An intersectional participatory action research approach to explore and address class elitism in medical education

Widening participation has increasingly been implemented to address the inaccessibility of medicine as a profession. However, 'less privileged' students who do 'get in' often struggle to 'get on'. This participatory action research project (PAR) gives space to medical students, who identify as 'less privileged' to express and explore their experiences.

PAR is underused in health profession education and is shown to increase marginalised communities' hope for change within historically oppressive structures. Here, participants and the researcher become partners in the process of developing research agendas and discussing themes raised in analysing marginalising experiences in medical education. Using an intersectional approach, students self-referred to join comics-based workshops and 1:1 interviews. Comics were used to elicit data and as a tool to analyse complex and interrelated themes raised. Participants reimagined their experiences into how they wish they had happened to develop ideas and actions for change.

We present four students' detailed accounts of marginalisation where their lived experience, feelings and ideas give us a source of knowledge to challenge classist, racist and sexist degradation widespread in medical culture. In particular, class elitism negatively impacted three women of working-class origins. Alongside other critical theorists, Bourdieu's work is used to understand how social class hierarchies are reproduced in medical culture, healthcare and society.

This project was an action in and of itself, creating a space to build community for marginalised students who feel 'peripheral' to commonly performed medical culture. Further actions were put forward for the medical school to implement as part of the decolonising and diversifying the medical curriculum movement. We also call for class to be put on the equality, diversity and inclusion agenda and for issues of financial insecurity and stress experienced by medical students of working-class origins to be recognised and further addressed within medical education.