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Zarate Rodriguez JG, Awad MM. Distance travelled: The road remains unclear. MEDICAL EDUCATION 2024; 58:172-173. [PMID: 37973610 DOI: 10.1111/medu.15268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 10/15/2023] [Accepted: 10/17/2023] [Indexed: 11/19/2023]
Abstract
@jzaraterod discusses Ellsworth et al's exploration of how "distance travelled" does (and could) influence medical school admissions by highlighting areas where greater illumination is required.
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Affiliation(s)
- Jorge G Zarate Rodriguez
- Department of Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Michael M Awad
- Department of Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
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Ellsworth BL, Solano QP, Evans J, Bidwell SS, Byrnes M, Sandhu G. Medical students' perception of their 'distance travelled' in medical school applications. MEDICAL EDUCATION 2024; 58:204-215. [PMID: 37485787 DOI: 10.1111/medu.15167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 06/15/2023] [Accepted: 06/27/2023] [Indexed: 07/25/2023]
Abstract
INTRODUCTION Within medical school's holistic review of applicants includes a review of their distance travelled to get to this point in their education. The AAMC defines distance travelled (DT) 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'. What medical students consider as their distance travelled has not been explored. The authors sought to identify the factors medical students perceive are important for medical school admissions to consider when assessing someone's 'distance travelled' by asking current medical students to share their DT experiences along with the barriers and facilitators they encountered on their medical school journey. METHODS The authors conducted semi-structured interviews with US medical students through purposeful sampling methods. The social-ecological model framework was used to develop questions to elicit participants' experiences that contributed to their distance travelled. Interviews were conducted in 2021 and ranged from 60-75 minutes. Transcribed interviews were qualitatively analysed using interpretive description. RESULTS A total of 31 medical students from seven medical schools were included in the study. Overall, participants defined distance travelled as an applicant's hardships (e.g. being the primary caregiver for a family member) and privileges (e.g. having physician parents) they experienced. Three major themes were identified: (1) individual-level characteristics and factors, (2) interpersonal relationships and (3) aspects of the participants' community and society. DISCUSSION Our findings show that medical school applicants considered DT to be a valuable component of a holistic medical school admission process. Participants' experiences of DT were varied and complex. Our research suggests that admissions teams for medical schools should incorporate more comprehensive recruitment practices and inclusive methodological frameworks to accurately capture the diversity of identities and experiences of medical school applicants and to consider the factors that shape their journey to medical schools.
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Affiliation(s)
| | | | - Julie Evans
- University of Michigan, Ann Arbor, Michigan, USA
| | | | - Mary Byrnes
- Department of Surgery and Center for Healthcare Outcomes and Policy, University of Michigan Health, Ann Arbor, Michigan, USA
| | - Gurjit Sandhu
- Department of Surgery and Learning Health Sciences, University of Michigan, Ann Arbor, Michigan, USA
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Perez MA, Williams C, Henderson K, McGregor R, Vapiwala N, Shea JA, Dine CJ. Association of applicant demographic factors with medical school acceptance. BMC MEDICAL EDUCATION 2023; 23:960. [PMID: 38098006 PMCID: PMC10720109 DOI: 10.1186/s12909-023-04897-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Medical school acceptance rates in the United States (US) have been lower for applicants who identify as Underrepresented-in-Medicine (UiM) compared to non-UiM applicants. The gap between UiM and no-UiM groups is narrowing in recent years. Less well-studied are associations of acceptance decisions with family income and parental education. This study's purpose is to evaluate the relationships between medical school acceptance and family income, parental education status, racial/ethnic background, Grade Point Average (GPA), Medical College Admission Test (MCAT) score, and participation in extracurricular activities. METHODS This is a cross-sectional study of first-time US medical school applicants between 2017 and 2020. Acceptance rates for first-time applicants were calculated for first-generation (FG), low-income (LI), and UiM applicants. Associations of these attributes with MCAT scores, science GPAs, and seven categories of extracurricular activities were evaluated. Regression analyses estimated associations between acceptance to medical school with all variables with and without interaction terms (FG*URM, LI*URM, FG*LI). RESULTS The overall acceptance rate for first-time applicants from 2017-2020 was 45.3%. The acceptance rates among FG, LI and UiM applicants were 37.9%, 39.6% and 44.2%, respectively. In univariable logistic regression analyses, acceptance was negatively associated with being FG (OR: 0.68, CI: 0.67-0.70), LI (OR: 0.70, CI: 0.69-0.72), and UiM (OR: 0.95, CI: 0.93-0.97). In multivariable regression, acceptance was most strongly associated with science GPA (OR: 7.15, CI: 6.78-7.54 for the highest quintile) and UiM (OR: 5.56, CI: 5.48-5.93) status and MCAT score (OR: 1.19, CI: 1.18-1.19), FG (OR: 1.14, CI: 1.10-1.18), and most extracurricular activities. Including interaction terms revealed a negative association between acceptance and LI (OR:0.90, CI: 0.87-0.94) and FG was no longer significant (OR:1.10, CI:0.96-1.08). CONCLUSIONS Collectively these results suggest medical school admissions committees may be relying on holistic admission practices. While MCAT and GPA scores continue to predict acceptance, individuals from racially and ethnically UiM backgrounds have favorable odds of acceptance when controlling for MCAT and GPA. However, these positive associations were not seen for low-income and first-generation applicants. Additional preparation for college and the MCAT for these latter groups may help further diversify the medical profession.
