Erica Southgate

The strange world of medical school for working-class and Indigenous students: doing extreme social mobility

What happens when becoming a doctor is a battle between staying true to yourself and fitting in to an elite profession? It sounds dramatic, but this is the struggle that working-class and Indigenous students face when entering the strange world of medical school.

Medicine – the final equity frontier?

Medical school has traditionally been the domain of white, upper middle-class males. There have been gradual shifts over time, with females and non-Anglo students now well represented. But when it comes to social class and Indigeneity, it’s a different story.

Medical schools have been slower to respond to the opening-up of higher education to diverse groups evident in teaching and nursing degrees. It’s a similar pattern in law. These high-status degrees represent the final frontiers for the widening access agenda in higher education. In undergraduate medical degrees, just 10% of students come from low-socioeconomic status (LSES) backgrounds and 1.9% are from Indigenous backgrounds. Proportional representation relative to the population would see 25% of students from LSES and 2.3% from Indigenous backgrounds.

What are the hurdles?

Are the privileged favoured in medical school admissions processes? Or are working-class and Indigenous students not applying? In Australia, low-socioeconomic status students have a higher success rate in medical school applications than their high-SES peers, but apply in smaller numbers. The exceptionally high ATAR for medicine is a substantial barrier for people from these backgrounds, as is the multi-phased admissions process, including hurdles such as the expensive Undergraduate Medicine and Health Sciences Admission Test. British and Australian research shows that low-socioeconomic status students imagine that medical school is full of ‘posh’ geniuses, and that they will not fit in.

Medical school: a strange new land

Working-class and Indigenous students find themselves in a clear minority when they arrive at medical school. Starting university is a tough transition for many students, but this is compounded by the pressure of the intensive coursework of medicine and trying to develop a sense of belonging in an exclusive environment. We recently interviewed medical students who were the first-in-family to go to university – most were working-class and a significant proportion Indigenous. These students had to be particularly strategic to succeed in the profession while struggling to remain connected to their families and communities.

Medical education involves socialisation into an elite, high-paid profession. Many of our interviewees entered medical school expecting not to fit in, and they did notice how different they were. Other students had ‘money to throw around’, and were ‘a different breed’, more ‘polished’ and ‘clean cut’. In contrast, some of our participants described themselves as ‘a bit rough around the edges’.

The students had to work hard to build knowledge and connections around medical careers that their middle- and upper-class peers already seemed to have. One told us that:

everyone seemed a lot more confident because a lot of them had planned to do medicine since they’d entered high school and had always wanted to do medicine. A lot of people have parents that are doctors and people in their family that are doctors, so I really had no idea, I didn’t know what actually happened after medical school.

‘99% medical student, 1% bogan’: Forging professional identity

Students described gradually becoming more confident in the world of medicine, but this involved a shift in identity and behaviour. Some changed the way they spoke, adopting the professional communication style taught within the degree.

How were these students seen by their families and communities? Becoming more like a ‘doctor’ meant creating a rift between their old and new identities, a source of tension for students themselves and people they had grown up with. One described her friends making comments like, ‘You won’t come back to [our town] when you’re rich’. An Indigenous student was uncomfortable with the high status afforded doctors – status was for her most often reserved for community Elders.

Our research showed these students were caught between two worlds: no longer fitting easily into their old lives, nor into medical culture. One said, regarding the other students on her course:

I do find it hard to relate to people that are from rich families….I don’t know, there are all these things that I’ve seen and done that are different to what they may have seen and done…

Interviewees recognised that their backgrounds were a professional asset that gave them an advantage when treating patients, most of whom also do not share the privileged background of doctors. An Indigenous student noticed that many students were ‘quite clueless with Indigenous health’. Another said that because of his ‘very humble’ background, growing up in an environment where people had little money and poor health, he understands where patients are coming from.

What stood out was the commitment of these students to return to their communities as doctors. The areas they came from – typically low-SES, rural or Indigenous community – are the very places most in need of better healthcare access. Encouraging doctors to work in these regions has always been a challenge, and there’s evidence that the best strategy is to recruit students who grew up in these areas.

Having this goal of returning to serve community meant that participants were not prepared to forfeit their identities to fit some medical professional norm. Instead they were learning to succeed in both worlds. One participant proudly told us he was ‘99% medical student, 1% bogan’. Another said:

I might have to be a slightly more refined version of myself as a doctor. But I think with the patients I’ll still be okay and with my family, I’ll still be much the same.

