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Community college (CC) has traditionally existed as a bridge between high school and a four-year, baccalaureate-awarding, university. With the ever-increasing number of CCs present in the United States and the rising numbers of applicants to medical school, there will inevitably be a substantial proportion of future physicians who have attended CC. Based on previous research, we surveyed the University of California, Irvine, School of Medicine (UCISOM) student body to assess how many students had attended CC, when and why they attended, and if they intended to practice with underserved communities in the future. A total of 30 (28.6%) of the 105 survey respondents attended CC prior to medical school. Those students cited Academic Flexibility, Financial Reasons/Affordability, and the inability to enroll in a particular course at their four-year institutions as the top three reasons for attending CC. Ten of those students (30%) reported they were informed that attending CC would negatively impact their medical school application. Older students were more likely to attend CC, and there was no statistically significant correlation between CC attendance and the number of times one applied to medical school or between CC attendance and gender, race, ethnicity, and intention to practice in underserved communities. This article highlights the understanding of the effects of CC attendance on medical school admissions while comparing our sample of 105 UCISOM students to previous research studies.

The maldistribution of family physicians challenges equitable primary care access in Canada. The Theory of Social Attachment suggests that preferential selection and distributed training interventions have potential in influencing physician disposition. However, evaluations of these approaches have focused predominantly on rural underservedness, with little research considering physician disposition in other underserved communities. Accordingly, this study investigated the association between the locations from which medical graduates apply to medical school, their undergraduate preclerkship, clerkship, residency experiences, and practice as indexed across an array of markers of underservedness. We built association models concerning the practice location of 347 family physicians who graduated from McMaster University's MD Program between 2010 and 2015. Postal code data of medical graduates' residence during secondary school, pre-clerkship, clerkship, residency and eventual practice locations were coded according to five Statistics Canada indices related to primary care underservedness: relative rurality, employment rate, proportion of visible minorities, proportion of Indigenous peoples, and neighbourhood socioeconomic status. Univariate and multivariable logistic regression models were then developed for each dependent variable (i.e., practice location expressed in terms of each index). Residency training locations were significantly associated with practice locations across all indices. The place of secondary school education also yielded significant relationships to practice location when indexed by employment rate and relative rurality. Education interventions that leverage residency training locations may be particularly influential in promoting family physician practice location. The findings are interpreted with respect to how investment in education policies can promote physician practice in underserved communities. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effects of gender discrimination in Japan's medical school admission process and to assess whether the situation has improved since the disclosure of such discrimination in 2018. Materials and Methods: A cross-sectional study was conducted using secondary data from the Ministry of Education, Culture, Sports, Science, and Technology. The proportions of male and female applicants vis-à-vis all successful candidates admitted from 2016 to 2021 were analyzed; four medical schools were found to be systematically guilty of discriminatory admission practices. Acceptance rate ratios (ARRs) were estimated, and difference-in-differences (DID) analysis was used to examine the differences in ARRs between the two groups—the 4 and 75 medical schools that were and were not reported, respectively—in the predisclosure (2016–2018) and postdisclosure (2019–2021) periods. Results: Female applicants were subjected to discriminatory admission practices at the four reported medical schools in the predisclosure period. However, postdisclosure, those four medical schools had higher female than male acceptance rates in all 3 years. DID analysis revealed a statistically significant estimated average treatment effect on the treated of 0.25148 (95% confidence interval [0.00455–0.49840]), indicating a 0.25-point increase in ARRs relative to the other 75 medical schools. Conclusions: Discriminatory practices against female applicants have decreased since the disclosure in 2018, with the acceptance rate of female students exceeding that of male students for the first time in 2021. In response to these findings, we propose recommendations to further promote gender equality in medicine. [ABSTRACT FROM AUTHOR]

Phenomenon: To increase racial diversity in medical school classes, many institutions have created underrepresented minority (URM) application streams. However, many URM students experience overt and passive marginalization throughout their training and this may be related to how matriculants from URM streams are perceived by their peers. Approach: We conducted a discourse analysis of online discussion forums to explore how URM streams across Canada and the United States are perceived. We analyzed 850 posts from 13 discussion threads published between 2015 and 2020. We used inductive content analysis to develop a data-driven coding scheme from which we identified common themes. Findings: Despite an overall appreciation of the benefits of a diverse workforce, participants engaged in prominent discussions surrounding the merits of URM streams. We identified perceptions that students admitted from URM streams are less academically and clinically competent, with URM applicants reporting feeling unworthy for admission in the eyes of non-URM applicants. Users felt that the influence of socioeconomic status was under-appreciated, and that admissions officers inadequately addressed this barrier. There were some applicants who perceived the admissions process as "broken" with non-URMs displaying a fear of social change, and URMs fearing that the system defines them by their racialized status. Insights: Online discussion forums provide unique insight into perceptions surrounding URM streams. We identified potentially harmful misconceptions about URM students applying to these streams and highlight that actionable measures to reduce marginalization against URM matriculants must begin before medical school. [ABSTRACT FROM AUTHOR]

The first, sometimes the only, selection tool for entry into undergraduate medicine is prior educational attainment (PEA). This is often further specified to include certain subjects, for example, biology is a prerequisite for entry into medicine in many Asian countries. However, there seems no clear evidence base for this prerequisite. Our aim, therefore, was to carry out a retrospective quantitative study comparing the performances of five cohorts of students (2015–2019 entry; n = 588) with and without biology PEA in Years 1 and 2 Bachelor of Medicine and Bachelor of Surgery (MBBS) integrated written assessments (n = 3) and anatomy practical examinations (APE) (n = 5). The study was conducted at one of Singapore's three medical schools. Data were analyzed using independent t-tests and Mann–Whitney U with p values of less than 0.05 were considered significant. There were no significant differences in performance on any Years 1 or 2 integrated written assessments. Similarly, in one of the APE, a significant difference was found for one cohort (academic year [AY] 2015–2016) out of five assessments. These results suggest that having a prior biology qualification does not make a difference in assessment performance in the early years of medical school. This information may help stakeholders and admissions committees decide whether biology is required for medical school entrance. [ABSTRACT FROM AUTHOR]

