Access to Higher Education Diploma: A Pathway to Healthcare Careers

For individuals aspiring to a healthcare career but lacking conventional university qualifications, an Access to Higher Education Diploma (Health Professions) can serve as an ideal stepping stone. These diplomas, particularly the Access to Medicine Courses (ATMCs), are designed for mature students and play a significant role in widening participation in medicine and related fields.

What is an Access to Higher Education Diploma (Health Professions)?

The Access to Higher Education Diploma Health Professions is tailored for those seeking careers in healthcare, encompassing fields like medicine, dentistry, pharmacy, and paramedicine, alongside other allied health professions. These diplomas act as an entry-level (level three) qualification to a higher-level course at university [12]. They have existed in some form in England and Wales since the 1970s [13]. They were initially established to allow non-traditional students to become teachers and were considered both a way of WP in general higher education and as a vehicle for social mobility [14].

Curriculum and Content

The curriculum typically covers a range of essential topics, including:

Human Anatomy and Physiology: Key systems like the skeletal and muscular systems, respiration and circulation, the nervous system, the urinary system, and homeostasis & the endocrine system are explored.
Human Disease & Prevention alongside Nutrition & Digestion: To support knowledge of disease prevention and treatment, you will study Human Disease & Prevention alongside Nutrition & Digestion, gaining insight into how healthcare professionals manage patient health and well-being.
Structure & Organisation of the Health and Social Care Sectors: An examination of the Structure & Organisation of the Health and Social Care Sectors, the Roles & Responsibilities of Healthcare Professionals, and the History of the NHS, providing essential context on the UK healthcare system and the role of different professionals within it.

Career Pathways

Upon completion of the diploma, graduates are well-prepared to progress into degrees and careers in various healthcare fields, including:

Medicine
Dentistry
Pharmacy
Paramedicine
Physiotherapy
Biomedical Sciences
Radiography

Access to Medicine Courses (ATMCs)

Access to Higher Education Diplomas (Medicine) are courses offered at UK Further Education colleges for mature students who lack the qualifications required to study medicine, dentistry or pharmacy). These courses are frequently referred to as Access to Medicine Courses (ATMCs) and provide students with the necessary entry level qualification to study these subjects at university. ATMCs play a role in efforts to widen participation in medicine for non-traditional students. ATMCs are crucial in efforts to widen participation in medicine, pharmacy and dentistry.

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Widening Participation in Medicine

It has been widely recognised that there is a requirement to widen participation in medicine. There are benefits to widening participation (WP) in medicine for reasons of social justice and because it may benefit patients to have a more varied group of doctors serving their needs [1-6]. Traditionally, doctors come from similar backgrounds. Of the foundation year one doctors surveyed in the 2014 General Medical Council (GMC) national training survey, 31% attended independent or fee-paying schools, despite only 7% of children in the UK being educated in these establishments [7]. Furthermore, work by Nottingham Medical School indicates that 80% of applicants to medical schools come from 20% of UK schools [7]. Approximately 75% of applicants to medical school have parents in higher managerial or professional occupations [8] and research suggests that students from lower socioeconomic groups were less likely to consider themselves able to study medicine [9]. In 2015 only 14% of new medical students were from lower socioeconomic groups despite these groups making up 56% of the general population [10]. ATMCs provide an atypical route into a career in medicine and are considered part of efforts to widen participation by their regulatory bodies the Medical Schools Council (MSC) and the Quality Assurance Agency for Higher Education (QAA) [15, 16]. ‘a route into medicine for mature learners who do not possess the usual formal qualifications, such as A Level Biology and Chemistry, or equivalent. ATMCs are generally one year in length and differ from foundation courses which are also integral to WP [17].

Experiences of ATMC Students

Relatively little is known about the experiences of former ATMC students during their course, professional degrees and early careers. Fifteen participants who had graduated from medicine or pharmacy after using an ATMC as their entry qualification were recruited using convenience and snowball sampling. Fourteen medical doctors and one pharmacist were interviewed. Ten participants were female and five male. Participants attended four ATMCs before studying at five universities. Nine participants could be classed as WP students. Interviews ranged from 30 to 75 min. Several themes and subthemes emerged from the analysis.

Factors Influencing ATMC Choice

The location of the course provider was a factor in ATMC choice. Reported disadvantages of ATMC were the limited number of medical schools accepting the qualification and deficiencies in chemistry. Advantages included supportive peers and tutors. Participants spoke about their experiences and views of WP and the role ATMC could play in it. There didn’t seem to be a whole… huge number of Access to Medicine Courses out there really, but certainly they were the only two [Sussex Downs College and College of West Anglia] that really stood out to me. Several of the participants had applied to more than one ATMC, with the courses at Sussex Downs College and the College of West Anglia being the most prominent courses running at that time. Two major factors in participants’ choosing their access course were how well linked the course was with a medical school/s and their evaluation of the likelihood that the access course would help them gain admission to medical school. At the time when participants applied to the Sussex Downs College ATMC, it had strong links with the local medical school (Brighton and Sussex Medical School). Candidates who were accepted onto this access course were given an interview at the medical school in addition to the normal Universities and Colleges Admissions Service (UCAS) application process, which is known as a linked interview [15]. UCAS is the centralised body in the UK which applicants apply to universities through. Just under half of the participants interviewed described close links with medical schools as a factor influencing their decision to apply to a particular ATMC. The locations of the colleges that provided the ATMC were extremely important to participants. Thirteen participants reported this as a factor in their decision-making when considering which course to apply for. There were several reasons that location had an impact on the choice of ATMC. These included; life and family commitments preventing the participant from moving to attend the ATMC, the financial implications of moving away from an area and leaving paid work behind, loss of their usual social support network and concerns about relocating if progression beyond the ATMC was uncertain. So, when I was initially applying for the access course, I don’t know that I would have done that if it hadn’t have been that there was something local to me. Participants who were located within a commutable distance of the ATMC described this as being a major factor in deciding to attend the course, and some may not have decided to attend the course if it were located further away. I needed a location that would allow me to work and earn money and also travel easily to. A location where I could do the… attend the course and then have enough time to do the study and the course work that was prescribed for us. Our study demonstrates that location is a significant consideration in ATMC choice. This presents challenges for potential candidates attending an ATMC, which could negatively impact WP efforts if such courses are not easily accessible in their area. The number of ATMCs has increased substantially since our participants attended them (from a handful to 26) which should open this route to more WP candidates [23].

