Thinking of selection and widening access as complex and wicked problems

Jennifer A. Cleland* (Corresponding Author), Fiona Patterson, Mark D. Hanson

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

29 Citations (Scopus)
4 Downloads (Pure)


Objectives: “Wicked problems” are complex in nature, have innumerable causes associated with multiple social environments and actors with unpredictable behaviour and outcomes, and are difficult to define or even resolve. This paper considers why and how the frameworks of complexity theory and wicked problems can help medical educators consider selection and widening access (WA) to medicine through fresh eyes to guide future policy and practice. We illustrate how “wickedity” can frame the key issues in this area, and then address steps that educational stakeholders might take to respond and act toward these issues.

Methods: We used the 10 properties of a wicked problem to frame common issues in the broad field of selection and WA in medicine. We drew heavily on literature from different disciplines, particularly education, and, through debate and reflection, agreed on the applicability of the theory for illuminating and potentially addressing outstanding issues in selection and WA.

Results: Framing medical school selection using the 10 properties of wicked problems is a means of shifting thinking from erroneous “simple” solutions to thinking more contextually and receptively. The wicked problem framework positions selection as a multi-causal, complex, dynamic, social problem, and foregrounds stakeholders’ views and context as being highly relevant in medical school selection.

Conclusions: The wicked problem lens shifts thinking and action from seeking one elusive, objective truth to recognising the complexity of medical school selection, managing uncertainty, questioning and considering “issues” associated with medical school selection more productively. While there are criticisms of this framework, labelling medical selection as “wicked” provides original insights and genuine reframing of the challenges of this important, and high profile, aspect of medical education. Doing so in turn opens the door to different responses than would be the case if selection and widening access were simple and readily tamed.
Original languageEnglish
Pages (from-to)1228-1239
Number of pages12
JournalMedical Education
Issue number12
Early online date7 Sept 2018
Publication statusPublished - Dec 2018

Bibliographical note

This work was unfunded but the ideas stem from numerous funded projects from over the years, particularly from the General Medical Council (GMC) and Medical Schools Council (MSC) of the UK. Our thanks also to the anonymous reviewers of an earlier version of this paper for their helpful feedback.


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