Thinking of selection and widening access as complex and wicked problems

Cleland, Jennifer; Patterson, Fiona; Hanson, Mark D.

doi:10.1111/medu.13670

Cited by 39 publications

(51 citation statements)

References 68 publications

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“…Inequities in medical school admission poses a 'wicked' political problem [55]. Addressing such inequities in the admissions process will take a large, coordinated effort.…”

Section: Discussionmentioning

confidence: 99%

Demographic and socioeconomic characteristics of Canadian medical students: A cross-sectional study

Khan

Apramian

Kang

et al. 2020

Preprint

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Background While the importance of medical students’ demographic characteristics in influencing the scope and location of their future practice is recognized, these data are not systematically collected in Canada. This study aimed to characterize and compare the demographics of Canadian medical students with the Canadian population. Methods Through an online survey, delivered in 2018, medical students at fourteen English-speaking Canadian medical schools provided their age, sex, gender identity, ethnicity, educational background, and rurality of the area they grew up in. Respondents also provided information on parental income, occupation, and education as markers of socioeconomic status. Data were compared to the 2016 Canadian Census. Results A total of 1388 students responded to the survey, representing a response rate of 16.6%. Most respondents identified as women (63.1%) and were born after 1989 (82.1%). Respondents were less likely, compared to the Canadian Census population, to identify as black (1.7% vs 6.4%) (P<0.001) or Aboriginal (3.5% vs. 7.4%) (P<0.001), and have grown up in a rural area (6.4% vs. 18.7%) (P<0.001). Respondents had higher socioeconomic status, indicated by parental education (29.0% of respondents’ parents had a master’s or doctoral degree, compared to 6.6% of Canadians aged 45-64), occupation (59.7% of respondents’ parents were high-level managers or professionals, compared to 19.2% of Canadians aged 45-64), and income (62.9% of respondents grew up in households with income >$100,000/year, compared to 32.4% of Canadians). Assessment of non-response bias showed that our sample was representative of all students at English-speaking Canadian medical schools with respect to age, though a higher proportion of respondents were female. Additionally, there were no differences between early and late respondents with respect to ethnicity, rurality, and parental income, occupation, and education. Conclusions Canadian medical students have different socioeconomic characteristics compared to the Canadian population. Collecting and analyzing these characteristics can inform evidence-based admissions policies.

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“…Inequities in medical school admission poses a 'wicked' political problem [55]. Addressing such inequities in the admissions process will take a large, coordinated effort.…”

Section: Discussionmentioning

confidence: 99%

Demographic and socioeconomic characteristics of Canadian medical students: A cross-sectional study

Khan

Apramian

Kang

et al. 2020

Preprint

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“…It is timely to step back and consider some of the key concepts in economics and how these can be applied to health professions education (HPE). First, there seems an appetite in the literature to rigorously evaluate and optimise allocation of medical education resources (Foo et al 2019 ; Maloney et al 2019 ), and to apply economic methodologies which could be used to address HPE questions (e.g., Cleland et al 2018b ). Second, in a recent commentary about strategic planning during COVID-19, Tolsgaard et al ( 2020 ) stated that the “choices that we make now for how to use our workforce, which education and training activities to stop, continue or modify, will [also] have profound workforce consequences and implications for quality of non-COVID-19 areas of clinical care”.…”

Section: Introductionmentioning

confidence: 99%

“You can’t always get what you want…”: economic thinking, constrained optimization and health professions education

Cleland

Foo

Ilić

et al. 2020

Adv in Health Sci Educ

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Every choice we make in health professions education has a cost, whether it be financial or otherwise; by choosing one action (e.g., integrating more simulation, studying more for a summative examination) we lose the opportunity to take an alternative action (e.g., freeing up time for other teaching, leisure time). Economics significantly shapes the way we behave and think as educators and learners and so there is increasing interest in using economic ways of thinking and approaches to examine and understand how choices are made, the influence of constraints and boundaries in educational decision making, and how costs are felt. Thus, in this article, we provide a brief historical overview of modern economics, to illustrate how the core concepts of economics—scarcity (and desirability), rationality, and optimization—developed over time. We explain the important concept of bounded rationality, which explains how individual, meso-factors and contextual factors influence decision making. We then consider the opportunities that these concepts afford for health professions education and research. We conclude by proposing that embracing economic thinking opens up new questions and new ways of approaching old questions which can add knowledge about how choice is enacted in contemporary health professions education.

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“…Designing admissions policies to meet academic and non-academic selection aims while ensuring fair access proves challenging [1,2]. Cleland et al have previously described medical school admissions as a wicked problem, recognizing its complexity, describing selection as dynamic rather than a static solution [3]. Admissions policies are adjusted continuously in response to evaluations of their effectiveness as well as unintended consequences, such as effects on equity.…”

mentioning

confidence: 99%