At a recent Faculty Operation Board away day, I was invited to talk about education, and I asked the question: “How do we negotiate the inherent tensions between inclusion/belonging and competitiveness in undergraduate education?” I believe this is a crucial question for the future of our medical school and one that we all have a responsibility to address.

Medical students start their journey competing to gain a place at medical school. Many continue feeling pressured to compete with their peers to obtain the best marks and ultimately the highest rankings to compete again for their place on the Foundation Training Programme. This supports the unhelpful discourse that academic achievement is what medical schools and the medical profession value most.

By default, this discourse assumes those not achieving the highest academic marks are less valued, contributing to a deficit framing of students who are not at the top of their class but can excel in other areas.  The student deficit discourse places the responsibility with the student for their situation, not acknowledging the systemic inequalities they face. In reality, many students, often from widening participation and minoritised backgrounds have to juggle competing demands on their time and without the many social and economic advantages commonly associated with high academic performance.

So here is the tension. To ensure a vibrant, diverse and enriched educational environment we actively want and need to attract students from underrepresented or widening participation backgrounds.  How then, in the face of the national and institutionalised competitiveness in medicine, do we ensure our discourse values uniqueness and belonging and is not a deficit discourse excluding those students we invite into our medical school?

Naturally, contextualising terms such as ‘excellence’, ‘brightest and best’ and ‘student success’ to encompass all our students’ attributes, including academic achievement, would be a good way to start. For example, celebrating students who pass their exams while undertaking paid employment to support themselves and their family, or those students who have caring responsibilities requiring them to travel home regularly, would challenge the unconscious exclusion at our medical school. We should explicitly value the uniqueness of our students, creating an environment where everyone belongs. We are immensely proud of all our students and we must ensure our medical school at Southampton is friendly and welcoming to all.

Our faculty’s reverse mentoring programme is enhancing staff’s understanding of underrepresented students’ experiences in our medical school. The scheme encourages meaningful conversations between mentors (students from underrepresented and minoritized backgrounds) and mentees (senior faculty and UHS placement staff). A key aim is to raise awareness of student experiences through conversation, to challenge the student deficit discourse and acknowledge the institutional and systemic responsibility for many of the barriers our students face. Most senior medical school and placement staff do not regularly meet or have the opportunity to spend time with students and frequently hold privilege, coming from backgrounds far removed from those of our underrepresented students. Implementing reverse mentoring has created the time and support for conversations and has enlightened staff to the realities of the student experience, challenging established and misconceived discourses.

Finally, I would like to invite you all to challenge exclusion, to consider how you view and talk about our students’ success and help create a truly valuing and welcoming environment for all our students.

“How do we negotiate the inherent tensions between inclusion/belonging and competitiveness in undergraduate education?” by Professor Sally Curtis

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