Abstract Background Allopathic medicine faces a daunting challenge of selecting the best applicants because of the very high applicant / matriculant ratio. The quality of graduates ultimately reflects the quality of medical practice. Alarming recent trends in physician burnout, misconduct and suicide raise questions of whether we are selecting the right candidates. The United States (US) lags far behind the United Kingdom (UK) and Europe in the study of non-cognitive tests in medical school admissions. Although more recently, medical schools in both the UK, Europe and the US have begun to use situational judgement tests such as the Computer-Based Assessment for Sampling Personal Characteristics (CASPer) and the situational judgement test (SJT), recently developed by the Association of American Medical Colleges (AAMC) and that these tests are, in a sense non-cognitive in nature, direct personality tests per se have not been utilized. We have historically used, in the admissions process within the US, knowledge, reasoning and exam performance, all of which are largely influenced by intelligence and also improved with practice. Personality, though also undoubtedly influenced by intelligence, is fundamentally different and subject to different kinds of measurements. Methods A popular personality measurement used over the past two decades within the US in business and industry, but not medical school has been the Neo Personality Inventory – Revised (NEO-PI-R) Test. This test has not been utilized regularly in allopathic medicine probably because of the paucity of exploratory retrospective and validating prospective studies. The hypothesis which we tested was whether NEO-PI-R traits exhibited consistency between two institutions and whether their measurements showed probative value in predicting academic performance. Results Our retrospective findings indicated both interinstitutional consistencies and both positive and negative predictive values for certain traits whose correlative strengths exceeded traditional premed metrics: medical college admission test (MCAT) scores, grade point average (GPA), etc. for early academic performance. Conclusions Our exploratory studies should catalyze larger and more detailed confirmatory studies designed to validate the importance of personality traits not only in predicting early medical school performance but also later performance in one’s overall medical career.

Background: Allopathic medicine faces a daunting challenge of selecting the best applicants because of the very high applicant / matriculant ratio. The quality of graduates ultimately reflects the quality of medical practice. Alarming recent trends in physician burnout, misconduct and suicide raise questions of whether we are selecting the right candidates. The United States (US) lags far behind the United Kingdom (UK) and Europe in the study of non-cognitive tests in medical school admissions. Although more recently, medical schools in both the UK, Europe and the US have begun to use situational judgement tests such as the Computer-Based Assessment for Sampling Personal Characteristics (CASPer) and the situational judgement test (SJT), recently developed by the Association of American Medical Colleges (AAMC) and that these tests are, in a sense non-cognitive in nature, direct personality tests per se have not been utilized. We have historically used, in the admissions process within the US, knowledge, reasoning and exam performance, all of which are largely influenced by intelligence and also improved with practice. Personality, though also undoubtedly influenced by intelligence, is fundamentally different and subject to different kinds of measurements. Methods: A popular personality measurement used over the past two decades within the US in business and industry, but not medical school has been the Neo Personality Inventory – Revised (NEO-PI-R) Test. This test has not been utilized regularly in allopathic medicine probably because of the paucity of exploratory retrospective and validating prospective studies. The hypothesis which we tested was whether NEO-PI-R traits exhibited consistency between two institutions and whether their measurements showed probative value in predicting academic performance. Results: Our retrospective findings indicated both interinstitutional consistencies and both positive and negative predictive values for certain traits whose correlative strengths exceeded traditional premed metrics: medical college admission test (MCAT) scores, grade point average (GPA), etc. for early academic performance. Conclusions: Our exploratory studies should catalyze larger and more detailed confirmatory studies designed to validate the importance of personality traits not only in predicting early medical school performance but also later performance in one's overall medical career. [ABSTRACT FROM AUTHOR]

Medical scribing is an increasingly common way for pre-medical students to gain clinical experience. Scribes are a valuable part of the healthcare team and have high rates of matriculation into health professional programs. Little is known about the effects of scribing on the success of the student. This manuscript aims to determine the effect of scribing experience on clinical self-efficacy during medical school. Perceived clinical self-efficacy was evaluated with validated survey questions using a 5-point Likert-type scale as well as free text responses. The survey was completed by 175 medical students at the Frank H. Netter, MD School of Medicine. Statistical analysis was conducted using SPSS. As part of the mixed methods study, free text responses were analyzed using thematic analysis. Quantitative results showed no statistical difference in perceived clinical self-efficacy between medical students with scribing experience and those without. Analysis of free text responses showed that medical students believed their scribing experience improved comfort in the clinical setting and increased familiarity with medical terminology. Medical students with scribing experience did not demonstrate greater clinical self-efficacy than their peers without scribing experience. However, medical students with scribing experience have a perceived value of their pre-medical scribing experience on their success in medical school. [ABSTRACT FROM AUTHOR]

Purpose Medical scribing is an increasingly common way for pre-medical students to gain clinical experience. Scribes are a valuable part of the healthcare team and have high rates of matriculation into health professional programs. Little is known about the effects of scribing on the success of the student. This manuscript aims to determine the effect of scribing experience on clinical self-efficacy during medical school. Participants and Methods Perceived clinical self-efficacy was evaluated with validated survey questions using a 5-point Likert-type scale as well as free text responses. The survey was completed by 175 medical students at the Frank H. Netter, MD School of Medicine. Statistical analysis was conducted using SPSS. As part of the mixed methods study, free text responses were analyzed using thematic analysis. Results Quantitative results showed no statistical difference in perceived clinical self-efficacy between medical students with scribing experience and those without. Analysis of free text responses showed that medical students believed their scribing experience improved comfort in the clinical setting and increased familiarity with medical terminology. Discussion and Conclusions Medical students with scribing experience did not demonstrate greater clinical self-efficacy than their peers without scribing experience. However, medical students with scribing experience have a perceived value of their pre-medical scribing experience on their success in medical school.

In the era of disability rights, medical schools retained the power to discriminate against applicants in wheelchairs. This article explores how medical schools set boundaries for admission into the profession, remained intransigent in their discrimination, and persuaded courts to side with them. Interviews with physicians in wheelchairs, legal documents, medical journal articles, and white papers demonstrate how medical schools established physical standards for entry into the profession specifically in response to applicants with disabilities. In the 1970s, medical schools created exclusionary physical requirements and persuaded the Supreme Court that these "technical standards" preserved patient safety. In the 1980s, schools asserted that students with disabilities would require expensive accommodations and lower educational standards. In the 1990s, medical schools strategically interpreted vague language in the Americans with Disabilities Act to justify continuing to exclude applicants with disabilities. This article complicates triumphalist histories of disability activism and reveals the continuation of exclusion in medical education, which had historically occurred based on race and gender. Interviews with successful applicants in wheelchairs provide powerful testimony against medical school policies and offer a clear path forward. Technical standards should change to value compassion and critical thinking over physical fitness. Physicians in wheelchairs perform most medical tasks and bring unique perspectives to a historically homogenous profession. [ABSTRACT FROM AUTHOR]