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Affiliation(s)
- Michael A Perez
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, US
| | - Cheyenne Williams
- Department of Urology, Hospital of the University of Pennsylvania, Philadelphia, PA, US
| | - Korey Henderson
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, US
| | - Ryan McGregor
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, US
| | - Neha Vapiwala
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, US
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, US
| | - Judy A Shea
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, US
- Leonard Davis Institute of Economics, University of Pennsylvania, Philadelphia, PA, US
| | - C Jessica Dine
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, US.
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA, US.
- Leonard Davis Institute of Economics, University of Pennsylvania, Philadelphia, PA, US.
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Perry R, Sciolla A, Rea M, Sandholdt C, Jandrey K, Rice E, Yu A, Griffin E, Wilkes M. Modeling the social determinants of resilience in health professions students: impact on psychological adjustment. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:1661-1677. [PMID: 37193860 PMCID: PMC10187518 DOI: 10.1007/s10459-023-10222-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 03/05/2023] [Indexed: 05/18/2023]
Abstract
Stressors inherent to training and stemming from the learning environment are associated with high rates of burnout, depression, and mental health problems in health professions students (HPS). There is evidence that disadvantaged or stigmatized groups are particularly affected. These problems not only impact students after graduation but may also have detrimental effects on patient outcomes. Resilience, conceptualized as the process of adapting well in the face of adversity, has inspired an increasing number of interventions aimed at addressing those problems in HPS. These interventions have mostly targeted individual students and their psychological traits while ignoring social and structural factors that may enhance or undermine individual resilience. To address this gap in the literature, the authors reviewed the evidence for psychosocial determinants of resilience and proposed a model inspired by the social determinants of health literature and the "upstream-downstream" metaphor. In this theoretical paper, the authors propose that upstream determinants such adverse childhood experiences and socioeconomic and sociodemographic markers of disadvantage have a direct effect on psychological adjustment and an indirect effect mediated by resilience. Additionally, the authors propose that the institutional downstream drivers of learning environment, social support, and sense of belonging moderate the direct and indirect effects of the upstream determinants on psychological adjustment. Future research should test these hypotheses and gather evidence that may guide the development of interventions. The authors present their model as part of a comprehensive response to recent calls to action to address diversity, equity and inclusion in health professions education.
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Affiliation(s)
- Ross Perry
- School of Medicine, University of California, Davis, Sacramento, CA, USA
| | - Andres Sciolla
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, USA
| | - Margaret Rea
- School of Medicine, University of California, Davis, Sacramento, CA, USA
| | - Cara Sandholdt
- Betty Irene Moore School of Nursing, University of California Davis, Sacramento, CA, USA
| | - Karl Jandrey
- School of Veterinary Medicine, University of California, Davis , Davis, CA, USA
| | - Elizabeth Rice
- Betty Irene Moore School of Nursing, University of California Davis, Sacramento, CA, USA
| | - Allison Yu
- School of Medicine, University of California, Davis, Sacramento, CA, USA
| | - Erin Griffin
- Washington State University, Elson S. Floyd College of Medicine, Spokane, WA, USA
| | - Michael Wilkes
- School of Medicine, University of California, Davis, Sacramento, CA, USA.
