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My name is Calum Crookshanks, Um, a doctor. I work in the world of vermouth, then Enbrel in medicine, the elderly. And at the moment I'm working and it's just life in psychiatry unusual, and I do a mix, but that's not really why I'm here today, Um, you to date because I'm a trustee of the charity. You could be a doctor. I got to talk to you a little bit about widening participation in medicine. Why? I think it's so important. But I'll be working in the last eight years on what the next steps are across the country. I can't see the chat. Well, I'm talking, and but I will do my best answer any questions at the end that I think this is being recorded if you want to catch up to. So I found it hard about the best way of of writing this talk. But I think the most helpful thing is to think back to when I was first standing up for you. Could be a doctor when I was a medical school and and broke when I was in third year. So, and this is a report that came out around that time called the Selecting Fractions report and have written by the medical schools cancelled, which is the sort of umbrella organizations for the different medical schools across Scotland. Just the UK in fact, other three of them. And this is one of the main facts that came out now. I don't very often agree with Boris Johnson, but one of the things that he says is that talent is evenly distributed. That opportunity isn't. And I think this that kind of highlights that really directly. There's no way that half the schools in the country didn't have anybody that could be a doctor. I think we as a profession or missing it with those applicants on those individuals, are missing out on the opportunity. Teo engage in the medical career. Another way of looking at that is the rates of private education. And so that's 6% off high school peoples in Scotland or privately educated. But about 26% of medical school places go to private school people, so they're about four times over represented you'd be right to criticize. This is like the older data getting on for 10 years old now, and but it is really the last major study that's been published. Looking at some of this data, this was a really great study, looked at over almost 33,000 applications to medicine from across the UK in that three year period 2019 to 2012 and really, hopefully it's split that up by country. So we were able to get the Scottish data. You probably won't be surprised to learn or least hopefully if you're at this talk that the main finding is that more affluent people's or more likely to apply to medicine and the more likely to get a place if they like. Well, the really interesting findings that came from this is the post court based measures and we might think of the Scottish Index of multiple deprivation, which is the Scottish governments. Preferred measure really overestimated widening participation effects. Actually, the thing that had the closest link was parental occupation. Um, Scotland. In that three year period, 89% of applicants to medicine had parents from the national statistics. Socioeconomic classification of one essentially means professionals. You know, accountants, lawyers did choose etcetera, and that was a much better gauge of how likely someone wants to get into medical school in just the postcoital lived in. So apparently what the problem is with some, since that's there and what will come up, come on to some more up to date data. We bit further down the line. And but why does that matter? Why is it a bad thing? And I think there's a couple of different reasons for that. A workforce perspective. The Scottish government. What first planet is quite clear that Scottish domicile students are more likely to enter training? They're also more likely to return to work in the areas that come from. So if you want a doctor to work in Nigeria or Creed Miller, then you probably want to be training someone from moved areas and much more likely to go back and back. There is a GP. The same thing is true or rural GPS, and that's partly in automation. But have the Scott Game project that Scottish graduate entry medicine running conjunction between the university and T and the University of some Andrews that you might have heard about recently? I think there's a broader point, though, that we want the energies workforce to reflect the population that service I think that has myriad benefits in terms of representation, cultural understanding and actually dealing with health equality. It's much easier to understand the social factors that influence someone's health if you've experienced them yourself. Now, when are dissipation is a much bigger deal now than it waas even 5 10 years ago, it wasn't being invited to conferences back then on Day, one of the main criticisms off it when it was first coming around was that it could reduce the standard of doctors. Be honest and see there's not a huge amount of data available on this, But the data that does exist suggest that that just isn't true on, actually, and students who get in through a contextual admissions or through a get with the medicine program actually do better at medical school from those who follow a conventional route to. We can maybe maybe got a bit of motivation to change things, but the first thing we need to understand is, why is this happening in the first place? This is that you could be a doctor model off whitening participation to be used. The four capitals we've built the eastern from different areas of literature, with sociology and elsewhere, and we're just going to talk a little bit about each of them people through so and cultural capital. The first one in that list is the benefit that's gained by exposure to the dome in and culture. So people have higher socio economic status or more exposed to this. They're left more likely to fit in and higher education institutions on that, you know. And as an example of that, most people who