Ben Ryan,1 Charlotte Auty,2 Matthew Maden,3 Amy Leggett,4 Alisha Staley,3 Enam Haque3 1Department of Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK; 2Surgical Division, Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, Nottinghamshire, UK; 3University of Manchester Medical School, The University of Manchester, Manchester, Greater Manchester, UK; 4Department of Undergraduate Education, East Lancashire Hospitals NHS Trust, Blackburn, Lancashire, UKCorrespondence: Ben RyanDepartment of Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, United KingdomTel +441772 716565Email benryan@doctors.org.ukPurpose: Individuals from lower socio-economic backgrounds are under-represented in the medical profession: confidence is a barrier to them successfully applying to medical school. This study examined the impact of two student-led conferences for Year 12 pupils, at which they had the opportunity to present their work. It looked at the ability of the conferences to improve participant confidence, and the feasibility of its replication by other student-led groups.Methods: The first, Conference A, had more time and finances invested into it than the second, Conference B. The latter relied solely on university society funding, but utilised WP criteria for selection of participants. Participants identified their confidence in six areas on a ten-point scale, immediately before and after the intervention.Results: A paired t-test showed a significant improvement (p < 0.01) in all areas of confidence for both conferences. Cohen’s d showed Conference A had larger effect sizes in five out of six areas than Conference B.Conclusion: This intervention has demonstrated a significant positive impact on participant confidence: a key factor to improve their chance of successful admission to medical school. Supporting participants with their presentations prior to the conference was found to further enhance their confidence. The authors feel that this work could be replicated successfully by other student groups.Keywords: widening access, social mobility, medical school admissions, confidence

BackgroundMedical schools aim to select and train future physicians representative of and able to serve their diverse population needs. Enhancing equity, diversity, and inclusion (EDI) in admissions processes includes identifying and mitigating barriers for those underrepresented in medicine (URM).Summary of InnovationsIn 2017, Schulich School of Medicine and Dentistry (Western University, Ontario, Canada) critically reviewed its general Admissions pathways for the Doctor of Medicine (MD) program. Till that time, interview invitations were primarily based on academic metrics rather than a holistic review as for its Indigenous MD Admissions pathway. To help diversify the Canadian physician workforce, Schulich Medicine utilized a multipronged approach with five key changes implemented over 2 years into the general MD Admissions pathways: 1. A voluntary applicant diversity survey (race, socioeconomic status, and community size) to examine potential barriers within the Admissions process; 2. Diversification of the admissions committee and evaluator pool with the inclusion of an Equity Representative on the admissions committee; 3. A biosketch for applicants' life experiences; 4. Implicit bias awareness training for Committee members, file reviewers and interviewers; and 5. A specific pathway for applicants with financial, sociocultural, and medical barriers (termed ACCESS pathway). Diversity data before (Class of 2022) vs. after (Class of 2024) these initiatives and of the applicant pool vs. admitted class were examined.ConclusionFor the Class of 2024, the percentage of admitted racialized students (55.2%), those with socioeconomic challenges (32.3%), and those from remote/rural/small town communities (18.6%) reflected applicant pool demographics (52.8, 29.9, and 17.2%, respectively). Additionally, 5.3% (vs. 5.6% applicant pool) of admitted students had applied through ACCESS. These data suggest that barriers within the admissions process for these URM populations were potentially mitigated by these initiatives. The initiatives broadly improved representation of racialized students, LGBTQ2S+, and those with disability with statistically significant increases in representation of those with socioeconomic challenges (32.3 vs. 19.3%, p = 0.04), and those with language diversity (42.1 vs. 35.0%, p = 0.04). Thus, these changes within the general MD admissions pathways will help diversify the future Canadian physician workforce and inform future initiatives to address health equity and social accountability within Canada.

A diverse physician workforce is needed to increase access to care for underserved populations, particularly as the Affordable Care Act expands insurance coverage. Yet legal restrictions constrain the extent to which medical schools may use race/ethnicity in admissions decisions. We conducted simulations using academic metrics and socioeconomic data from applicants to a California public medical school from 2011 to 2013. The simulations systematically adjusted medical school applicants' academic metrics for socioeconomic disadvantage. We found that socioeconomic and under-represented minority disparities in admissions could be eliminated while maintaining academic readiness. Adjusting applicant academic metrics using socioeconomic information on medical school applications may be a race-neutral means of increasing the socioeconomic and racial/ethnic diversity of the physician workforce.

Objectives: This study aims to determine whether there is a difference in the academic performance of medical students based on admission type and examine the extent to which entrance examinations predict their performance. Methods: This observational study utilized existing data from Asahikawa Medical University. Participants were 1057 medical students who had enrolled between 2010 and 2019. Analysis of variance and Tukey's test were utilized to identify differences between admission types. The multiple linear regression explored predictors of cumulative grade point average for each type. Results: Analysis of variance showed significant differences in the National Center Test (F(3, 1053) =70.78, p <0.001) and cumulative grade point average (F(3, 1053) =3.93, p <0.01). Tukey's post hoc test revealed that two types of general admission students (M=83.52, SD=3.22; M=85.57, SD=3.01) were significantly higher on the National Center Test than two types of regional quota students (M=81.61, SD=3.93; M=80.65, SD=3.61). The cumulative grade point average of a regional quota group (M=2.23, SD=0.34) was significantly higher than two types of general admissions (M=2.11, SD=0.36; M=2.12, SD=0.34). High school grade point averages and females were significant in predicting cumulative grade point averages for each admission (16.0-28.3% variance). Conclusions: Regional quota students earned a higher cumulative grade point average than those from general admissions, despite their significantly lower scores on the National Center Test. Enhanced utilization of regional quota admissions could become an effective strategy to increase the rural physician workforce. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has mandated the use of virtual interactions in medical school. Although this falls mainly in the area of didactic instruction, of necessity, it has extended to the critical Admissions Process and the Medical School Interview itself. The California University of Science and Medicine (CUSM) with their flipped classroom approach had previously entered a virtual space of instruction even before COVID-19. Because CUSM was, in a sense, already committed to 'virtual' education, in the face of the COVID-19 pandemic, CUSM focused not on what it might lose but what it might gain and what their applicants to medical school might gain with the virtual format. The COVID-19 pandemic provided a unique opportunity to initially compare the Virtual Interview with the traditional On-Campus (In-Person) Interview during the hybrid 2020 year when the COVID-19 pandemic began. The Virtual Interview was patterned after the On-Campus Interview with some modifications. The same faculty conducted both interviews. A number of inherent advantages of the Virtual Interview surfaced to these faculty interviewers based on their subjective observations and conclusions. The overall interviewee satisfaction with the Virtual Interview was very positive based on their subjective observations and conclusions. The objective data from the Virtual Interviews compared to the On-Campus Interviews in the hybrid year resulted in a greater percentage of both offers of acceptance (p =.001) and matriculations (p =.001). In order to strengthen our initial observations, we expanded our study to include 2 pre-COVID-19 years (2018, 2019) of exclusively On-Campus interviews (n = 743) and 1 additional COVID-19 year (2021) of exclusively Virtual Interviews (n = 529). In this expanded study, interviewee demographics were not confounding and the Virtual Interview gave rise to overall greater interviewee satisfaction (p =.001), a trend to greater interviewer satisfaction and a greater percentage of both offers of acceptance (p =.047) and matriculations (p =.036). [ABSTRACT FROM AUTHOR]