Understanding extreme social mobility

Australia’s comparatively good rates of social mobility are less apparent in high status professions. The proposed increase in university fees, especially for degrees like medicine, may well curtail what limited mobility exists. It’s important for educators and policy makers to better understand journeys of extreme social mobility. Understanding how people from ‘humble’ backgrounds make their extraordinary journey into, through and beyond medical school is important if the profession is to diversify and become more inclusive of the truly talented, regardless of social background.

 

Erica Southgate is an Associate Professor at the School of Education, University of Newcastle, Australia. She is her first in her family to go to university. In 2016, as national Equity Fellow, she conducted research on increasing access to high status professions such as medicine, law and engineering for young people experiencing disadvantage and marginalisation. She believes emerging technologies such as virtual and augmented reality can be used to broaden the career education of young people and is the author of the report: ‘Immersed in the future: A roadmap of existing and emerging technology for career exploration.’ https://www.ncsehe.edu.au/wp-content/uploads/2016/08/Immersed-In-The-Future-A-Roadmap-of-Existing-and-Emerging-Technologies-for-Career-Exploration.pdf

 

 

Caragh Brosnan is a Senior Lecturer in Sociology at the University of Newcastle, Australia. Her research focuses particularly on understanding how different kinds of knowledge come to be valued in scientific and health professional practice and education. She recently led an ARC Discovery Early Career Researcher Award project, Complementary and alternative medicine degrees: new configurations of knowledge, professional autonomy and the university. This explored how what is taught in complementary and alternative medicine (CAM) degrees reflects the professional status of CAM, at the same time examining the broader relationship between professions and the university. Caragh’s work on medical education has focussed on issues of equity and access, as well as on the construction of legitimate knowledge in medical curricula. Her publications include the edited collections, the Handbook of the Sociology of Medical Education (Routledge 2009) and Bourdieusian Prospects (Routledge 2017).

Digital footprint of children: latest research on the issues and implications

Australian children are among the youngest and most prolific users of the internet in the world. They are, on average, a little under eight years old when they begin using the internet and most go online daily. So it is not long before they develop an extensive digital footprint. But not much is known about young people’s digital footprint awareness and how to best educate them to manage their growing online presence.

My colleagues, Jill Scevak, Shamus Smith, Erica Southgate and I decided to investigate the issues involved in children understanding and managing their digital footprint.

We surveyed a variety of experts about what they thought were the main digital footprint issues for children and for young people. We spoke to primary school students (and next year we will be following this up by speaking to secondary students), did an online survey of Australian university students, and ran focus groups with university students at one Australian university. Here I will give an overview of what we found so far, and look at what this might mean for careers education.

What the experts say

We surveyed 53 digital and career experts (academics, researchers, policymakers, teachers, and university career advisers). They told us that:

  • Education for digital print management should be sequential to match the development of those being educated.
  • They were concerned that children don’t have the cognitive development to understand the longevity of what is put online
  • They said a holistic approach needs to be taken to manage the issue of digital footprints – education should come from family, schools, universities, government and career educators. It is considered to be both a societal and an individual issue.

The experts noted that children ( aged 5 to 12) can be technically clever online but lack an understanding of the possible consequences of their actions, especially regarding safety issues such as security, privacy settings, abuse, predators, and bullying. Some of those surveyed were concerned that due to children’s innocence, that they may be too trusting. Children also have little control of what gets posted about them. Privacy was considered to be overall the most serious issue for children.

When asked about the digital footprint issues for young people ( aged 18 to 24) the experts surveyed identified many of the same concerns as for children, but with additional concerns about the permanence of what is posted online and the implications of this for employability. They noted that is it nearly impossible for most people to be completely anonymous online and that they need to be aware of the immediacy and longevity of their digital engagement.

What the children said

We ran focus groups with thirty-three 10-12 year olds from three primary schools in regional NSW. The children we spoke to were very aware of cyber safety and could discuss the issues of privacy, security, cyber bullying and online predators. This knowledge has come from school and (to a lesser degree) from home. They could tell us the rules for safety (don’t click on anything strange, don’t ‘friend’ people you don’t know, don’t put information about yourself online).

These students have varying degrees of parental support and involvement with their internet use. They know what digital footprints are, and are able to describe the implications of these (‘the internet keeps everything’). They manage their digital footprints by minimising them. They see digital footprints as a ‘danger’ and so they use social media for private chats, not for making public posts. They did not know that you could create a positive digital footprint.

