Admissions Is Not Enough: The Racial Achievement Gap in Medical Education.

The achievement gap is a disparity in academic and standardized test performance that exists between White and underrepresented minority (URM) students that begins as early as preschool and worsens as students progress through the educational system. Medical education is not immune to this inequality. URM medical students are more likely to experience delayed graduation and course failure, even after accounting for science grade point average and Medical College Admission Test performance. Moreover, URM students are more likely to earn lower scores on licensing examinations, which can have a significant impact on their career trajectory, including specialty choice and residency competitiveness. After the release of preliminary recommendations from the Invitational Conference on USMLE Scoring (InCUS) and public commentary on these recommendations, the National Board of Medical Examiners and Federation of State Medical Boards announced that the United States Medical Licensing Examination (USMLE) Step 1 would transition from a 3-digit numeric score to pass/fail scoring. Given that another of InCUS's recommendations was to "minimize racial demographic differences that exist in USMLE performance," it is paramount to consider the impact of this scoring change on URM medical students specifically. Holistic admissions are a step in the right direction of acknowledging that URM students often travel a further distance to reach medical school. However, when residency programs emphasize USMLE performance (or any standardized test score) despite persistent test score gaps, medical education contributes to the disproportionate harm URM students face and bolsters segregation across medical specialties. This Perspective provides a brief explanation of the achievement gap, its psychological consequences, and its consequences in medical education; discusses the potential effect of the Step 1 scoring change on URM medical students; and provides a review of strategies to redress this disparity.

Assessment of English language performance scores and academic performance in an English-based curriculum for pharmacy students with English as a second language.

BACKGROUND: The primary objective was to determine if there is a relationship between English language performance and graduating grade point average (GPA) in pharmacy students with English as a second language (ESL). METHODS: Students graduating from a four-year pharmacy program in 2016-2018 were invited to participate in the study. We compared pharmacy students' pre-admission ESL scores to their cumulative GPA at graduation in each of the three graduating cohorts and also determined if these results held true for both genders. Correlation of GPA to individual mathematics, chemistry, and Chinese language scores were used as points of reference to compare the degree of correlation. RESULTS: There were 148 students screened for the study with 31 students not meeting the inclusion criteria and four students declining to participate. Statistical analyses show an overall weak correlation. There was a statistically significant stronger correlation between pre-admission ESL scores and cumulative graduating GPA (r = 0.273) as compared to the correlation of GPA with mathematics (r = 0.187), chemistry (r = 0.181), or Chinese language scores (r = 0.059). The results did not change when the study population was separated by gender as English score still had the strongest correlation as compared to the other subjects. CONCLUSION: This study provides evidence that English language scores correlate more strongly with academic performance than mathematics, chemistry, or Chinese language scores in ESL pharmacy students. Also, this English language correlation is stronger for females than males.

Correlation of the Pharmacy Curriculum Outcomes Assessment and Selected Pre-pharmacy and Pharmacy Performance Variables.

Objective. To identify the correlation between the Pharmacy Curriculum Outcomes Assessment (PCOA) and pre-pharmacy and pharmacy performance variables. Methods. Four years of PCOA data (2012-2015) were analyzed for students taking the assessment in the third professional year (P3). Using the Pearson correlation coefficient, data was correlated to a series of performance variables: pre-pharmacy grade point average (GPA), pre-pharmacy science GPA (pre-pharmacy science courses only), Pharmacy College Admission Test (PCAT) composite score, P3 pre-advanced pharmacy practice experience (APPE) GPA and the North American Pharmacist Licensure Examination (NAPLEX). Scores that were correlated at r ≥ 0.30 were added to a multivariate linear regression model to compare their unique contributions. Results. There was a moderate correlation between PCOA and PCAT (r=0.60), P3 pre-APPE GPA (r=0.60) and the NAPLEX (r=0.64). The multivariate regression analysis explained 60% of the variance of the total PCOA score, with PCAT making the largest unique contribution. Conclusion. The PCOA was moderately to strongly correlated to the pre-APPE GPA, thus providing an acceptable assessment of student learning. The PCOA was also moderately to strongly correlated to the NAPLEX, making it a useful tool in predicting performance and identifying students in need of further remediation before the NAPLEX.