Gap years have grown in popularity among students attempting to go to medical school in recent years. According to the Association of American Medical Colleges (AAMC), more than half of matriculated students now have taken time off between their undergraduate studies and medical school. Although many claim benefits to taking gap years, research on the impacts of these experiences on medical students is largely nonexistent. This study aimed to qualitatively analyze the gap year phenomenon and its impacts on medical students through semistructured interviews conducted at the University of Central Florida College of Medicine. Through these interviews, the research team collected in-depth responses that were thematically analyzed. Analysis revealed the following major themes regarding the impacts of gap years: 1) adaptability to change and failure, 2) professional identity formation and understanding of team role, 3) understanding the “real world,” 4) refocusing of goals, 5) resilience and stress management, and 6) reinforcement of motivation. [ABSTRACT FROM AUTHOR]

Objectives: A paucity of information exists to advise medical school applicants who have had to retake the Medical College Admission Test (MCAT) to achieve a competitive score. To better advise repeat test takers from West Virginia and other Appalachian and southern areas, MCAT data from West Virginia applicants were analyzed and compared with national data.Methods: In the application cycles of 2017-2020, the following factors were analyzed in relation to medical school acceptance in West Virginia applicants: MCAT scores, the number of test-taking attempts, biology-chemistry-physics-math grade point average, time between test-taking attempts, and academic major. MCAT data from medical school applicants from West Virginia who took the test more than once also were compared with national data.Results: Of the total repeat test takers from West Virginia (N = 285) in the study timeframe, 57 (20%) were ultimately accepted into medical school. Factors associated with medical school acceptance were as follows: first MCAT test score (odds ratio [OR] 1.3, 95% confidence level [CL] 1.2-1.4, P < 0.001), change in MCAT test score (OR 1.2, 95% CL 1.1-1.3, P = 0.0015), and biology-chemistry-physics-math grade point average (OR 15.1, 95% CL 4.2-54.8, P < 0.0001). The highest benefit for improved scores occurred between the first and second attempts. The highest point gain occurred when the first MCAT score was in the range of 477 to 487 (<1st-12th percentile); this finding was not found in the national data.Conclusions: Although the study was limited to West Virginia medical school applicants, this information could prove useful in advising premedical applicants from other Appalachian and southern US areas. [ABSTRACT FROM AUTHOR]

Reginald F Baugh University of Toledo College of Medicine and Life Sciences, Toledo, OH 43623, USACorrespondence: Reginald F BaughUniversity of Toledo College of Medicine and Life Sciences, 3000 Arlington Avenue, MS 1905, Toledo, OH 43623, USATel +1 419-383-6834Email reginald.baugh@utoledo.eduAbstract: This perspective surveys healthcare’s response to the increased prominence of racial, ethnic, religious and sexual minorities as well as females in American culture. It argues for understanding physicians both as products of the broader society and its changes. Starting in the 1960s, empiric evidence for the rise of reactionary viewpoints in response to major social movements is outlined. Structural reasons for the prevalence of such ideologies within medicine are highlighted. Its negative consequences for minority health are addressed. Finally, the author turns to compensatory strategies to improve the social environment within healthcare. Alternative selection strategies for medical school are proposed, with a stronger focus on empathetic candidates.Keywords: social beliefs, empathy, diversity and inclusion, social justice, medical school admissions, discrimination, multiculturalism, assimilation

The existence of systemic racism in Canadian healthcare, among other determinants including accessible education, available occupation, and affordable housing, contributes to the racial divide in treatment and poor health outcomes for Black communities. Recent promising work has demonstrated patient-physician racial concordance in populations of colour as a potential area of focus for addressing health inequities for diverse communities. The impact of shared cultural experiences and cultural competency leads to mutual respect, trust, and improved communication between patients and physicians guiding their care. This approach is dependent on the availability of physicians of colour and similarly other healthcare providers. The Temerty Faculty of Medicine at the University of Toronto has attempted to address the deficit in its own community through a two-pronged approach: mentorship through the Community of Support (COS) and the Summer Mentorship Program (SMP), and the implementation of the Black Student Application Program (BSAP). These initiatives have significantly increased Black medical student representation and continue to have considerable impact on Black communities in the surrounding area. Through partnerships with community organizations that support the ethos of these programs, the vision of a more culturally diverse physician workforce in Canada has been reinforced. The adoption of similar programs across Canadian medical schools can lead to better representation within medicine and help contribute to a necessary culture shift within the ranks of medical institutions. These are critical steps in laying the foundation for a medical education grounded in equity, excellence, and strength in diversity, and a healthcare system that truly provides patient-centred care. [ABSTRACT FROM AUTHOR]

Aaron D Baugh,1 Allison A Vanderbilt,2 Reginald F Baugh31Pulmonary and Critical Care Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA; 2Emergency Medicine, Fulton County Health Center, Wauseon, OH, USA; 3Department of Surgery, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USACorrespondence: Reginald F BaughDepartment of Surgery, College of Medicine and Life Sciences, University of Toledo, 2120 Dowling Hall MS 1905, 3000 Arlington Avenue, Toledo, OH 43623, USATel +1 419 383 6834Email reginald.baugh@utoledo.eduAbstract: Approximately one-third of the US population lives at or near the poverty line; however, this group makes up less than 7% of the incoming medical students. In the United Kingdom, the ratio of those of the highest social stratum is 30 times greater than those of the lowest to receive admission to medical school. In an effort to address health disparities and improve patient care, the authors argue that significant barriers must be overcome for the children of the disadvantaged to gain admission to medical school. Poverty is intergenerational and multidimensional. Familial wealth affects opportunities and educational attainment, starting when children are young and compounding as they get older. In addition, structural and other barriers exist to these students pursuing higher education, such as the realities of financial aid and the shadow of debt. Yet the medical education community can take steps to better support the children of the disadvantaged throughout their education, so they are able to reach medical school. If educators value the viewpoints and life experiences of diverse students enriching the learning environment, they must acknowledge the unique contributions that the children of the disadvantaged bring and work to increase their representation in medical schools and the physician workforce. We describe who the disadvantaged are contrasted with the metrics used by medical school admissions to identify them. The consequences of multiple facets of poverty on educational attainment are explored, including its interaction with other social identities, inter-generational impacts, and the importance of wealth versus annual income. Structural barriers to admission are reviewed. Given the multi-dimensional and cumulative nature of poverty, we conclude that absent significant and sustained intervention, medical school applicants from disadvantaged backgrounds will remain few and workforce issues affecting the care patients receive will not be resolved. The role of physicians and medical schools and advocating for necessary societal changes to alleviate this dynamic are highlighted.Keywords: lower socioeconomic populations, medical school admissions, health disparities, diversity and inclusion, social justice

Filipa Matos Lopes De Campos, Katie Clementson Faculty of Medicine, Department of Medicine, Imperial College London, London, UKCorrespondence: Filipa Matos Lopes De Campos Email filipacampos998@gmail.com View the original paper by Dr Ryan and colleagues