What the university students said

We ran an online survey for university students and had 635 responses from 28 Australian universities. From this survey we found that university students are very concerned about their digital footprints and want more guidance.

  • Over 75% (n=425) of students claim that their university has provided them with no guidance on how to manage their digital footprints.
  • Over 70% of students (n=445) responded to the question: What would you like to know about your digital footprint?
  • Typical responses include:-

“how to erase, keep private and monitor”;

“How can I create a professional digital footprint? What kind of information should I avoid posting for my digital footprint to look professional?”

We also ran focus groups with 30 students at one Australian university. We found that due to their concerns about their digital footprints they use a variety of strategies to manage their digital footprints. Their strategies include

  • Varied privacy settings
  • Use of pseudonyms and anonymity
  • Selectivity in the use of their real names
  • Locking profiles down (aiming for complete privacy)
  • Making profiles completely public but never posting anything
  • Separation of professional and personal profiles
  • Not using any social media

Implications for careers education

There have been massive changes in employment over the past 2 generations. A single-track career is no longer the norm and new career patterns have emerged: serial careers, (a number of career changes) lifestyle careers (making career decisions based on lifestyle choices, for example working part time to care for children), portfolio careers (a combination of carefully chosen jobs undertaken simultaneously which utilize different skills) and well as more haphazard career paths due to the increase in part-time work, and under and unemployment.

Along with these changing patterns, the internet has changed the way people seek and find jobs and the way companies recruit and select employees. More than half of all organisations have a policy of profiling potential employees and a quarter of workers have witnessed their employers using the internet to profile candidates.

In this context it is very important that students are taught to present themselves well online. Responsible online engagement can create a positive public persona which acts as ongoing résumé of achievement and identity.

From surveying and talking to university students we know that they are not confident that they are able to create a professional digital footprint.

Our conversations with primary students suggests that the end of primary school is a good time to start educating them to build a positive online presence. This would build upon their cyber safety awareness and help them to transition to high school where their internet usage increases.

This education could be further developed in high school and university. That way students are given more options regarding the informed management of their developing digital identity.

 

BuchananDr Rachel Buchanan is a Senior Lecturer in Education at the University of Newcastle. She teaches educational foundations and researches into the equity and social justice implications of education policy and the increased deployment of digital technologies within the education sector. She can be contacted via Rachel.Buchanan@newcastle.edu.au or found on twitter: @rayedish.     

 

Rachel is undertaking this research with Dr Jill Scevak, Dr Shamus Smith and Dr Erica Southgate. Part of this research was funded by the Australian Government Department of Education, through a HEPP National Priority Pool grant. The research with primary schools was funded by the .auDA Foundation. More information about our research can be found here. (This post provides a follow up of our investigation into Australian students’ understanding of their digital footprints.)

First in family to attend university: latest Australian research findings

Over the past fifty years there has been a huge increase in enrolments in higher education in many countries, including Australia. Increases range between 15 to 50 per cent, and Australia is approaching the upper limits of that measure. This has resulted, in part, from a drive in countries such as the US, UK and Australia, to improve economic growth by encouraging students from backgrounds previously not attracted to university education, to gain a tertiary qualification.

The enrolment surge has raised many issues for universities as they deal with the influx of a new type of student. Having attracted these students into tertiary education, universities have a moral and ethical responsibility to identify and support them. It is unethical to invite students into university study for broad economic and corporate purposes without considering how participation affects the students involved.

In Australia, universities have particularly targeted students from low socioeconomic backgrounds. However there is now a stigma attached to this label, and it can lead to deficit approaches, where students are treated as being from problematic backgrounds, or needy communities, who are not likely to succeed without outside help.

In contrast, in the US there has been a focus on research around students who are first-in-family (FiF) to attend university. This category is more useful as far as education services and support goes, and students are more likely to be comfortable being identified as first in family to attend university. However this category of students does not appear in Australian policy.

Currently, FiF students are gaining increased attention from researchers and institutions around the world, including here in Australia. While some of these students may come from low socioeconomic status backgrounds, not all do. However, much of the research suggests that FiF students, if they do enrol, are more likely to struggle at university and to discontinue their studies.

