Equity Beyond Entry: A Capability Approach to Understanding Widening Participation in Medical Education

Widening participation aims to promote equity in medical education and build a more diverse healthcare workforce. Despite ongoing efforts, systemic inequities persist in shaping students' trajectories. This study explores how widening participation students experience medical education, examining the factors that enable or constrain their success across the continuum of entry and progression. It offers a novel contribution by applying the capability approach to explore the conditions that influence students' freedoms to pursue valued outcomes.

This qualitative study employed semi-structured interviews with 16 medical students from widening participation backgrounds in Scotland. Data were analysed using reflexive thematic analysis and interpreted through the capability approach, which considers individuals' freedoms to pursue outcomes they value. Central to this are personal, sociocultural, and institutional conversion factors that determine whether individuals can transform available resources into genuine opportunities.

Participants described persistent capability constraints. Early aspirations were undermined by discouragement and low expectations from teachers and advisers. Educational disadvantage hindered preparation for entry. Once admitted, financial insecurity, opaque support systems, cultural exclusion, and limited career guidance restricted capabilities. Privilege functioned as an enabling conversion factor but was unevenly distributed. Structural supports were limited, with enabling factors more often linked to individual resilience than to institutional provision.

Achieving equity in medical education requires more than just widening access; it demands attention to systemic barriers that shape students' experiences and outcomes. Applying the capability approach highlights the need to transform institutional conditions that influence students' freedoms to succeed, offering both theoretical and practical insights for reform.