The COVID-19 pandemic has mandated the use of virtual interactions in medical school. Although this falls mainly in the area of didactic instruction, of necessity, it has extended to the critical Admissions Process and the Medical School Interview itself. The California University of Science and Medicine (CUSM) with their flipped classroom approach had previously entered a virtual space of instruction even before COVID-19. Because CUSM was, in a sense, already committed to ‘virtual’ education, in the face of the COVID-19 pandemic, CUSM focused not on what it might lose but what it might gain and what their applicants to medical school might gain with the virtual format. The COVID-19 pandemic provided a unique opportunity to initially compare the Virtual Interview with the traditional On-Campus (In-Person) Interview during the hybrid 2020 year when the COVID-19 pandemic began. The Virtual Interview was patterned after the On-Campus Interview with some modifications. The same faculty conducted both interviews. A number of inherent advantages of the Virtual Interview surfaced to these faculty interviewers based on their subjective observations and conclusions. The overall interviewee satisfaction with the Virtual Interview was very positive based on their subjective observations and conclusions. The objective data from the Virtual Interviews compared to the On-Campus Interviews in the hybrid year resulted in a greater percentage of both offers of acceptance (p = .001) and matriculations (p = .001). In order to strengthen our initial observations, we expanded our study to include 2 pre-COVID-19 years (2018, 2019) of exclusively On-Campus interviews (n = 743) and 1 additional COVID-19 year (2021) of exclusively Virtual Interviews (n = 529). In this expanded study, interviewee demographics were not confounding and the Virtual Interview gave rise to overall greater interviewee satisfaction (p = .001), a trend to greater interviewer satisfaction and a greater percentage of both offers of acceptance (p = .047) and matriculations (p = .036).

Abstract Background Under-representation of some socio-economic groups in medicine is rooted in under-representation of those groups in applications to medical school. This study aimed to explore what may deter school-age children from applying to study medicine. Methods Workshops were undertaken with school students aged 16–17 years (‘Year 12’, n = 122 across three workshops) and 13–14 years (‘Year 9’, n = 295 across three workshops). Workshops used a variety of methods to identify and discuss participants’ perceptions of medicine, medical school and the application process. Year 12 workshops focused on applications and medical school, while Year 9 took a broader approach reflecting their relative distance from applying. Subsequent workshops were informed by the findings of earlier ones. Results The main finding was that potential applicants had limited knowledge about medicine and medical school in several areas. Older students would benefit from accessible information about medical degrees and application processes, access to work experience opportunities and personal contact with medical students and junior doctors, particularly those from a similar background. Younger students demonstrated a lack of awareness of the breadth of medical careers and a limited understanding of what medicine encompasses. Many Year 9 students were attracted by elements of practice which they did not associate with medicine, such as ‘talking to people with mental health problems’. An exercise addressing this elicited an increase in their interest in medicine. These issues were identified by participants as being more marked for those without knowledgeable support at home or school. It was apparent that school teachers may not be equipped to fill these knowledge gaps. Conclusion Gaps in knowledge and support may reflect the importance of ‘social capital’ in facilitating access to medical school. Medical schools could act as hubs to introduce students to resources which are essential for widening participation. Outreach and support to schools may ensure that fundamental knowledge gaps are equitably addressed for all prospective applicants. More generally, a focus on medicine which under-emphasises aspects of medical practice involving communication may deter some students and have longer term impact on recruitment to careers including general practice and psychiatry.

Alexis Danielle Vick,1 Aaron Baugh,2 Julie Lambert,1 Allison A Vanderbilt,3 Evan Ingram,1 Richard Garcia,4 Reginald F Baugh5 1College of Medicine and Life Sciences, 2Department of Internal Medicine, 3Department of Family Medicine, College of Medicine and Life Science, University of Toledo, Toledo, OH, 4Consultant, The Ethnic Health Institute, Oakland, CA, 5Department of Surgery, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA Abstract: A growing body of research illustrates the importance of aligning efforts across the operational continuum to achieve diversity goals. This alignment begins with the institutional mission and the message it conveys about the priorities of the institution to potential applicants, community, staff, and faculty. The traditional themes of education, research, and service dominate most medical school mission statements. The emerging themes of physician maldistribution, overall primary-care physician shortage, diversity, and cost control are cited less frequently. The importance and salience of having administrative leaders with an explicit commitment to workforce and student diversity is a prominent and pivotal factor in the medical literature on the subject. Organizational leadership shapes the general work climate and expectations concerning diversity, recruitment, and retention. Following the Bakke decision, individual medical schools, supported by the Association of American Medical Colleges, worked to expand the frame of reference for evaluating applicants for medical school. These efforts have come together under the rubric of “holistic review”, permitted by the US Supreme Court in 2003. A large diverse-applicant pool is needed to ensure the appropriate candidates can be chosen for the incoming medical school class. Understanding the optimal rationale and components for a successful recruitment program is important. Benchmarking with other schools regionally and nationally will identify what should be the relative size of a pool. Diversity is of compelling interest to us all, and should pervade all aspects of higher education, including admissions, the curriculum, student services and activities, and our faculties. The aim of medical education is to cultivate a workforce with the perspectives, aptitudes, and skills needed to fuel community-responsive health-care institutions. A commitment toward diversity needs to be made. Keywords: diversity, inclusion, medical school admissions, admissions committee

Phenomenon: Despite a high degree of interest in research among matriculating M.D. students, very few apply to combined M.D.-Ph.D. training programs. Even fewer of those applicants are female, leading to a gender disparity among M.D.-Ph.D. trainees. We used a qualitative approach to understand why students choose not to apply or matriculate to M.D.-Ph.D. programs. Approach: We recruited recently matriculated medical students at a private research university with a self-reported interest in academic medicine and biomedical research to participate in focus groups, in which students discussed their career and life goals, general knowledge and sources of information for M.D.-Ph.D. programs, perceived benefits and downsides, and barriers to applying to such programs. Findings: Twenty-two students participated in focus groups. Participants desired careers combining clinical work, research, and teaching. Students had knowledge of the structure and goals of M.D.-Ph.D. training and received information about dual-degree programs from research mentors, the Internet, and peers. Tuition remission and increased grant access were cited as benefits of M.D.-Ph.D. programs, whereas duration, perceived excessive research training, and early commitment were downsides. Perceived competitiveness, misconceptions about training, a lack of M.D.-Ph.D. program-specific advising, discouragement from applying, and duration of training all served as barriers preventing students from pursuing dual-degree training. Insights: Through this qualitative study, we identified perceptions and misconceptions that recent medical school applicants have about M.D.-Ph.D. programs. These findings suggest targetable barriers to increase applications from interested students, such as improving awareness of programs, increased accessibility of advising and resources, and addressing concerns over training length, with the goal of improving training access for aspiring physician-scientists. [ABSTRACT FROM AUTHOR]

