Meet The Expert: Katherine Woolf

Katherine Woolf is Associate Professor at UCL Medical School whose research aims to understand and improve medical students’ and doctors’ education, and thereby improve patient care. Katherine’s major research areas include improving the educational experiences and outcomes for Black and Minority Ethnic medical students and doctors, and improving access to medicine by helping medical applicants from diverse backgrounds make informed choices about which medical schools they apply to. 

Katherine is currently a National Institute for Health Research (NIHR) Career Development Fellow in Medical Education and runs the UK Medical Applicant Cohort Study (UKMACS). She is also an educational advisor to the Membership of the Royal Colleges of Physicians (UK) and a Fellow of the Higher Education Academy.

After completing a degree in Psychology at Goldsmith’s College and a stint working in Parliament, Katherine joined UCL Medical School in 2004 as a Research Assistant. She went on to undertake a PhD in Medical Education and Psychology supervised by Professor Dame Jane Dacre and Professor Chris McManus. In 2009, Katherine became a Lecturer in Medical Education and an Honorary Research Fellow in Psychology at UCL. In 2014 she had twins and was promoted to Associate Professor.

Today a key focus for Katherine is improving access to medicine by helping medical applicants from diverse backgrounds make informed choices about which medical schools they apply to, as part of the NIHR-funded UKMACS study.

UKMACS will produce evidence to help applicants navigate the complex and highly competitive process of applying to medical school – something that can be more difficult for students from under-represented groups.  It will also allow researchers to find ways of improving how medical students and doctors are trained.

The study’s findings will be used to help future students apply to the right medical school for them and ultimately to ensure the NHS benefits from having the best doctors.  The results of the study will help ensure that moving forward those interested in becoming doctors, from a diversity of backgrounds, are supported during their application and that patients benefit from having the best medics.

We sat down with Katherine (virtually) to find out more about her work.

Question: What made you want to combine specialising in medicine and psychology?

Katherine: It was an accident! I have always been fascinated to understand why people make the choices and decisions they do, and in particular how and why people differ from one another in that regard. In psychology, this is called the study of individual differences.

After graduating from university I was looking for a job studying individual differences in a psychology department, but ended up getting a job at UCL Medical School instead, studying the education and training of medical students and doctors. I discovered that medics are a particularly interesting group for a number of reasons, not least because of their importance to the nation’s health. 

I really fell on my feet at UCL. I was lucky enough to meet some seriously inspiring and encouraging people, in particular Jane Dacre, Chris McManus, Jayne Kavanagh, Inam Haq, Jude Cave, and Trish Greenhalgh who encouraged me to try and find out why it is that medical students from Black and Minority Ethnic groups tend to have poorer educational and career outcomes than their white counterparts and what we can do about it. They have supported me as I’ve made a career of understanding and addressing educational inequalities.

This experience together with my research findings helped me realise that success results from support and opportunities and not just from ability and hard work.

Question:  The UKMACS study is a massive undertaking.  Can you tell us more about the purpose of the study?  

Katherine: It’s often said that the biggest hurdle in any doctor’s career is getting into medical school, yet we know that some people face more hurdles than others because of their background.

Medical school admissions is the subject of much research, but that research is overwhelmingly from the perspective of the people doing the selecting. UKMACS turns selection research on its head, looking at medical school admissions from the perspective of the applicant, asking how and why applicants from different social background choose which medical schools they apply to and how this affects whether or not they are successful.

Over the last month or so we have also been looking at how current medical applicants have been affected by the coronavirus pandemic which has closed schools and cancelled examinations.

Question:  What are the key UKMACS findings so far?

Katherine: UKMACS is made up of a longitudinal cohort study of applicants to all UK medical schools; a qualitative interview study with applicants and first year medical students from around the UK; and eleven years’ worth of UK medical school admissions data from the UK Medical Education Database (www.ukmed.ac.uk).

Over the summer of 2019, 6500 medical applicants completed a UKMACS questionnaire about how they were choosing which medical schools to apply to in October 2019. We followed this group up with another questionnaire in January 2020. Then in March 2020, the coronavirus pandemic struck, their schools closed, and their examinations were cancelled, all with potentially very significant implications for medical education and training. We immediately surveyed them again to find out their opinions and experiences of the disruptions.

Initial findings from the questionnaires and interviews show that applicants from under-represented groups differ in the priorities they have in choosing a medical school and also in the resources they have for making those choices. For example, applicants from lower socioeconomic groups were more likely to prioritise being able to stay close to home and meeting the grade requirements of a medical school. But despite being attracted to medical schools that take applicant background into consideration in selection, those from lower socioeconomic groups were less likely to be aware of Gateway medical courses that have reduced academic entry requirements and are designed specifically for students from their backgrounds. They had less support with their medical school applications, particularly from doctors and other healthcare workers but also from parents, siblings, careers advisors and medical schools, and they felt they needed more support and advice.  