Our research findings on first in family (FiF) to attend university in Australia

A group of colleagues and I conducted a study at a large regional university in NSW on first in family to attend university. Our findings would be useful for any university that is expanding its enrolment base, and should underpin future government policy-making in this area.

FiF are a diverse group with common aspirations

We discovered FiF students are a diverse group, in terms of age, life experience and expectations of university. However they share a common desire for a better life and hope that university will help them achieve this. Some are keen to gain financial freedom, and many older students are aiming to improve their careers. They all share an interest in the focus of their degree program.

Transitions are different but university is an alien place

The transition to and through university differs for every FiF student, but they share a need to overcome a sense of university as an alien place, and to develop a sense of belonging. This is especially true for those who were not high achievers in high school. Many struggle against the belief that ‘university is for really smart people’ and ‘not people like us’.

Most have to do paid work and study

Most FiF students have to undertake some level of paid work while they study. Students who have to relocate in order to study, and those with family commitments are affected most by finances.

There are costs for travel, books, printing, childcare and loss of income while undertaking professional experience placements.

Families can impact study

Family commitments can impact study in many ways. One student told us:

I am from a family of 11, so studying at home can be an issue most of the time. I don’t have many friends either, there isn’t much help around!

Dropping kids to school and driving to uni getting parking takes about an hour so if lecture begins before 10am then it has to be missed.

However family and friends are a major source of support for these students, even though those people may not understand what the student is going through.

Loss of social life, health and well being

FiF students also suffer from loss of social interactions and reduced health and wellbeing, especially during peak assessment times.

New friends

Making friends in their courses is also important. These students, in particular, need peers to discuss course content and assessment with.

Achievement gap

There remains an achievement gap for FiF students. Our study indicates that the achievement outcomes of FIF and non-FIF are similar in the first year of study, but that achievement decreases for FIF in subsequent years of study. Most support structures at universities are aimed at first year students.

Realistic expectations

FiF students generally have realistic expectations of university and work hard to achieve their goals. They do not take success for granted. They are aware of the changes made to their skills, lives and future opportunities because of their studies.

Overwhelmingly, FiF students find the struggle worth persevering. They cite benefits in terms of personal growth, social experiences and a better understanding of society, and feel this benefits other members of their families too. These students often pave the way for other family members. Many feel ‘lucky’ to have the opportunity to attend university, often underestimating the impact of their own hard work and determination.

Help from university staff is important

University staff and services (academic, medical and financial) can also be of help. One student said:

staff that smile and are always approachable. The resources available such as extended library hours and IT staff. The HUB. A psychologist. Meditation and relaxation classes. Utilising all the available resources in the first year from the learning support centre. A positive attitude. Helping others helps me. Persistence.

Despite the available support services, it can be difficult to navigate the landscape of university, especially for those struggling with family and/or health issues, or to understand language used by staff and requirements of enrolment and assessment. Time-poor students find it difficult to access services in addition to the demands of study and paid work.

More research and more support is needed

Although a number of universities, including the one where the current research was conducted, have a strong corporate commitment to attracting and retaining low SES and/or FiF students, the commitment is not always supported sufficiently to filter down in a practical way to the students involved. Many of these students do succeed, but all could be better supported.

 

A full report of the study can be found here

I would like to acknowledge the financial support for the study received from the National Centre for Student Equity in Higher Education.

 

Suzanne Macqueen1-1Suzanne Macqueen is a Lecturer in the School of Education at the University of Newcastle teaching courses related to primary social studies curriculum, classroom management, literacy and professional preparation. She has a Master of Education (Research) on the topic of between-class achievement grouping for literacy and numeracy classes in primary schools. She is currently undertaking PhD research related to the impact of widening participation initiatives in teacher education. She is also involved in research projects studying equity in higher education and Global Education.

Suzanne would like to acknowledge the financial support for the study received from the National Centre for Student Equity in Higher Education.

Digital Footprint: not everyone is equal and why unis need to teach managing DF as a 21st century skill

Australians are among the most digitally connected in the world and young people spend a lot of time online. Most young Australians have an extensive digital footprint, especially university students.

Digital footprints are created through interaction with the internet and social media. Increasingly, digital footprint management is an important career development skill and one that is vital to the professional opportunities of university students.

However, we know very little about what university students know and do, in regards to their digital footprints. This post provides an initial overview of our* investigation into Australian university students’ understanding of their digital footprints. This research and our data collection are still taking place.