McMaster University's medical school, faced with the need to socially distance during the COVID-19 pandemic, recently replaced their structured admission interview process with a partial lottery. At first, it may seem that leaving medical school admissions partly to chance could erode autonomy and meritocracy. Yet our current system for selecting medical students is strained by a limited predictive ability. In the search for good doctors, we lack meaningful, quantifiable, and comparable criteria. Partial or weighted admissions lotteries can offer us an escape. They have the potential to reduce mental and financial burdens on both applicants and medical schools, avoiding an overemphasis on marginal differences between applicants. Lotteries are also a simple way to address persistent admissions disparities by being truly non-discriminatory. At the very least, lotteries represent a useful benchmark against which we can rigorously compare current and future selection methods. [ABSTRACT FROM AUTHOR]

Introduction: Globally, medical schools are trying to widen access and to increase the diversity of their student body to be more representative of the population and to meet the future heath care needs of society. Selection methods must not disadvantage the applicants from priority groups. In Memorial University’s Faculty of Medicine, rural applicants and applicants from low socioeconomic status are priority groups. Methods: Since 2013, Memorial University has used a combination of traditional panel interviews and MMIs to interview candidates for medical school. We wondered whether applicants who participate in this medical school interview process perform differently on the MMIs compared to the traditional panel interview process and whether performance differs on either of the two interview processes based on age, sex, origin(urban or rural), or socioeconomic status. Results: The mean score on the traditional panel interview was higher than that on the MMI. Females scored higher than males on both the traditional panel interview and the MMI. Applicants aged 22 and younger performed worse on both the traditional panel interview and the MMI than the other age groups. Neighborhood socioeconomic status, and urban/rural living status were not significantly related with applicants’ performance on the traditional panel interview or MMI. Discussion: The type of interview is not disadvantaging applicants from Memorial University’s priority areas.

The holistic review in admissions framework has gained ground in medical schools. Because holistic review is unique at each institution, there is a paucity of evidence about whether it produces a more diverse interview pool than metrics-driven processes. The aim of this quantitative causal-comparative replication study was twofold: (1) to assess whether holistic review produced a more diverse interview group than one based solely on metrics and (2) to assess how the students enrolled through holistic review performed compared to national averages. Participants included 4643 medical school applicants applying for entering years 2011 through 2015. Three interview subgroups included a holistic review group (n = 1505), an academic group (n = 1505), and an overlap group (n = 1633). The sample included 44% women, 11.9% first-generation college students, and 14.9% underrepresented in medicine. Analyses found that in all categories of demographics and experiences, the holistic review group had significantly higher percentages than the academic group. One class performed lower than the national average on both United States Medical Licensing Exam Step 1 and Step 2 Clinical Knowledge; however, the other two classes performed similar to students nationally. This study supports the view that holistic review produces a more diverse interview pool than a metrics pool and is a valuable tool for increasing broad diversity. [ABSTRACT FROM AUTHOR]

There is over a century of research on selection and recruitment and the field has both developed and expanded significantly over this time. Previous research has tended to focus on reviewing the effectiveness of selection methods (academic records, references, personal statements, aptitude tests, personality assessments, situational judgement tests, and interviews), where good quality evidence is now emerging. Many challenges remain however, reflecting that selection and recruitment into medical education (both undergraduate and postgraduate) is a complex, multi-dimensional, dynamic phenomenon. For example, issues regarding diversity and fairness in selection have been researched over many years but there remains a huge gap between the research evidence and policy enactment in many parts of the globe. In this opening editorial for our special issue on selection and recruitment in medical education we encourage authors to consider six key question areas (amongst others), including: how will technology (e.g. social media, big data, artificial intelligence, etc) influence selection research and practices in future? should selection criteria be reviewed to include creativity, innovation, resilience and adaptability (beyond heavy reliance on prior academic attainment as the main criterion)? is selection for medical education fair? How do we address issues regarding widening participation and diversity in practice? to what extent do political, cultural and social factors influence selection philosophy and policies internationally? what are the risks to effective selection (e.g. access to coaching, legal challenge of poor practices) and, a new Ottawa consensus on selection and recruitment has been published - to what extent does this statement reflect your experiences of designing and implementing selection systems in your locality? In contributing to the debate, this special issue provides a platform for authors to present the latest research, empirical studies, systematic reviews, reflections, case studies and practical tips on current/future issues in selection and recruitment in medical education.

Context Widening participation to medicine aims to remove barriers to medical education for under-represented groups. This study examined the impact of a widening participation workshop for medical school applicants. The intervention was delivered by a team of medical student volunteers operating in the North West of England: Manchester Outreach Medics. Methods 39 pupils, typically aged 16-17, attended the workshop at Royal Blackburn Hospital, Lancashire. Activities included a variety of lectures and interactive group sessions. Using questionnaires, participants highlighted their understanding in areas relating to the medical school application process on a scale of zero to ten. This was performed before and after the intervention to allow for comparison. The results were evaluated using a one-tailed paired t-test and Cohen's d effect size. Results There was a significant improvement (p 0.8) in the understanding of all topics assessed. The largest improvements were seen in topics that the participants had little understanding in prior to attending the workshop. Conclusions This student-led activity improved participant understanding in areas pertaining to the medical school application process. The study also showed the effectiveness of pre- and post-intervention questionnaires, which could be used by all post-16 medical widening participation activities in the UK.

Introduction Multiple mini-interview (MMI) comments can help to reveal an underlying personality or behavioral flaw that the numerical scores are not designed to illustrate. The importance of the comments provided by interviewers has not been documented in the literature. This study sought to examine whether MMI comments influenced admission committee decision-making. Methods Five thousand de-identified interview comments from a subset of 625 medical school applicants were reviewed by study raters who followed a rubric that outlined scoring assignments based upon the number of positive and negative statements made by MMI interviewers. The presence of extremely negative MMI comments was also evaluated. Results MMI score strongly correlated with MMI comment score assigned by the raters and contributed to overall committee score and decision for acceptance or rejection to medical school. The presence of one negative outlier comment score alone did not impact committee score or acceptance; however, when extremely negative attributes were identified by study raters within an outlier comment, this was associated with a reduction of final committee score and higher incidence of rejection. Conclusions A strong correlation existed between the MMI comments and overall MMI score. Both MMI comments and MMI scores predict acceptance to medical school. The additional value of the MMI comments lies in the extremely negative outlier comments.

