A model for diversity in admissions: a review of issues and methods and an experimental approach

Am I Disadvantaged? How Applicants Decide Whether to Use the Disadvantaged Status in the American Medical College Application Service

PURPOSE

To add to the limited research on the Disadvantaged Status, a component in the American Medical College Application Service (AMCAS) primary application, the authors explored how applicants to a medical school between 2014 and 2016 determined whether they were disadvantaged and whether to apply as such.

METHOD

The authors used case study methodology to explore the experiences of students at a medical school in the Northeast. The authors derived data from transcripts of semistructured interviews with students and the students' AMCAS applications. Transcripts and applications were analyzed using a constant comparative approach and considered in the context of social comparison and impression management theories.

RESULTS

Overall, the 15 student participants (8 used the Disadvantaged Status) had difficulty determining whether they were disadvantaged and how applying as such would affect their prospects. Contributing factors included ambiguity around both the term disadvantaged and its use in the admissions process. Simply experiencing hardship during childhood was insufficient for most participants to deem themselves disadvantaged. Participants' decision processes were confounded by the need to rely on social comparisons to determine whether they were disadvantaged and impression management to decide whether to apply as such.

CONCLUSIONS

The ambiguous nature of the Disadvantaged Status, comparisons with even more disadvantaged peers, and uncertainty about how shared information might affect admission decisions distorted participants' understandings of identity within the context of the application. The authors believe that many applicants who have experienced significant hardships/barriers are not using the Disadvantaged Status.

A meta-analytic perspective on the valid use of subjective human judgement to make medical school admission decisions

While medical educators appear to believe that admission to the medical school should be governed, at least in part, by human judgement, there has been no systematic presentation of evidence suggesting it improves selection. From a fair testing perspective, legal, ethical, and psychometric considerations, all dictate that the scientific evidence regarding human judgement in selection should be given consideration. To investigate the validity of using human judgements in admissions, multi-disciplinary meta-analytic research evidence from the wider literature is combined with studies from within medical education to provide evidence regarding the fairness and validity of using interviews and holistic review in medical school admissions. Fourteen studies, 6 of which are meta-analytic studies that summarized 292 individual studies, were included in the final review. Within these studies, a total of 33 studies evaluated the reliability of the traditional interview. These studies reveal that the interview has low to moderate reliability (~.42) which significantly limits its validity. This is confirmed by over 100 studies examining interview validity which collectively show interview scores to be moderately correlated with important outcome variables (corrected value ~.29). Meta-analyses of over 150 studies demonstrate that mechanical/formula-based selection decisions produce better results than decisions made with holistic/clinical methods (human judgement). Three conclusions regarding the use of interviews and holistic review are provided by these meta-analyses. First, it is clear that the traditional interview has low reliability and that this significantly limits its validity. Second, the reliable variance from interview scores appears moderately predictive of outcomes that are relevant to consider in medical school admission. And third, the use of holistic review as a method of incorporating human judgement is not a valid alternative to mechanical/statistical approaches as the evidence clearly indicates that mechanistic methods are more predictive, reliable, cost efficient, and transparent.

A measurement perspective on affirmative action in U.S. medical education

BACKGROUND

The U.S. Supreme Court has recently heard another affirmative action case, and similar programs to promote equitable representation in higher education are being debated and enacted around the world. Understanding the empirical and quantitative research conducted over the last 50 years is important in designing effective and fair initiatives related to affirmative action in medical education. Unfortunately, the quantitative measurement research relevant to affirmative action is poorly documented in the scholarly journals that serve medical education.

METHODS

This research organizes and documents the measurement literature relevant to enacting affirmative action within the medical school environment, and should be valuable for informing future actions. It provides summaries of those areas where the research evidence is strong and highlights areas where more research evidence is needed. To structure the presentation, 10 topic areas are identified in the form of research questions.

RESULTS

Measurement evidence related to these questions is reviewed and summarized to provide evidence-based answers.

CONCLUSIONS

These answers should provide a useful foundation for making important decisions regarding the use of racial diversity initiatives in medical education.

Social media use and educational preferences among first-year pharmacy students

BACKGROUND

Social media may offer a means to engage students, facilitate collaborative learning, and tailor educational delivery for diverse learning styles.

PURPOSE

The purpose of this study is to characterize social media awareness among pharmacy students and determine perceptions toward integrating these tools in education.

METHODS

A 23-item survey was administered to 1st-year students at a multicampus college of pharmacy.

RESULTS

Students (95% response rate; N = 196) most commonly used wikis (97%), social networking (91%), and videosharing (84%). Tools reported as never used or unknown included social bookmarking (89%), collaborative writing (84%), and RSS readers (73%). Respondents indicated that educational integration of social media would impact their ability to learn in a positive/very positive manner (75%) and make them feel connected/very connected (68%).

CONCLUSIONS

Selectively targeting social media for educational integration and instructing pharmacy students how to employ a subset of these tools may be useful in engaging them and encouraging lifelong learning.

A perspective on medical school admission research and practice over the last 25 years

Over the last 25 years a large body of research has investigated how best to select applicants to study medicine. Although these studies have inspired little actual change in admission practice, the implications of this research are substantial. Five areas of inquiry are discussed: (1) the interview and related techniques, (2) admission tests, (3) other measures of personal competencies, (4) the decision process, and (5) defining and measuring the criterion. In each of these areas we summarize consequential developments and discuss their implication for improving practice. (1) The traditional interview has been shown to lack both reliability and validity. Alternatives have been developed that display promising measurement characteristics. (2) Admission test scores have been shown to predict academic and clinical performance and are generally the most useful measures obtained about an applicant. (3) Due to the high-stakes nature of the admission decision, it is difficult to support a logical validity argument for the use of personality tests. Although standardized letters of recommendation appear to offer some promise, more research is needed. (4) The methods used to make the selection decision should be responsive to validity research on how best to utilize applicant information. (5) Few resources have been invested in obtaining valid criterion measures. Future research might profitably focus on composite score as a method for generating a measure of a physician's career success. There are a number of social and organization factors that resist evidence-based change. However, research over the last 25 years does present important findings that could be used to improve the admission process.

