Opening up the black box of a Gateway to Medicine programme: a realist evaluation

Kathrine Gibson Smith, Kirsty Elizabeth Alexander, Jennifer Cleland* (Corresponding Author)

*Corresponding author for this work

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3 Citations (Scopus)
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Objectives A Gateway to Medicine programme, developed in partnership between a further and higher education setting and implemented to increase the socioeconomic diversity of medicine, was examined to identify precisely what works within the programme and why.

Design This study employed realist evaluation principles and was undertaken in three phases: document analysis and qualitative focus groups with widening access (WA) programme architects; focus groups and interviews with staff and students; generation of an idea of what works.

Setting Participants were recruited from a further/higher education setting and were either enrolled or involved in the delivery of a Gateway to Medicine programme.

Participants Twelve staff were interviewed either individually (n=3) or in one of three group interviews. Nine focus groups (ranging from 5 to 18 participants in each focus group) were carried out with Gateway students from three consecutive cohorts at 2–3 points in their Gateway programme year.

Results Data were generated to determine what ‘works’ in the Gateway programme. Turning a realist lens on the data identified six inter-relating mechanisms which helped students see medicine as attainable and achievable and prepared them for the transition to medical school. These were academic confidence (M1); developing professional identity (M2); financial support/security (M3); supportive relationships with staff (M4) and peers (M5); and establishing a sense of belonging as a university student (M6).

Conclusions By unpacking the ‘black box’ of a Gateway programme through realist evaluation, we have shown that such programmes are not solely about providing knowledge and skills but are rather much more complex in respect to how they work. Further work is needed to further test the mechanisms identified in our study in other contexts for theory development and to identify predictors of effectiveness in terms of students’ preparedness to transition.
Original languageEnglish
Article numbere049993
Number of pages12
JournalBMJ Open
Issue number7
Early online date14 Jul 2021
Publication statusPublished - 14 Jul 2021

Bibliographical note

Acknowledgements We would like to thank all our study participants for their valuable input into the study and all those who set up and supported the programme. In particular, thank you to Professor Rona Patey, Professor Stephen Davies, Dr Wendy Dollery, Anna Johnston, Dr Christine Kay, Professor Colin Lumsden, Dr Pietro Marini, Dr Sally Middleton, Sarah Miller, Gwen Smith, Laura Young. In addition, we would like to thank Pat Maclennan for all administrative support and Scottish Government for granting the funding.

Funding The programme and work was supported by Scottish Goverment.


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