ABS data indicates that over 90% of Australians aged 18-40 regularly use the internet. The increase in online activity and social media usage has implications for digital footprints given that 800 000 Australians post videos online, and of the 47% of 16-25 year olds that use platforms such as snapchat, 25% admit to posting material of a sexual nature online.

Digital Footprints

Such social media activities can create a negative, publically accessible digital footprint that can detrimentally impact an individual’s current prospects and future careers.

However, responsible online engagement can create a positive public persona which acts as ongoing résumé of achievement and identity.

Management of digital footprints is a 21st century life skill, a lack of which could have serious social and professional consequences for students. Popular media is full of warnings about the problems caused by poor digital footprint management:

From The Age: “What if today’s sexting teenager is tomorrow’s prime minister – adult lives can be marred by the digital footprint students are laying down now.”

From the SMH: “Young ones, your online reputation is, like, forever”

Professional social media platforms, such as LinkedIn, make the professional implications of a badly managed online presence clear: “Your digital footprint is ruining your job application

Higher Education, Social Media and Digital Footprints

Yet, with our increased digital connectivity having no online presence can be as detrimental as having a badly managed one. Research tells us that

  • Human Resources practitioners are increasingly using social media in recruitment, selection and hiring practices.
  • Social Networking awareness is largely absent from the Higher Education curriculum.
  • Curation and management of digital footprints is emerging as an essential skill for career development, yet universities are not adequately addressing this.

In regards to university students:

  • Students with a high Socio-Economic Status (SES) background are coming to university with more technological knowledge and skills, have more experience with, and positive attitudes towards the use of ICT, than students with a low SES background.
  • These students are better placed, than students from other backgrounds, to develop and manage their digital footprints while at university.
  • Higher education institutions must help students who are coming to university without the digital education confidence and knowledge develop the required digital skills for success and achievement at university and beyond.

The Equity and Digital Footprint Project

Our project focuses on this emerging equity issue to better understand what undergraduate students from low SES and non-traditional backgrounds know and do in relation to their digital footprints. Information from this research will be used to develop resources to help students build a positive digital footprint.

To achieve this we are currently:

  • Reviewing the relevant literature
  • Conducting an online survey of university students across Australia to determine their knowledge and behaviour in relation to digital footprint management.
  • Running focus groups with University of Newcastle students to speak to students in more depth about their use of professional social media.
  • Doing an audit of university online resources on digital footprint to determine how well Australian universities are addressing this issue
  • Conducting an online survey of ICT educators, policy makers and higher education career service personnel to garner collective wisdom and evidence of which educational approaches would be most effective for students.

Preliminary findings

While it is very early days, our initial explorations reveal that:

  • “Anecdata” abounds – There is lots of anecdotal evidence about the uses and abuses of social media and digital footprints, and media reports of the sensational examples provide only a distorted picture.
  • There is conflicting information about the extent to which employees are using digital footprints to vet applicants.
  • Students are aware that their internet usage creates a digital footprint, and they employ a variety of strategies to minimize or manage their digital footprints. These strategies range from a refusal to use social media, judicious use of privacy settings, minimal or highly strategic use of their real names when online, through to working from an assumption that privacy does not exist. Most students see their digital footprint as a liability rather than an opportunity.
  • While Universities in the United Kingdom are producing some excellent comprehensive resources and services for digital footprint education the approach is very uneven in Australian universities.

Given the emphasis on excellence and equity in Australian universities and the pattern of increased access to universities from students from all backgrounds it is important that universities provide adequate support to all their students. Increased access to university is not an achievement if students are not provided with the resources and skills to participate and succeed in, and beyond, university. Not all students come to university with the necessary digital skills and knowledge.

Given the increased importance of social media management and having a traceable online presence, digital footprint education can provide students with opportunity to turn access and participation in university education into success; a positive online presence acts as an on-going record of identity and achievement.

 

BuchananDr Rachel Buchanan is a Lecturer in Education at the University of Newcastle. She teaches educational foundations and researches into the equity and social justice implications of education policy and the increased deployment of digital technologies within the education sector. She can be contacted via Rachel.Buchanan@newcastle.edu.au or found on twitter: @rayedish.       *Rachel is undertaking this research with Dr Jill Scevak, Dr Shamus Smith and Dr Erica Southgate. This project was funded by the Australian Government Department of Education, through a HEPP National Priority Pool grant. More information about our research can be found here