Strategies For Enhancing Equity, Diversity, and Inclusion in Medical School Admissions–A Canadian Medical School's Journey

Abstract

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.

Association Between a Medical School Applicant’s Community College Attendance and the Likelihood of Application Acceptance: An Investigation of Select Medical School Characteristics

“…Fifth, given the role of GPA and MCAT scores in admissions, future studies could explore how the association between CC attendance and the likelihood of acceptance varies by GPA and/or MCAT scores at the applicant level and whether these interactions differ across school characteristics at the application level. Finally, there are extensive efforts to contextualize recruitment and selection processes, and thus increase representation of groups who are historically underrepresented, in countries, such as Australia, 36 Canada, 37 and the United Kingdom, 38 which could limit the generalizability of our findings to these contexts. While recognizing issues of generalizability due to cultural and institutional differences, future studies could explore cross-national differences in initiatives to address diversity in medical school admissions.…”

Medical students' perception of their ‘distance travelled’ in medical school applications

“…16 Furthermore, medical schools in the US, UK, Canada and Australia are incorporating novel interview assessment strategies including Situational Judgement Tests (SJT) or Multiple Mini Interview (MMI) scenarios to assess applicants' personal attributes. 17,18 Although some of these interventions have been successful at reducing bias in admission processes and improved medical school diversity, 11,17,18 interventions designed to understand applicants' DT have been largely unsuccessful. [19][20][21] One such mechanism within medical school applications is the personal statement, which has been used as an avenue for the applicant to share elements of their DT.…”

“…DT is defined by the AAMC as, ‘any obstacles or hardships you've overcome to get to this point in your education or any life challenges you've faced and conquered’ 10 . Similar language, such as the applicants ‘life story’, has been used to define DT in other countries 11,12 . In recent years, medical schools have improved at incorporating an applicant's demographic factors and personal attributes.…”

“…10 Similar language, such as the applicants 'life story', has been used to define DT in other countries. 11,12 In recent years, medical schools have improved at incorporating an applicant's demographic factors and personal attributes. For example, medical schools in multiple countries have expanded their demographic questionnaires to include more inclusive racial and ethnic identities, sexual orientation and gender information 13,14 ; US medical schools are now utilising socio-economic disadvantage calculators 15 ; and UK medical schools are asking students about their parental education level to understand demographic differences between applicants that may represent disadvantages between applicants.…”

Guaranteed Admissions Pathway Initiatives to Medical School as a Means to Physician Workforce Diversification

“…Other pathway initiatives may focus on diversity to make admissions to medical schools socially accountable by adopting a complementary holistic review for increasing diversity in medicine. 2 Despite growing demand for evidence supporting outcomes of pathway initiatives, studies have been limited in examining the impact of GA programs relative to standard admissions (SA) programs. 3 This study explores opportunities and challenges in the GA initiative in relation to diversity goals by examining preadmissions characteristics and performance during medical school.…”