grew up in Scotland from a low socioeconomic status background would grew up speaking in Scottish standard English or Scott's language. But certainly that's not the language that spoke in university, least in it. So people from higher socioeconomic status understand the behavior that's expected off them to get the value of working hard at school because they can see the benefit of that. All the random quite closely related to that is social capital. We might think, if that's what we would classically describe those nepotism. It's the idea that people knew of someone who is a doctor or another half their professional, so they're able to organize work experience. They're able to get someone to check the personal statement all that kind of stuff. No, this paper university is not for me. I'm a Nike person, is one of my favorite papers, and I absolutely love that court, your shoes, you that people from lose to a second of it states it says they're looking at students and they're not seeing themselves. They see people were different closed, talking differently on often They're experiencing discrimination and from the people that they're trying to emulate, whether that's perceived or otherwise. Other interesting piece of research in this kind of area and something that's driven the young person's guarantee. Israel's developing your workforce, the scholars, government initiatives. Is that meaning form or employers? Well, your school increases your earning potential and your chances of future employment. So one of the main benefits of going to private school is the access to social and cultural capital, even if you're from losers. Economic status in the first place. So one of the main fenders that drove the Fuse and Health campaign, which launched around eight years ago and then my primary school was the chief medical officer at the time, was that private schools had much better links to employers, including in healthcare and they were not doing much better Job of leveraging that to the people's advantage. No economic capital on the face of it, maybe seems the most intuitive of the four dates of capital, and it makes sense that not being able to afford by us, you know, to go on extra courses would effect. And, well, you're likely to to school. But it is a little bit more complicated than that. There's also the fear off the cost of living and the enormous deck that we have to create coming to university. But there's even paying for necessities. I remember revising for my hires, but the had gloves on because we couldn't afford to put heat on. And that's only more of an issue now with the cost of living crisis that were experiencing just a lot of research about the psychology of being in poverty, which eloquent in detail here. But essentially it promotes that kind of short term s thinking, and that seems intuitive in a way. If you're more worried about where your next meal early next paycheck is coming from, it's very difficult to think about spending five or six years university, A crew in debt with the hope that you learn more money in the future. And science capital has come from something called the Aspires Research and which was done done in King's College, London and then in the university Carlos London. And it's really fantastic piece of reception encourage you to have a look at it. Essentially, what they found. Looking at stem subjects, which included medicine, was that the more exposures people had to people's had to science from a young age, the more likely they were to enjoy science. More likely, they were to choose to study it at school, on more likely work to become scientists further down, like on the same thing, applies to medicine. Now these capitals don't explain everything, and I'm not pretending there are completely comprehensive model, but they are a useful structure when we're designing events. No, we haven't talked about gender or racial stereotypes, but the undoubtedly a huge role on back there in green a lot earlier than we think they are. So that's fires research that I mentioned as this actually fantastic video of a private school class being asked to draw a firefighter the ultra men on then, when the female firefighter walks in the rocking shocks that this is possible know that this is really quite entertaining video, but it's a little bit depressing. And one of the main it comes from and from this first research is that some of these ideas South belief, general admission stereotypes actually becoming green much earlier than we think, probably between the ages of seven and 12. So if you want to intervene to change those, that's the kind of malleable period will come on. We got more talk that towards the end now, this tape of March and I'll and spoke to the older people's and ask them to identify what they thought were the barriers of applying to medical school. And you could see that the group, roughly by the capitals that we've talked about already. So what this adds up to is a system is biased against people from low socioeconomic status is, it's much easier to get five days if you go to high performing school. If your parents went to university and if you can afford necessity. So even though grades particularly higher chemistry project outcomes of medical school, that's clearly not the whole story. People from losers economic status and less likely to want to be doctors because of Lifelock social effects, including those sides. Capital last like it, too believe that can be doctors because of the cultural capital less likely to be successful if they do apply because they're little social capital on even though they perform better at medical school, they're likely to be discriminated against there, too. No, that that sentence maybe is a little bit June gloom, but we're gonna come on to more positive aspects of talking about what what we can do about it. And this. Probably three main. And it's trying still that in Scotland at the moment. So the first