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Harrison LE, Fletcher L, Dunleavy D, Price-Johnson T, Vashi Kundu R, Fogerty GT, Berardi-Demo L. Self-Reported Disadvantage in Medical School Admissions: A Call to Review, Revise, and Further Advance Holistic Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:1044-1052. [PMID: 37232756 DOI: 10.1097/acm.0000000000005272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
PURPOSE This study examined how applicants interpret the self-reported disadvantaged (SRD) question in the American Medical College Application Service (AMCAS) application. METHOD Data from 129,262 applicants who applied through AMCAS from 2017 through 2019 were used, including financial and family history, demographic characteristics, and work status and residence. Fifteen applicants from the 2020 and 2021 AMCAS cycles were interviewed about their experiences with the SRD question. RESULTS Large effects were found for SRD applicants with fee assistance waivers ( h = 0.89), Pell grants ( h = 1.21), state or federal aid ( h = 1.10), and parents with less education ( h = 0.98) and non-SRD applicants with a large proportion of their education paid by family ( d = 1.03). Another large difference was found for reported family income distribution (73% of SRD applicants reporting family income < $50,000 vs 15% of non-SRD applicants). More SRD applicants were Black or Hispanic (26% vs 16% and 5% vs 5%), Deferred Action for Childhood Arrivals recipients (11% vs 2%), born outside the United States (32% vs 16%), and raised in a medically underserved area (60% vs 14%). There was a moderate effect for first-generation to college SRD applicants ( h = 0.61). SRD applicants had lower Medical College Admission Test scores ( d = 0.62) and overall and science grade point averages ( d = 0.50 and 0.49, respectively) but no meaningful differences in acceptance or matriculation rates. The interviews identified 5 themes: (1) unclear disadvantage definition; (2) different perceptions of disadvantage and overcoming challenges or obstacles ; (3) identification as disadvantaged or not; (4) SRD essay content; and (5) concerns about lack of transparency in how the SRD question is used in admissions. CONCLUSIONS Revising the SRD question by including context, phrasing, and instructions for broader experience categories might be beneficial because of lack of transparency and understanding.
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Affiliation(s)
- Leila E Harrison
- L.E. Harrison is vice dean for admissions, student affairs, and alumni engagement and assistant professor, Department of Medical Education and Clinical Science, Washington State University Elson S. Floyd College of Medicine, Spokane, Washington; ORCID: https://orcid.org/0000-0002-6804-075X
| | - Laura Fletcher
- L. Fletcher is senior research analyst, Association of American Medical Colleges, Washington, D.C
| | - Dana Dunleavy
- D. Dunleavy is director of admissions and selection research and development, Association of American Medical Colleges, Washington, DC
| | - Tanisha Price-Johnson
- T. Price-Johnson is associate dean for student affairs, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Roopal Vashi Kundu
- R.V. Kundu is professor, Department of Dermatology and Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois; ORCID: https://orcid.org/0000-0002-7509-3606
| | - Glen T Fogerty
- G.T. Fogerty is associate dean for admissions and student services and assistant professor, Department of Bioethics and Medical Humanism, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona
| | - Linda Berardi-Demo
- L. Berardi-Demo is executive vice president of student support, R3 Education, Devens, Massachusetts
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Butt A, Mankbadi M, Erikson C, Marshall A, Masselink LE, Tong G, Hafler J, Podoltsev N, Lee AI. Bias Against International Medical Graduates in the Hematology/Oncology Fellowship Recruitment Process: Findings From a Nationwide Survey of Fellowship Program Directors. JCO Oncol Pract 2022; 18:783-787. [PMID: 36108253 DOI: 10.1200/op.22.00219] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Ayesha Butt
- Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT
| | - Michael Mankbadi
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Clese Erikson
- Fitzhugh Mullan Institute for Health Workforce Equity, George Washington University, Washington, DC
| | - Ariela Marshall
- Department of Hematology-Oncology, University of Pennsylvania, Philadelphia, PA
| | - Leah E Masselink
- Fitzhugh Mullan Institute for Health Workforce Equity, George Washington University, Washington, DC
| | - Guangyu Tong
- Department of Biostatistics, Yale School of Public Health, New Haven, CT
| | - Janet Hafler
- Teaching and Learning Center, Yale School of Medicine, New Haven, CT
| | - Nikolai Podoltsev
- Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT
| | - Alfred Ian Lee
- Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT
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