Inclusion in an exclusive world? A two-country comparison of widening participation in medicine.

Prior studies of the effectiveness of widening participation (WP) tend to focus on 'getting in' to medical school. But what of 'staying in'? Few studies have focused explicitly on the lived experiences of WP students once in medical school, nor have there been direct comparisons of the (potentially) diverse journeys of WP students from different contexts. To address these gaps, we explored how WP medical students in the UK and Australia experience the journey into and at medical school. In this qualitative interview study of 23 participants, we focus on six individual experiences (UK = 3, Australia = 3) via a narrative inquiry approach following inductive and deductive analyses. Narratives were coded in relation to students' experiences with the key actors in their journey through medical education. In both contexts, experiences of social and cultural mobility and challenges to identity featured significantly in participant narratives. Similarly, experiences of misrecognition and microaggression reinforced feelings of being unwelcome in a culturally unsafe environment. Indigenous Australians struggled to feel comfortable in the world of medicine, but person-centred support from key staff members helped establish a sense of security and stability in developing a new identity as a medical student. The data illustrates how WP students carry the long-term impact of historical disadvantage and marginalisation into their time at medical school. Existing supports help, but institutions need to recognise that their actions and structures are unwelcoming and indeed harmful to those from non-traditional backgrounds. To be transformative, medical education must learn to promote different kinds of excellence and embrace diversity and inclusion in more socially accountable ways.