is the gateway to Madison programs, and all the medical schools and Scotland except Ediborah now offer a gateway to medicine program that typically replace is six Year of High School. And you go do it essentially a medicine prep course that includes and includes work experience and said Andrews, for example, will have increased the size of this car specks of standardly this year from six people's to 20 and I think one of the criticisms off it is that it encourages people to go down the gateway to medicine program when, actually, perhaps the good of got straight into medicine in the first place. But nonetheless, it is a helpful resource. And when it's given to the right people, the second thing there is contextual admissions. And again, all the universities in Scotland offer this, and this is looking at the context off the application. So, for example, if your care experienced, you might a crew what they call it a whiting participation flag on each university does a different thing with that. But it's actually, for example, some of them will give you 10% higher on your you caps core. Seven Little move agreed from a be today or what? What letter? Great and and things like that when you're in the application process. And finally you could be a doctor. Reached Scotland on a whole host of other organizations. Provide direct support, people's and the dressing Francisco buyers. I'm trying to inspire them to consider medicine and where we traditionally been very focused on the later years in the 5th and 6th year of high school and what we're going to talk a week but more about how we're trying to change that At the moment it's fire study that I keep referencing that really would read it and recommend a social justice mindset. And we should be part of all policy decisions. And that's something that we advocate for on the medical school. Scarcer. Collect data on did use something called a blueprint for fairness, which is essentially a gauge for medical schools. You know that we have limited resources to do that in the event you need to be targeted at the people's your moves to need. They're watching the peoples with the least social cultural in science capsule. Currently, private schools are the best way to get into medicine, and they really don't need more help than the roller to get it to supporting people's with interview techniques with you cats With the personal statement, you know it's not really about happening with those individual components of the application process. It's about helping them to believe in themselves and to reduce that anxiety around the application process to make it less off roading well happened to be more into contact with other people from similar backgrounds. This is a list of some of the events that we run as you could be a doctor and we host you could be a doctor, but good that you came in, which is our website. It really has all the information that you need to make an application to medical school from the school nurse states. Good background. And but we run a whole host of other things and we do a lot of talks about, like this one to try and raise the profile of I do participation across Scotland. I quite like this diagram, and it's just another way of thinking about it. So the top left inequality is probably more or less the default situation. And so you were the people who are less fortunate enough get along apples. Quality is probably what we might turn outreach to preventing the same support to everyone in or every school, regardless of the type of school of that person's background. Equity is widening participation. Providing the personalized in specific tools that the individual people needs, and then justice in this context probably means more or less eradicating poverty and which might set you could be doctor we while. But I'm I am clear. That's that that is part off every doctor's role I said, actually some slightly more upbeat data on buses that so this was obtained by Freedom of Information. Request from the start is funding. Cancel looking at the percentage off enrollments to medical school in Scotland who come from Scottish Index multiple activation 20 which is the 20% period School school's in Scotland, essentially, and we can see that that number is notice. I said like that for present percent should be 20% have even representation, but it has more than doubled over the past five years. We're still waiting on the 2021 22 data. Try to 2021 data and but we can see that we are making some progress. I'd love to claim that that was entirely And don't you could be a doctor, and but it's not actually the contextual missions. The university, but I think have made a difference. What we've seen in Terms Off and Applications University, though, is that they haven't kept up, so we'll do more. People are more applicants are successful. We're not seeing an increase in the total number of Africans, and that's what we're working on that the movement. So you know we're more people's to believe that they can succeed with are backing, but not necessarily the cause off it. I really would encourage you if you've been It's variable a stalker. If you're interested in it, to have a look at you could be a doctor too good with your key and to say not to our mailing list. And so you can follow your some of our events and a good day. And with a bit of a brief discussion, I am one of our current projects, which is our s one event program. And we're working with a whole range of organizations that we can add the role College of Emergency Medicine on the Association of the PSA tests this like a current list and to try and visit high schools targeting S one people's. We're doing that quick deliberately because we think that intervening earlier is probably the right thing to do. But it's always gonna be a long time before we see the benefits of that. I'm really excited that we've got four fantastic events that have been designed by my colleagues and based