Web-based interviewing may be an effective element of a medical school's larger approach to promotion of holistic review, as recommended by the Association of American Medical Colleges, by facilitating the feasibility of including rural and community physicians in the interview process. Only 10% of medical schools offer videoconference interviews to applicants and little is known about the impact of this interview modality on the admissions process. This study investigated the impact of overall acceptance rates using videoconference interviews and face-to-face interviews in the medical school selection process using an equivalence trial design. The University of New Mexico School of Medicine integrated a videoconferencing interview option for community and rural physician interviewers in a pseudo-random fashion during the 2014-2016 admissions cycles. Logistic regression was conducted to examine whether videoconference interviews impacted acceptance rates or the characteristics of accepted students. Demographic, admissions and diversity factors were analyzed that included applicant age, MCAT score, cumulative GPA, gender, underrepresented in medicine, socioeconomic status and geographic residency. Data from 752 interviews were analyzed. Adjusted rates of acceptance for face-to-face (37.0%; 95% CI 28.2, 46.7%) and videoconference (36.1%; 95% CI 17.8, 59.5%) interviews were within an a priori ± 5% margin of equivalence. Both interview conditions yielded highly diverse groups of admitted students. Having a higher medical college admission test score, grade point average, and self-identifying as disadvantaged increased odds of admission in both interview modalities. Integration of the videoconference interview did not impact the overall acceptance of a highly diverse and qualified group of applicants, and allowed rural and community physicians to participate in the medical school interview process as well as allowed campus faculty and medical student committee members to interview remotely. [ABSTRACT FROM AUTHOR]

Diversity in the physician workforce lags behind the rapidly changing US population. Since the gateway to becoming a physician is medical school, diversity must be addressed in the admissions process. The Association of American Medical Colleges has implemented a Holistic Review Initiative aimed at assisting medical schools with broadening admission criteria to include relevant, mission-driven attributes and experiences in addition to academic preparation to identify applicants poised to meet the needs of a diverse patient population. More evidence is needed to determine whether holistic review results in a more diverse selection process. One of the keys to holistic review is to apply holistic principles in all stages of the selection process to ensure qualified applicants are not overlooked. This study examines whether the use of holistic review during application screening at a new medical school increased the diversity of applicants selected for interview. Using retrospective data from the first five application cycles at the Oakland University William Beaumont School of Medicine (OUWB), the author compared demographic and experiential differences between the applicants selected using holistic review, including experiences, attributes and academic metrics, to a test sample selected solely using academic metrics. The dataset consisted of the total group of applicants selected for interview in 2011 through 2015 using holistic review (n = 2773) and the same number of applicants who would have been selected for an interview using an academic-only selection model (n = 2773), which included 1204 applicants who were selected using both methods (final n = 4342). The author used a combination of cross-tabulation and analysis of variance to identify differences between applicants selected using holistic review and applicants in the test sample selected using only academics. The holistic review process yielded a significantly higher than expected percent of female (adj. resid. = 13.2, p < .01), traditionally underrepresented in medicine (adj. resid. = 15.8, p < .01), first generation (adj. resid. = 5.8, p < .01), and self-identified disadvantaged (adj resid. = 11.5, p < .01) applicants in the interview pool than selected using academic metrics alone. In addition, holistically selected applicants averaged significantly more hours than academically selected students in the areas of pre-medical school paid employment (F = 10.99, mean difference = 657.99, p < .01) and community service (F = 15.36, mean difference = 475.58, p < .01). Using mission-driven, holistic admissions criteria comprised of applicant attributes and experiences in addition to academic metrics resulted in a more diverse interview pool than using academic metrics alone. These findings add support for the use of holistic review in the application screening process as a means for increasing diversity in medical school interview pools. [ABSTRACT FROM AUTHOR]

Multiple Mini-Interviews (MMIs) are increasingly used in medical school admissions. We previously reported that while under-represented minority (URM) status was not associated with MMI scores, self-designated disadvantaged applicants had lower MMI scores, possibly affecting their matriculation prospects. No studies have examined how URM status or socioeconomic disadvantage (SED) are associated with academic performance following admission through an MMI. We examined the adjusted associations of MMI scores, SED, and URM status with U.S. Medical Licensing Examination Steps 1 and 2 performance and third-year clerkship Honors, measures affecting residency matching. While URM status was not associated with the measures, students with greater SED had lower Step 1 scores and fewer Honors. Students with higher MMI scores had more Step 1 failures, but more Honors. The findings identify areas to address in medical school admissions, student support, and evaluation processes, which is important given the need for a more representative physician workforce. [ABSTRACT FROM AUTHOR]

Adam EM Eltorai, Alan H Daniels Warren Alpert Medical School, Brown University, Providence, RI, USA Abstract: The medical school admissions process is inefficient and costly to both applicants and medical schools. For the many rejected applicants, this process represents a costly, unproductive use of time. For medical schools, numerous applications are reviewed that ultimately do not yield matriculants, representing a substantial inefficiency. In order to streamline the process and reduce costs, we propose the development of a national medical school matching program. Keywords: medical school, admissions, match program

In-person interviewing is the norm during the medical school application process, but it is not always possible due to reasons such as exorbitant cost of travel, work or residence outside the country and adverse travel conditions. In January 2016 during Winter Storm Jonas in the eastern United States of America, officials at the West Virginia University School of Medicine (WVU SOM) mandated a closure of the campus resulting in the cancellation of twenty on-site medical school interviews. The impromptu solution to overcoming this obstacle to in-person interviewing is described here as a case study. The successful use of digital interviewing has already been described at the residency and fellowship level; we believe this is the first reported case study about the successful use of FaceTime interviewing at the medical school level, and it may encourage admissions officials to expand the use of this modality in medical student recruitment.

This study investigates the effects of socioeconomic status and schooling on the academic attainment of a cohort of students at a single medical school (N = 240). Partial least squares structural equation modelling was used to explore how students' summative assessment scores over 4 years of medical school were affected by: attainment in secondary school examinations (GCSEs and A-levels); the Income Deprivation Affecting Children Index (IDACI) rank associated with students' home postcodes; the performance of students' A-level institutions, measured as the percentage of A-level students achieving 3 A-levels at AAB or higher in two or more facilitating subjects. The effects were consistent across time; the final linear regression model used students' cumulative scores (the basis of the medical school's UK Foundation Programme submission) as the dependent variable. The final model fit was quite poor (R2 = .184, n = 178). IDACI Rank was non-significant and excluded from the final model. Both GCSE (.340, p < .001) and A-level (.204, p < .005) scores were associated with increasing Cumulative Score; School Performance was associated with decreasing Cumulative Score (-.159, p < .05). This study confirmed the predictive validity of prior academic attainment and found the same inverse relationship between schooling and medical course performance as previous studies. The study found no evidence that socioeconomic background affects course performance; however, students admitted to medicine from poorly performing schools achieve higher academic attainment throughout the course than students admitted from better-performing schools with the same grades. Schooling could be taken into account for admissions purposes. [ABSTRACT FROM AUTHOR]

