Free text adversity statements as part of a contextualised admissions process: a qualitative analysis.

BACKGROUND: Medical schools globally are encouraged to widen access and participation for students from less privileged backgrounds. Many strategies have been implemented to address this inequality, but much still needs to be done to ensure fair access for all. In the literature, adverse circumstances include financial issues, poor educational experience and lack of professional-status parents. In order to take account of adverse circumstances faced by applicants, The University of Dundee School of Medicine offers applicants the opportunity to report circumstances which may have resulted in disadvantage. Applicants do this by completing a free text statement, known as an 'adversity statement', in addition to the other application information. This study analysed adversity statements submitted by applicants during two admissions cycles. Analysis of content and theme was done to identify the information applicants wished to be taken into consideration, and what range of adverse circumstances individuals reported. METHODS: This study used a qualitative approach with thematic analysis to categorise the adversity statements. The data was initially analysed to create a coding framework which was then applied to the whole data set. Each coded segment was then analysed for heterogeneity and homogeneity, segments merged into generated themes, or to create sub-themes. RESULTS: The data set comprised a total of 384 adversity statements. These showed a wide range of detail involving family, personal health, education and living circumstances. Some circumstances, such as geographical location, have been identified and explored in previous research, while others, such as long term health conditions, have had less attention in the literature. The degree of impact, the length of statement and degree of detail, demonstrated wide variation between submissions. CONCLUSIONS: This study adds to the debate on best practice in contextual admissions and raises awareness of the range of circumstances and impact applicants wish to be considered. The themes which emerged from the data included family, school, personal health, and geographical location issues. Descriptions of the degree of impact that an adverse circumstance had on educational or other attainment was found to vary substantially from statements indicating minor, impact through to circumstances stated as causing major impact.

A learning package for medical students in a busy urology department: design, implementation, and evaluation.

OBJECTIVES: The need for innovation in the delivery of quality teaching and learning for undergraduates in urology is driven by a number of factors. An increasing proportion of care is delivered in ambulatory settings, hospital inpatients are increasingly unwell, and the National Health Service staff must find a balance in their dual roles as healthcare providers and clinical teachers. We describe the design, implementation, and evaluation of an innovative learning package for undergraduate medical students in urology. This consisted of a simulated urology outpatient clinic to prepare students for learning in the outpatient environment and an on-line self- and peer-assessed learning exercise to provide students with the necessary clinical knowledge of the core problems in urology and to encourage reflection. METHODS: Action research principles were used to design, deliver, and evaluate a model for teaching and learning in the outpatient setting. Fourth-year medical students at the start of a 1-week clinical teaching block were given the opportunity to participate in a simulated urology outpatient clinic. On-line support material was designed around 2 core clinical problems in urology. The evaluations were gathered using an anonymous on-line questionnaire and a pre- and postcourse test of knowledge for a sample group. RESULTS: Of the students who responded, 100% found the on-line material helpful for learning about the core clinical problems. The results demonstrated a 12% improvement in scores in a knowledge test at 1 week and 18% at 1 month after the teaching block compared with the control group from the previous academic year for which the mean improvement was 7% at 1 week and 8% at 1 month after the teaching program. CONCLUSIONS: The evaluation results demonstrated a positive effect on learning without compromise to the service provided to patients. This could be developed as a model for teaching and learning urology or other specialties.