8 minute read
Non-selective state schools engagement programme: The British Hip Society Experience
Marieta Franklin, Joanna Maggs and Vikas Khanduja
Medical school applications are disproportionately skewed towards the more affluent end of society. When using the National Statistics Socio-economic Classification, a self-reported system based on parental occupation with a range of options, 72% of applications came from the category of ‘managerial/professional occupations’, while only 11% identified as being from either the ‘lower supervisory and technical occupations’ and ‘semi-routine and routine occupations’ groups [1].
In the book The Class Ceiling [2], Friedman and Laurison deliver an analysis of earnings data from the Office of National Statistics Labour Force Study [3]. They note that the children of doctors are 24 times more likely to enter the profession than those without a doctor parent. If individuals are not exposed to surgical careers, how will they be inspired to pursue them?
The UK undergraduate curriculum for medicine provides variable – and at times limited – exposure to surgery, and in particular trauma and orthopaedic surgery (T&O) [4]. Some medical schools no longer have formal placements in T&O at all. This, despite Hospital Episode Statistics (HES) data showing that T&O sees the highest number of outpatients of any surgical specialty and is second only to general surgery in number of hospital admissions [4,7]. The loss of the firm structure and changes to working schedules, means that doctors who had little exposure to T&O in medical school, may not have very much more in their early years of qualification unless this is something they actively pursue. Studies have demonstrated that some of the most powerful and valuable aspects of surgical learning are personal, and positive practical interactions with surgeons [5,6]. If we want the best people to join our specialty, we need to sow inspirational seeds early. Therefore, why not begin this process prior to entry into medical school?
We outline a simple, free, reproducible and effective way to address the issues around widening participation in medicine and surgery.
Engaging with schools
As part of the British Hip Society’s (BHS) ongoing work on Diversity, Equity & Inclusion, our Culture & Diversity Committee formed a working group to develop an engagement project with non-selective secondary state schools. The American Academy of Orthopaedic Surgeons runs a ‘Playground Build’ programme during their annual meetings [8]. We decided on a similar approach in the hope of giving something back to the local community. With our annual meeting in Edinburgh fast approaching, we contacted all the non-selective state secondary schools in Edinburgh and Lothian, offering the opportunity to attend our schools engagement session: ‘Do you want to be a surgeon’? Twenty-eight young people along with an accompanying adult from each school availed themselves of the opportunity. BHS funded their transport to and from school, and provided refreshments throughout the morning and lunch.
We devised a programme with the goal of being engaging, interactive and beneficial (see Figure 1). We ensured that our working group was a team of individuals with diverse characteristics with respect to gender, age, background and location of work – after all, diverse teams perform best [9]. With the awareness that hip surgery would be a niche career option for a secondary school pupil, we were keen to expose our school students to as wide a breadth of our work as possible. The tone for the day was set brilliantly by an informative set of talks from third year medical students. They talked about ‘life as a medical student’ and ‘accessing medicine’, including discussing routes into medicine designed to widen participation and the eligibility criteria for these. We had fabulous engagement from industry with practical workshops on stems, and cementing and demonstration of new technologies and robotics. Extended scope physiotherapists were recruited to run a workshop using goniometers and dynamometers – opening the students’ minds to allied health professional roles. Laparoscopic box and radiograph sessions run by surgeons were well-received. Groups were also allowed time to wander the stands with a surgeon host and to experience the environment of a professional conference.
To the best of our knowledge, this is the first project of its kind to run at a UK orthopaedic conference. It was a step into the unknown and we were unsure as to how interactive our students would be. Our reward was the privilege of engaging with a room full of enthusiastic students and to see these young people get hands-on in workshops, excited and happy.
What did we learn?
A number of learning points emerged from this session. These will help us to refine our approach next year, and we hope will be of use to others considering setting up a similar initiative:
• We approached more than 100 Edinburgh and Lothian non-selective state schools, and uptake was lower than we had anticipated. This was in part due to school policies regarding senior pupils not going on school trips close to national exams (Scottish Highers commence at the end of April).
• We stipulated that a member of staff/suitable guardian accompanied the pupils from each school. Some schools reported that they didn’t have a free staff member and could not easily arrange another accompanying adult with the appropriate Disclosure and Barring Service (DBS) clearance.
• Our workshops lasted for 15 minutes, but we felt that in future we would allow a little more time, as the groups tended to still be really engaged at the 15-minute mark and had to be cajoled into moving onto the next station!
• A friendly familiarity developed between the pupils from different schools over the course of the morning, and our group sizes of around 8-12 students seemed to work well, allowing everyone to feel involved, but not under undue pressure.
• We received some interesting feedback from one tutor – she explained that she had taken a group to another industry event for school children a year or so previously. At that event, there were children from both private and state education. She had observed a tendency in her students on that occasion to defer to the somewhat more confident children from private schools and remarked that the students at this event had felt more comfortable, due to their similar schooling backgrounds.
• We were fortunate that our self-selected group were similar in age, ranging from 15-17 years old. This meant that workshop hosts and faculty could deliver teaching at a similar level for all students, and peer to peer interaction happened naturally.
• The awe and excitement of the school students was infectious! Word spread about how much fun the faculty and members of the BHS Executive committee were having, and some very senior FRCS examiners rolled up their sleeves and came to join in with demonstration and hosting.
• This positivity continued for the subsequent days of our largest ever, 700-strong conference. Word spread, and colleagues from far and wide came to find us to enquire about the session, and how they could get involved in future events.
Future plans
We plan to make the schools engagement session a permanent feature of the British Hip Society annual meeting. In addition, we are hoping to collaborate with the British Orthopaedic Trainees Association (BOTA), the British Orthopaedic Medical Student Association (BOMSA), and the British Orthopaedic Association (BOA) to run a similar session at this year’s BOA meeting. Next steps will also include our members reaching out to pay schools visits, with supporting materials provided by our working group. The British Hip Society Culture & Diversity Committee would welcome all thoughts and ideas around schools’ engagement to cd.com@britishhipsociety.com
References
References can be found online at www.boa.ac.uk/publications/JTO.
Marieta Franklin is an ST7 registrar in Mersey where she is on the Specialty Training & Education Committee. She is on the BOTA committee as the Specialty Advisory Committee Representative and forms part of their Culture & Diversity subgroup. Representing BOTA on the British Hip Society’s Culture & Diversity Committee, Marieta is Project Lead for their Schools Engagement Programme.
Joanna Maggs is a Consultant orthopaedic surgeon at Torbay Hospital specialising in trauma, lower limb arthroplasty and revision hip surgery. She completed her undergraduate studies at University College London, intercalating with a BSc in the history of medicine and later completed an MSc in musculoskeletal science at University of Oxford, awarded with distinction. She is chair of the British Hip Society Culture and Diversity Committee.
Vikas Khanduja is a Consultant Trauma and Orthopaedic Surgeon at Addenbrooke’s - Cambridge University Hospital NHS Foundation Trust. He is the President of the British Hip Society and Trustee of NAHR. He has been involved in the conception, initiation and development of Schools Engagement Programme run by the BHS.