around different areas of healthcare. One of them is a healthcare professionals matching system where they get a card with the name of the profession and then a description of different parts and you have to match them up. And then they have to follow the patient, generally working at which professional might be involved in which one. And we've got a medical things escape room, which is quite exciting. And we're just finalizing the instructions for that at the moment. A little. Interestingly, my collect your doctors seem to be struggling with more than the people's do that we might be over thinking it. And we've got one on the cardiovascular system and one of the suggestive sistemas well, so we're very hopeful that will be able to visit a lot more schools this year that we have done in the past, and I really do hope that that will make a significant difference to end. Teo comes through people's across Scotland, and we continue to advocate in the meantime, So I got to wrap up there and see if there's any questions, and it's not usually that's a reasonable number of questions. So I thought I was comes likely short. And is there anything anybody would like to ask? Uh, yes, we already have a question in the chart. Actually, um, this is from Donna Quinn. He's asking, and she's wondering if, within your research, as much mean said about people's views of doctors, for example, stereotypes. Onda have any people's commented that they feel they wouldn't bitten because of factors like having the correct accent. Yeah, so I think this is really important point. And I guess this is the cultural capital that we're talking about. Just the other day I was in a multi disciplinary to admitting with a whole bunch of different out of professionals and urologists and the from every on we had someone come in from an alcohol support charity, and her comment was that they had a volunteer. He was quite well to do for morning side, so she would fit in well with the professional friend stable. And I have a limit to being slightly offended by that comment. But But it shows you have any greens that these ideas are on. You know, the people that I work with, I speak with this is absolutely something that they think about. You know, I don't sound like a doctor. I don't look like a doctor. I do it on a suit. The first state that I saw it was when I went for a lot of exertion because I injured my knee. You know, this isn't normal life for most people. And, you know, look, working with undergraduates as well. You know, we were very happy to be working on the safety symposium this year at which you might have come across a messy later in the year. And one of the things that we're looking at is the experience off watching desiccation medical students. One of things that's going to really strongly and is that use of language is being told off for using Scott's words is been told off route financing Antique as tack because that's how it's pronounced in a large part of the country. And, you know, I think that's unfortunate. Pretty Coleman. I certainly remember I'm medical school being marked down for using the word with which, it turns out, is a sculptor word. And I I I asked him if he could get another words you could use and stays on. The could have kept using it out with is exactly the word, um, that I've had an issue with two. Uh, I suppose. Is there anything that you go alone from that question? Is there anything to think that current medical professionals could be doing to help break down those stereotypes? Yeah, I think there is. And I guess part of our plan to go to s one and your good eye schools across Scotland on Target s ones is to get and people's into contact with with Dr. So we're trying to improve their cultural capital by doing that. And, you know, I think even in and, you know, healthcare setting it's just being mindful all the difficulty that people might be experiencing at home on remembering that, you know, we know that poverty is probably the single biggest excited for LDL. So the majority of the patients that were looking at there are coming from loose. Which economic status is the exact opposite where the majority of doctors were coming from? Perhaps not a surprise that it's sometimes difficult for health professionals to empathize with that with people coming from those cancer backgrounds. I think empathy is really the key thing for for medics in general, and but I think particularly in this kind of area. We really need to be working on that and actually simple things like using sculpts, language, using or using Go to stand English When your consulting with patients. That's the normal way of speaking for a huge number of people across the country, even if it's no unprofessional settings. Thank you. Um, are there any other questions for Doctor Cruickshank? Please take two in the chat. Um, but in case people who are perhaps watching this by recording or people who are thinking about the questions, is there any way that they can contact you? Your best way to do that? Sign up that you could be a doctor, so we'll encourage him to have a look at you. Could be doctor dot good UK, which has ah, whole host of resources and some material for volunteering. You've got a specific question that you want to. Even with it. I'm happy to be contacted directly, and you can do that at Cal. Um, with two l's at you could be a doctor dot cold UK and which is, like, you could be a doctor email address Your opposite. Baesler's All right. Well, thank you very much. I think we have a few minutes before dinner. Next set of sessions start. So if I wanted, the room would like to move around based. You can just go into the session. Stop top on the last time sides. Um, we will be around for a few more minutes if you feel like you would like to ask some more questions and we can absolutely pass on anything to that that Cruickshank late to on a swell. So I hope you enjoy the rest of your day. Thank you for coming. No.