients.
The NHS recognises this, linking workforce diversity with increased patient satisfaction, better care outcomes, reduced staff turnover, and greater productivity.
A promising start
Efforts to widen participation in higher education began at the turn of the century following the Dearing report. Over time, access to medical schools gained attention due to concerns about its status as one of the most socially exclusive professions. Medical schools responded in 2014 with the launch of the Selecting for Excellence report and the establishment of the Medical Schools Council (MSC) Selection Alliance, representing admissions teams from every UK medical school and responsible for fair admissions to medical courses.
With medical school expansion under government review, institutions face increasing pressure to demonstrate meaningful progress in widening participation to secure additional places. Although medicine programmes still lag in representing some demographic groups, they now align more closely with wider higher education efforts.
However, widening participation policy often follows a deficit model, viewing disadvantaged young people as needing to be “fixed” or “topped up” before joining the profession. Phrases like “raising aspirations” suggest these students lack ambition or motivation. This model shifts responsibility onto individuals, asking them to adapt to a system shaped mainly by the experiences of white, male, middle-class groups.
Beyond access
To create real change, organisations must move beyond this model and show that students from diverse backgrounds are not only welcomed but valued for their unique perspectives and strengths. This requires a systems-based approach that rethinks every part of medical education, starting with admissions. In its recent report, Fostering Potential, the MSC reviewed a decade of widening participation in medicine. Medical schools across the UK have increased outreach, introduced gateway year courses, and implemented contextual criteria into admissions.
Contextual markers recognise structural inequalities affecting educational attainment. Students from low socioeconomic backgrounds often attend under-resourced schools and face personal challenges hindering academic performance. Yet evidence shows that, when given the chance, these students often outperform more advantaged peers at university. Contextual admissions reframe achievements in light of these challenges, offering a fairer assessment of potential.
Despite progress, access remains unequal. Although acceptance rates for students from the most deprived areas have increased, their chances remain 37 per cent lower than those from the least deprived areas. Research indicates that a two-grade A-level reduction is needed to level the playing field—an approach several schools now adopt. Other policies include fast-tracking interviews, test score uplifts, and alternative scoring for widening participation candidates.
Not just special cases
These processes, however, are often opaque and hard to navigate. Many applicants struggle to determine eligibility. With no single definition of disadvantage, medical schools use varied proxy indicators, often poorly explained online. This confusion disproportionately affects the students these policies aim to support; those without university-educated parents, lacking insider knowledge, and attending under-resourced schools.
A commitment to transparency is vital but must go beyond rhetoric. Transparency means all medical schools clearly outline contextual admissions criteria in one accessible place, provide step-by-step guides to applicants and advisors, and offer examples of how contextual data influences decisions. Medical schools could collaborate to agree on standardised metrics for identifying widening participation candidates. This would simplify eligibility understanding, reduce confusion, and promote fairness.
Tools like MSC’s entry requirements platform are a good start but must be expanded, standardised, and actively promoted to the communities that need them most. Genuine transparency empowers applicants to make informed choices, selecting schools best suited to their circumstances and maximising success chances. This also eases the burden on schools, advisors, and outreach staff who struggle to interpret inconsistent criteria.
Ultimately, moving away from the deficit model toward an open, systems-based approach is about more than fairness. It is essential for building a medical workforce that reflects society’s diversity, improving patient care, strengthening the profession, and upholding the NHS’s commitment to equity and excellence.
