Krstic, Courtney
(2025)
Habitus transformation of medical students from low socioeconomic backgrounds: A collective case study of two medical schools.
PhD thesis, University of Nottingham.
Abstract
For over two decades, the UK higher education sector has continued to strive toward equal opportunities for all young people through Widening Participation (WP) policy. Medicine in particular has drawn attention for its lack of representation of particular demographics, being known as one of the most socially exclusive professions. WP in medicine is not only important for social justice and mobility, but benefits patient care by having a workforce which is representative of the population it serves.
Whilst WP initiatives have traditionally focused on helping applicants gain entry to university, in recent years attention has been drawn to the unequal experiences and attainment of under-represented groups during their degree study, indicating that disadvantage continues to follow young people through their higher education journeys. The first part of this thesis is a systematic review of the qualitative literature outlining the experiences of WP students on medical courses in the UK. The review uncovers several themes related to unfamiliarity with higher education and the medicine profession, lack of sense of belonging, and difficulty in establishing social networks with peers.
Students from low socioeconomic backgrounds were a relatively understudied group within the existing literature. The second part of this thesis therefore expands upon the evidence base exploring the experiences of students from working-class backgrounds in depth at two medical schools following the same curriculum, learning outcomes, and assessments, by using Bourdieu’s theory of habitus. One medical school is part of a traditional, Russell Group university in a large city and with a large cohort size, and the other is a new medical school in a small city accepting relatively few students in its first year of operation. This collective case study triangulates data from narrative analysis of students and includes a unique approach of also including family member interviews, as well as thematic analysis of faculty interviews and critical discourse analysis of key university documents.
Students from working-class backgrounds have varied and diverging journeys through medical school, represented through a novel conceptual framework - a typology of habitus change across contexts. Comparison of these two case study medical schools illuminate differences induced by the historic background and environment of the respective institutions, drawing parallels between the pre- and post-1992 institution divide in higher education more widely, and provoking social stratification of medical education. Despite delivering the same medicine course, institutional policies manifest through the applicants they aim to attract, the cultures they foster, and the ways in which faculty interact with their students, which in turn influence the degree to which working-class students are able (or choose to) retain their existing identities. This may have a secondary consequence of influencing their tendency toward working with underserved populations.
In the concluding chapters, this thesis reflects on the philosophies of Widening Participation driving these norms and values at each medical school and explores mechanisms through which educators and policymakers can translate these findings into actionable recommendations at each stage of the student journey. First, breaking down the deficit model of Widening Participation currently enacted through discourse, beginning at the point of application. Students from disadvantaged backgrounds must also be supported to transition into higher education successfully and build social capital through mentorship and role modelling. Finally, course structures which highlight and perpetuate inequalities in student background must be reformed, and faculty must be visible, receptive and cognisant of Widening Participation issues.
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