Preparedness for Professional Degrees

There were two main views expressed about how well prepared ATMC students felt when starting their professional degrees (medicine or pharmacy), if they compared themselves to their traditional route student peers. These views were split equally between feeling as well prepared as A-level students and feeling poorly prepared. I think I did not get a good educational experience on the access course and I think obviously I did enough to like get into medical school. …I remember we had in the first week there was a physiology lecture and they were talking about something, some like feedback thing [a physiological regulatory mechanism] and I remember thinking what the [profanity] is going on? And then the lecturer said OK, turn to the person next to you and fill out like these gaps and so I turned the person next to me who I didn’t know, and I expected them to go what is this about? And they were just like oh so I guess it would be blah, blah, blah, blah, blah, and I remember having a moment of just like oh my God, other people actually understand what’s happening and that moment of realisation. Another of the participants also felt that they were not as well prepared for their professional degree (in this case medicine) compared to their A-level colleagues. I don’t think I felt as academically well prepared as I suspect I would have been if I’d gone and done the A-levels as an eighteen-year-old and come straight through. I think that wasn’t specifically the access course’s fault, but you’re doing it in one year on the access course. We covered five or six subjects inevitably, in less depth, I think. There was a feeling amongst some participants that they were not well prepared for their professional degrees by the ATMC. One particular area that came under criticism was ATMC chemistry. Six participants made specific reference to the ATMC chemistry being at an inadequate level for starting their professional degrees. Well, like I mentioned, the chemistry, not having formal [A-level] chemistry was difficult and I had a lot of catching up to do the first year at med school. Another example of a participant feeling underprepared at medical school because of inadequacies in ATMC chemistry is shown below. There is some similarity to the example given by Ruth in the previous section (although this experience is more specific to chemistry). When I got to medical school and we sat down to do like the biochemistry, like particularly one thing, the molecules, genes and diseases module. That was like A-level chemistry stuff and we ha…

Key Considerations for Prospective Students

Course Location: Consider the proximity of the course provider to your home and whether it fits with your life and family commitments.
Links with Medical Schools: Investigate how well-linked the course is with medical schools, as this can increase your chances of gaining admission.
Chemistry Preparation: Be aware of potential inadequacies in ATMC chemistry and consider supplementary study to bridge any gaps.

Support and Resources

Many institutions offer comprehensive support to students pursuing Access to Higher Education Diplomas, including:

UCAS Application Support: Assistance with navigating the university admissions process.
1:1 Support: Personal guidance on career options through online video calls and messenger chats.
Tutor Support: Access to professionals in their chosen fields, such as midwives or nurses, for guidance and support.
Financial Aid: Flexible payment plans, including buy now, pay later options, to make education more accessible.

Overcoming Anxieties and Concerns

Exam-Free Learning: Many courses are exam-free, focusing on assessments with clear criteria and assessment descriptors.
Presentation Support: Assistance with developing presentation skills for university.
Practical Experiment Support: Guidance and demonstrations for practical investigations.

The Future of SHPEP

The Robert Wood Johnson Foundation (RWJF), SHPEP’s core funder, has decided to end their funding as part of their evolving strategic priorities. The decision is not a reflection on our program, and RWJF remains committed to making health systems more diverse, equitable, and inclusive. SHPEP will host its last cohort in 2026.

Competency-Based Education in Nursing

Nursing programs are encouraged to institute a process to ensure curricula address the competencies delineated in the Essentials and assesses student achievement of those competencies. AACN is not requiring schools to move to time-variable education or organize academic content according to competencies instead of by course. In fact, we anticipate most programs will continue to organize academic content by course. While the Essentials are not mandated, they are the national consensus-based professional standards for baccalaureate and graduate nursing education, and embracing CBE is central to advancing this transformative vision. With the release of the 2021 AACN Essentials, CBE is more than a suggestion-it is an expectation and a guiding framework that all nursing programs are called to adopt. The Essentials are structured around ten domains of nursing practice and eight core competencies, with sub-competencies that provide a clear roadmap for competency development. The focus is on ensuring that graduates can demonstrate competency across these domains.

AACN's Transition to Competency-Based Education

AACN is committed to facilitating this transition and providing support and resources to make the implementation a reality. Provide extensive learning opportunities for deans and faculty (e.g. Develop an Essentials Implementation Tool Kit to provide current information on competency-based education and assessment, suggested learning resources and content, and assessment exemplars for each of the domains. The template for the toolkit has been developed, and the implementation has already been started based on input received from faculty and others.

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