Graduate entry to medicine: widening academic and socio-demographic access

OBJECTIVE

This study aimed to examine whether a graduate entry course widens access to medicine.

METHODS

We carried out a retrospective study at the University of Nottingham Medical School of socio-demographic and academic data collected by the Universities and Colleges Admission Service (UCAS). Study participants comprised all applicants to the 5-year (mainly school-leavers) and 4-year (graduates only) medical courses for admission in October 2003.

RESULTS

In 2002-03, there were 2392 applicants for the 5-year course and 1235 applicants for the 4-year course. Significantly, applicants for the 4-year course comprised more males, were more socio-economically deprived and had lower UCAS tariff point scores compared with applicants for the 5-year course. These differences were preserved in those students who eventually started on either of the 2 courses in October 2003 (254 and 94 students for the 5- and 4-year courses, respectively). Comparing entrants with non-entrants (mainly rejected students), those joining the 5-year course were younger, were less socio-economically deprived, were more likely to be White and had higher UCAS tariff point scores than non-entrants, but there were no significant gender differences. Those joining the 4-year course were more likely to be White and had higher UCAS tariff point scores than non-entrants. By contrast with entrants to the 5-year course, entrants to the 4-year course were significantly older than non-entrants.

CONCLUSIONS

Graduate entrants to medicine widen academic and socio-demographic diversity in the medical school student population.

A commentary on the use of cut-scores to increase the emphasis of non-cognitive variables in medical school admissions

The academic performance consequences of relying solely on non-cognitive factors for selecting applicants above a GPA and MCAT threshold have not been fully considered in the literature. This commentary considers the impact of using a "threshold approach" on academic performance as assessed with the USMLE Step 1.

Race-neutral admission approaches: Challenges and opportunities for medical schools

In 2003, the U.S. Supreme Court's rulings in Grutter v. Bollinger and Gratz v. Bollinger affirmed the use of narrowly tailored, race-conscious admission programs by institutions of higher education that find that the benefits derived from diversity rise to a compelling interest. The rulings also required institutions that use race-conscious admission programs to explore whether the results of such programs could be met through race-neutral alternatives. In this article, the authors review relevant literature in the context of medical education and summarize the existing information about race-neutral alternatives and the challenges and opportunities in implementing them, with the goal of encouraging further research that will inform medical school admission policies. The authors argue that although undergraduate and graduate institutions across the nation are pursuing the goal of diversity within the guidelines set forth by the Court, there is too little known about how race-neutral alternatives to race-conscious admission policies can be effective in promoting diversity. They conclude that although certain approaches show promise, medical schools--as they continue to employ race-conscious admission policies to achieve the benefits of diversity--must take advantage of their compliance with the Court's decision to investigate whether race-neutral approaches can contribute to the diversity of medical school classes.

Economic diversity in medical education: the relationship between students' family income and academic performance, career choice, and student debt

Providing access to higher education across all income groups is a national priority. This analysis assessed the performance, career choice, and educational indebtedness of medical college students whose educational pursuits were assisted by the provision of financial support. The study looked at designated outcomes (academic performance, specialty choice, accumulated debt) in relation to the independent variable, family (parental) income, of 1,464 students who graduated from Jefferson Medical College between 1992 and 2002. Students were classified into groups of high, moderate, and low income based on their parental income. During the basic science years, the high-income group performed better; however, in the clinical years, performance measures were similar. Those in the high-income group tended to pursue surgery, while those in the low-income group preferred family medicine. The mean of accumulated educational debt was significantly higher for the low-income group. The study provides support for maintaining economic diversity in medical education.

"Not a university type": focus group study of social class, ethnic, and sex differences in school pupils' perceptions about medical school

OBJECTIVE

To investigate what going to medical school means to academically able 14-16 year olds from different ethnic and socioeconomic backgrounds in order to understand the wide socioeconomic variation in applications to medical school.

DESIGN

Focus group study.

SETTING

Six London secondary schools.

PARTICIPANTS

68 academically able and scientifically oriented pupils aged 14-16 years from a wide range of social and ethnic backgrounds.

MAIN OUTCOME MEASURES

Pupils' perceptions of medical school, motivation to apply, confidence in ability to stay the course, expectations of medicine as a career, and perceived sources of information and support.

RESULTS

There were few differences by sex or ethnicity, but striking differences by socioeconomic status. Pupils from lower socioeconomic groups held stereotyped and superficial perceptions of doctors, saw medical school as culturally alien and geared towards "posh" students, and greatly underestimated their own chances of gaining a place and staying the course. They saw medicine as having extrinsic rewards (money) but requiring prohibitive personal sacrifices. Pupils from affluent backgrounds saw medicine as one of a menu of challenging career options with intrinsic rewards (fulfillment, achievement). All pupils had concerns about the costs of study, but only those from poor backgrounds saw costs as constraining their choices.

CONCLUSIONS

Underachievement by able pupils from poor backgrounds may be more to do with identity, motivation, and the cultural framing of career choices than with low levels of factual knowledge. Policies to widen participation in medical education must go beyond a knowledge deficit model and address the complex social and cultural environment within which individual life choices are embedded.