Spotlight on LEARN! Researchers: Anouk Wouters

This (monthly) interview series highlights some of our LEARN! researchers. This month the spotlight is on Anouk Wouters. Interview by: Alissa Postpischil

27-09-2019 | 14:20

AnoukWoutersHow can we have fair admissions processes for the selection of medical students in the Netherlands? Anouk Wouters completed her PhD studies on the effects of selection for the medical study. In the interview she talks about the results of her PhD thesis as well as about her current project in which she and her colleagues are analysing the discourses on fairness in the selection process of medical students. The project is funded by a grant of the Association for Medical Education in Europe (AMEE).

What is the project about you are currently working on and how is it related to the research institute LEARN!?

Well, before I am going to tell you what I am currently working on I think it is important to know what I did until now. My PhD was mainly about the effects of the medical selection process here in the Netherlands. In general, I wanted to figure out: Does it work? Do we select the best students with a selection process? The previous Dutch admission system for medicine provided us the opportunity to compare selected students and students admitted through a lottery procedure. The results of this comparison showed that selection in medical school does not result in a better student population. Selected or via lottery, all students do very well and they rarely drop out. Moreover, there are strong indications for issues of inequity even before the selection takes place, which we further looked into. It seems that some students are more confident to apply for medical school than others, while some students may be less likely to apply because of the use of selection. Students specifically experiencing more barriers seem to be those from a low socio-economic background, who are first in their family to go to higher education and who have an ethnic minority background. These findings really inspired me to continue our work on the societal impact of selection.

And this is what your current project is about?

Yes, my research and the research of others all around the Netherlands seems to show that selection does not fix any real problems in medical education, so why do we continue with it? The results got quite some attention in the media when we first published them, however, even after lots of debates nothing really changed. What we do now is investigate why people find it difficult to change the system and what the people really value. The government started with selection because in the weighted lottery some students who had really good grades in high school did not get in. This was considered unfair. In our current project we are analysing different discourses around selection and fairness in selection. For this we are looking at policy documents, news articles in the national and local media but also university magazines and online discussion forums. From all these diverse types of documents we get an idea about what people value in medical school admissions and what they consider fair. Additionally, we are conducting focus groups with different stakeholders, such as medical students and high school students, parents and professors, but also doctors and patients.

Do you see a difference in what people consider fair depending on the perspective they come from?

No, not yet. We have not spoken with every stakeholder group yet but what we are finding so far is that the discourses are similar across the groups. There is this general feeling that selection is fair when everyone has the same chances to be successful in selection. On the other hand there is this strong believe that those who have the best grades will be the best doctors, and should therefore get in. However, this is an assumption based on no evidence. Also, when it gets personal, so when it affects the person or someone they know, the honest answer to equal chances is no, and the selection procedure should ensure that those people get in. Those who are benefitting from the current system do not seem to consider this as an advantage. It is a common thought that when you work hard enough you will get in. However, there is no understanding that some people might not have to work that hard to get in as they grew up in highly privileged circumstances.

Is this what keeps you motivated working in this field of research?

Yes, that is what really triggers me. I personally think everyone should have the chance to study medicine. Unfortunately, it is not possible to let everyone study medicine, but your background should not be decisive of whether you get in or not. I also really want to understand, how we can make sure that whatever policy we as researchers or the government comes up with is accepted and supported by the people that are affected by it.

When you sum it up, why should people talk about your research?

At some point we’re all going to need a doctor, we’re all going to be patients. In my opinion we should all strive for admitting a diverse group of students already in medical school so that in the end we have a diverse population of doctors who will be able to serve a diverse group of patients.

What would you say was your greatest achievement in this process so far?

I received a prize for my PhD thesis and for me this was really an acknowledgment that the work I am doing is important. Moreover, the media attention it received and the fact that we received an NRO-grant to further investigate selection and diversity show even more that it is a topic that tackles an important issue. The second accomplishment I am proud of is that I was able to translate our research findings into a hands-on project (Buddies Breaking Barriers). In this project current medical students will help high school students, who are underrepresented in medical education, to prepare for selection and if they manage to get in, the students will continue to help them to feel at home at the university and within their medical studies. The project just had its kick-start two days ago and I am really glad that we now have the opportunity to put our findings into action.

And how do you choose the students who can participate in this program?

The project is aimed at high-school students who are first generation higher education students and students who do not have a medical network through their families. Those will also be the target group among the medical students we recruit for the program. For this project I will collaborate with student committee D.O.C.S. and with Loes Mulders as she already runs projects for first generation higher education students here at the VU.

When you think back about your own journey of being a student and pursuing your PhD, was there any advice or support you got which kept you on track?

People find my research difficult because sometimes it is just not what they expected or wanted to hear. Although people think that my work is important, they may also feel a bit uncomfortable with the results we got so far. But Rashmi, the head of our department, who was also my PhD supervisor always supports me and reminds me that it is important that we look into these issues, and the occasional headwinds we get emphasize this even more. Working in a supporting team really helps as well. In our team we always try to make sure that everyone feels alright and there is someone you can talk to helping you to continue your work.

One last question, if you had not pursued a career in academia, where would you be?

Maybe I would have become a doctor after all (through a graduate entry programme, because after high school I was unlucky in the lottery three times) or maybe I would still be working in psychiatry as a psychologist.