Improving Access for Students From Widening Participation Backgrounds Applying to Medical School: A Quality Improvement Project.

Introduction Students from widening participation (WP) backgrounds - including those attending non-selective state schools, from lower socioeconomic groups, and from underrepresented ethnic groups - have a disproportionately low number of applications to medical school in the United Kingdom. Evidence suggests that such students have limited knowledge of the medical school application process, less support from teachers, and fewer contacts to access work experience. This quality improvement project (QIP) aims to identify challenges faced by students from WP backgrounds when applying to medical school, by implementing a pilot WP programme to address these challenges and improve their confidence and preparedness. Methods Challenges were first identified through a focus group (n = 4) and an anonymised pre-intervention survey. A WP programme was subsequently developed in line with student feedback and delivered at a district general hospital to 20 participants aged 16-18. Programme components included talks on the application process, hospital-based work experience, and interview practice. A mixed-methods evaluation compared pre-intervention (n = 16) and post-intervention (n = 18) questionnaires, with paired responses tracked using anonymous identifiers. Self-reported changes in confidence in the application process and preparedness for interviews (via Likert scale: 1 = not confident/prepared at all, 5 = very confident/prepared) were analysed using the Wilcoxon signed-rank test. McNemar's test assessed directional changes in the number of application-strengthening themes identified. Thematic analysis of free-text responses identified perceived benefits pre-intervention, what applicants found most useful, and further support needs post-intervention. Results Following the pilot WP programme, there was a statistically significant improvement in confidence in the application process (n = 13, p = 0.003, r = 0.79), with median scores rising from 3 (IQR 3-4) to 4 (IQR 4-5), and in feeling prepared for medical school interviews (n = 11, p = 0.003, r = 0.90), with medians increasing from 2 (IQR 1-3) to 3 (IQR 3-4). A greater breadth of application-strengthening themes was reported post-intervention, with a statistically significant increase in students identifying exposure to life as a doctor as a strength (from 3 to 12, p = 0.004). Similarly, thematic analysis found that students noted clinical and career exposure to be the most useful aspects of the programme, followed by interview preparation and professional identity development. The small sample limited power, preventing subgroup analysis, while limited ethnic diversity, single-centre study design, and self-reported outcomes limit generalisability. Conclusions This QIP found that a pilot WP programme, designed with student input, improved students' confidence and knowledge in navigating the medical school application process by strengthening various domains, including their confidence throughout the process, exposure to life as a doctor, and readiness for interviews. Such initiatives can be easily adopted by other centres. Future iterations should incorporate more work experience and long-term mentorship to better support underrepresented applicants, prioritise recruiting students from underrepresented ethnic backgrounds, and include longitudinal follow-up. Further attention is required to ensure WP students retain support within medical school.