Traditional methods of assessing personality traits in medical school selection have been heavily criticised. To address this at the point of selection, "non-cognitive" tests were included in the UK Clinical Aptitude Test, the most widely-used aptitude test in UK medical education (UKCAT: http://www.ukcat.ac.uk/ ). We examined the predictive validity of these non-cognitive traits with performance during and on exit from medical school. We sampled all students graduating in 2013 from the 30 UKCAT consortium medical schools. Analysis included: candidate demographics, UKCAT non-cognitive scores, medical school performance data-the Educational Performance Measure (EPM) and national exit situational judgement test (SJT) outcomes. We examined the relationships between these variables and SJT and EPM scores. Multilevel modelling was used to assess the relationships adjusting for confounders. The 3343 students who had taken the UKCAT non-cognitive tests and had both EPM and SJT data were entered into the analysis. There were four types of non-cognitive test: (1) libertariancommunitarian, (2) NACE-narcissism, aloofness, confidence and empathy, (3) MEARS-self-esteem, optimism, control, self-discipline, emotional-nondefensiveness (END) and faking, (4) an abridged version of 1 and 2 combined. Multilevel regression showed that, after correcting for demographic factors, END predicted SJT and EPM decile. Aloofness and empathy in NACE were predictive of SJT score. This is the first large-scale study examining the relationship between performance on non-cognitive selection tests and medical school exit assessments. The predictive validity of these tests was limited, and the relationships revealed do not fit neatly with theoretical expectations. This study does not support their use in selection. [ABSTRACT FROM AUTHOR]

Situational Judgement Tests (SJTs) are increasingly implemented in medical school admissions. In this paper, we investigate the effects of vocational interests, previous academic experience, gender and age on SJT performance. The SJT was part of the selection process for the Bachelor's degree programme in Medicine at University of Groningen, the Netherlands. All applicants for the academic year 2015-2016 were included and had to choose between learning communities Global Health (n = 126), Sustainable Care (n = 149), Intramural Care (n = 225), or Molecular Medicine (n = 116). This choice was used as a proxy for vocational interest. In addition, all graduate-entry applicants for academic year 2015-2016 (n = 213) were included to examine the effect of previous academic experience on performance. We used MANCOVA analyses with Bonferroni post hoc multiple comparisons tests for applicant performance on a six-scenario SJT. The MANCOVA analyses showed that for all scenarios, the independent variables were significantly related to performance (Pillai's Trace: 0.02-0.47, p < .01). Vocational interest was related to performance on three scenarios (p < .01). Graduate-entry applicants outperformed all other groups on three scenarios (p < .01) and at least one other group on the other three scenarios (p < .01). Female applicants outperformed male applicants on three scenarios (p < .01) and age was positively related to performance on two scenarios (p < .05). A good fit between applicants' vocational interests and SJT scenario was related to better performance, as was previous academic experience. Gender and age were related to performance on SJT scenarios in different settings. Especially the first effect might be helpful in selecting appropriate candidates for areas of health care in which more professionals are needed. [ABSTRACT FROM AUTHOR]

Background Students from lower socioeconomic groups tend to underestimate their chances of acceptance to medical school and their likelihood of success once admitted. Objective The objective of this study is to determine if socioeconomic disadvantage status is linked to lower medical college admission test (MCAT) scores and academic performance in medical school. Methods Using the Association of American Medical Colleges (AAMC) education/occupation (EO) indicator, we compared economically disadvantaged students to students with no financial disadvantage on the MCAT, Phase 1 National Board of Medical Examiners (NBME), United States Medical Licensing Examination (USMLE) Step 1, Phase 2 NBME, and USMLE Step 2 test scores. Results Medical students in the disadvantaged group scored significantly lower on the MCAT than students with no financial disadvantage. The disadvantaged group showed a non-significant lower trend in performance until USMLE Step 2. Conclusions Applicants from lower socioeconomic backgrounds may perform lower on their MCAT and early medical school benchmark exams, but they appear to catch up with and even surpass their peers on their USMLE Step 2 examination., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Ely et al.)

This perspectives article considers the potential implications an affirmative action ban would have on patient care in the US. A physician's race and ethnicity are among the strongest predictors of specialty choice and whether or not a physician cares for Medicaid and uninsured populations. Taking this into account, research suggests that an affirmative action ban in university admissions would sharply reduce the supply of primary care physicians to Medicaid and uninsured populations over the coming decade. Our article compares current conditions to the potential effect of an affirmative action ban by projecting how many future medical students will become primary care physicians for Medicaid and uninsured patients by 2025. Based on previous evidence and current medical student training patterns, we project that a ban could deny primary care access for 1.25 million of our nation's most vulnerable patients, considerably worsening existing healthcare disparities. More broadly, we argue that the effects of eliminating affirmative action would be fundamentally contrary to the Association of American Medical Colleges' stated goal of medical education-"to improve the health of all." [ABSTRACT FROM AUTHOR]

Context: Some racial and ethnic groups are underrepresented in the medical field because they face unique barriers to admission to medical school. One admission requirement that can present a barrier for applicants is the physician letter of recommendation (PLOR). Undergraduate students report confusion with the application process and lack of mentorship to be two of their biggest challenges to becoming a doctor. It is especially challenging to those who already have limited access to practicing physicians. Therefore, we hypothesized that in the presence of a PLOR requirement, the diversity of students who apply and matriculate into medical school will be decreased., Objectives: This study aims to determine if a relationship exists between a PLOR requirement for the medical school application and the proportion of underrepresented in medicine (URM) students applying and matriculating to that school., Methods: A retrospective study was conducted utilizing data published by the American Association of Colleges of Osteopathic Medicine Application Services (AACOMAS) on the race and ethnicity of applicants and matriculants to osteopathic medical schools during the years 2009-2019. In total, 35 osteopathic schools with 44 campuses were included in the study. Schools were grouped based on whether they required a PLOR. For each group of schools, descriptive statistics were performed for the following variables: number of total applicants, class size, application rate per ethnicity, matriculation rate per ethnicity, number of applicants per ethnicity, number of matriculants per ethnicity, and percentage of student body per ethnicity. The Wilcoxon rank-sum test was utilized to detect differences between the two groups. Statistical significance was assessed at the α=0.05 level., Results: Schools that required a PLOR showed decreases in the number of applicants across all races and ethnicities. Black students showed the greatest difference between groups and were the only ethnicity to show significant reductions across all outcomes in the presence of a PLOR requirement. On average, schools that required a PLOR have 37.3% (185 vs. 295; p<0.0001) fewer Black applicants and 51.2% (4 vs. 8.2; p<0.0001) fewer Black matriculants., Conclusions: This study strongly suggests a relationship between requiring a PLOR's and decreasing racial and ethnic diversity in medical school matriculants, specifically the Black applicants. Based on this result, it is recommended that the requirement of a PLOR be discontinued for osteopathic medical schools., (© 2023 the author(s), published by De Gruyter, Berlin/Boston.)