In April 2020 it was announced that due to the coronavirus pandemic A-level grades would be replaced with teacher-estimated ‘calculated’ grades. We found that applicants from more deprived areas, those attending non-selective state schools, and those from Black and Minority Ethnic backgrounds were more concerned that calculated grades might not be fair, and were less positive about their use in medical school selection. Those from non-selective state schools reported significantly less access to educational resources, particularly the most expensive and educationally-valuable resources such as online face-to-face teaching in real time. 

In 2021 we will be able to find out how these differences in choices and resources influenced our cohort’s chances of getting into medical school, and over the coming years, we hope to discover what impact selection has on the educational and career achievements of our future doctors.

Question: How will the results of the UKMACs study influence the process that future medical students will go through to apply for careers in medicine – and in what ways will this be an improvement?

Katherine: Currently applicants from poorer backgrounds and from some Black and Minority Ethnic groups are less likely to get into medical school, and those who get in unfortunately also have relatively poorer academic and career outcomes. 

We plan to use our findings to provide applicants, particularly those from under-represented groups, with better information and support in applying to medicine to help them be successful. Much of the information currently available is fairly generic and does not take into account potential differences in the priorities and resources of students from under-represented groups.

By following up our cohort over the course of their medical training, we also hope to understand more about the barriers they may face and how to remove these barriers.

Question: How much of a challenge do you think the current circumstances that we are all living through due to the coronavirus pandemic are having, or will have, on students applying to study medicine this year?

Katherine: As with previous pandemics it tends to be the most disadvantaged who suffer the most. I heard many people at the start of the pandemic say that “the virus does not discriminate” and we are “all in the same boat”, but in fact, the expression “we are all in the same storm but in different boats” seems more accurate to me. It is imperative that those responsible for selecting, educating and training medical students and doctors do all we can to level a playing field that was already uneven and has become even more so.

Question:  Without giving too much away…what do you think is next in line in terms of research focus for you and your team?

Katherine:  I’m hoping to spend the next twenty-five years or so following up our cohort! I want them to help us find out how to improve the quality and fairness of selection, education and training of doctors, and to understand how they influence long-term outcomes such as medical specialty choice, career satisfaction and educational achievement. And of course, I want to find out how we can use this information to improve patient care.

Question:  Can you tell us why in your opinion UCL is such a global leader in medical education?

Katherine: Medical education research is still a relatively small field but it manages to bring together people from a huge variety of different disciplines. We are incredibly lucky at UCL to have some really excellent academics from a wide variety of backgrounds who are also brilliant teachers, and who continue to inspire and guide students and junior researchers.

We have really good links with the NHS, medical Royal Colleges, Health Education England, and the General Medical Council, which means we are able to ensure our research makes a difference and we aren’t just stuck in our ivory tower.

Question: Can you explain how much your teaching of students informs and inspires your research and visa-versa?

Katherine: Not having been to medical school myself, and being a white person who studies ethnic inequalities, I’m really reliant on current medical students and doctors in training to share their experiences with me. I never fail to be incredibly impressed and humbled by the amazing people who choose to practice medicine. It is a real privilege to work with them.

Question: What would you say to a sixth form student today who is considering whether to apply for a career in medicine?

Katherine: Speaking as someone who studies medical education rather than someone who has studied medicine myself, I was surprised to find out was how diverse medical careers can be, with lots of opportunities to pursue other interests such as education, research or leadership. There really isn’t just one type of life as a doctor.

That being said, the vast majority of the doctors I know really love being with their patients and talk about the immense privilege they feel to be able to spend their time helping people. Medicine can be very sociable as well and such long and intense training can help medics forge life-long friendships.

There is no getting away from the fact that a career in medicine is hard work. Anyone wanting to be a doctor needs to make sure they’re happy spending a lot of time taking exams! Medical school is five or six years long and is typically followed by between five and ten years of postgraduate training, and there are regular assessments throughout. We’ve seen time and again that the people who often do well in exams at school are the ones who tend to manage exams well throughout the rest of their careers.

I also want to say that while medical education and training can unfortunately still be a place of inequity, we are working hard to tackle unfairness and redress inequalities.

Question: What’s the drive that makes you leap out of bed every day..?!

Katherine: My son, who regularly gets up before 6am! He’s a twin and his sister is just the opposite: she loves to sleep in. As a psychologist, having twins is fascinating, although I try not to subject them to too many experiments!

Work-wise, it’s the thrill of discovery and the opportunity to use what I find out to improve medical students’ and doctors’ lives that keeps me going.