Testing for medical school selection: What are prospective doctors' experiences and perceptions of the GAMSAT and what are the consequences of testing?

Written tests for selection into medicine have demonstrated reliability and there is accumulating evidence regarding their validity, but we know little about the broader impacts or consequences of medical school selection tests from the perspectives of key stakeholders. In this first Australian study of its kind, we use consequential validity as a theoretical lens to examine how medical school students and applicants view and experience the Graduate Medical Schools Admission Test (GAMSAT), and the consequences of testing. Participants (n = 447) were recruited from five graduate-entry medical schools across Australia and a publicly available online test preparation forum. An online survey was used to gather demographic information, and quantitative and qualitative data. Quantitative data were analysed via descriptive statistics and qualitative data were thematically analysed. The findings showed there was a considerable financial burden associated with preparing for and sitting the GAMSAT and moderate agreement regarding the GAMSAT as a fair selection method. The main unintended consequences of using the GAMSAT as a selection tool included barriers related to test affordability and language, and socialisation into the hidden curriculum of medicine. Selection tools such as the GAMSAT have some limitations when the goals are to support equitable participation in medicine and professional identity development. Our study highlights the value interpretive and theoretically-informed research in contributing to the evidence base on medical school selection.

How Medical School Applicant Race, Ethnicity, and Socioeconomic Status Relate to Multiple Mini-Interview-Based Admissions Outcomes: Findings From One Medical School.

PURPOSE: To examine associations of medical school applicant underrepresented minority (URM) status and socioeconomic status (SES) with Multiple Mini-Interview (MMI) invitation and performance and acceptance recommendation. METHOD: The authors conducted a correlational study of applicants submitting secondary applications to the University of California, Davis, School of Medicine, 2011-2013. URM applicants were black, Southeast Asian, Native American, Pacific Islander, and/or Hispanic. SES from eight application variables was modeled (0-1 score, higher score = lower SES). Regression analyses examined associations of URM status and SES with MMI invitation (yes/no), MMI score (mean of 10 station ratings, range 0-3), and admission committee recommendation (accept versus not), adjusting for age, sex, and academic performance. RESULTS: Of 7,964 secondary-application applicants, 19.7% were URM and 15.1% self-designated disadvantaged; 1,420 (17.8%) participated in the MMI and were evaluated for acceptance. URM status was not associated with MMI invitation (OR 1.14; 95% CI 0.98 to 1.33), MMI score (0.00-point difference, CI -0.08 to 0.08), or acceptance recommendation (OR 1.08; CI 0.69 to 1.68). Lower SES applicants were more likely to be invited to an MMI (OR 5.95; CI 4.76 to 7.44) and recommended for acceptance (OR 3.28; CI 1.79 to 6.00), but had lower MMI scores (-0.12 points, CI -0.23 to -0.01). CONCLUSIONS: MMI-based admissions did not disfavor URM applicants. Lower SES applicants had lower MMI scores but were more likely to be invited to an MMI and recommended for acceptance. Multischool collaborations should examine how MMI-based admissions affect URM and lower SES applicants.

Medical school admission test: advantages for students whose parents are medical doctors?

BACKGROUND: Admission candidates especially in medicine do not represent the socio-demographic proportions of the average population: children of parents with an academic background are highly overrepresented, and those with parents who are medical doctors represent quite a large and special group. At Göttingen University Medicine, a new admission procedure was established with the intention to broaden the base of applicants towards including candidates with previous medical training or lower final school grades. With a view to family background, we wished to know whether candidates differ in the test scores in our admission procedure. METHODS: In February 2014 we asked all admission candidates of Göttingen University Medicine by questionnaire (nine closed, four open questions) about the academic background in their families, specifically, the medical background, school exam grades, and previous medical training as well as about how they prepared for the admission test. We also analysed data from admission scores of this group (semi-structured interview and four multiple mini-interviews). In addition to descriptive statistics, we used a Pearson correlation, means comparisons (t-test, analysis of variance), ANOVA, and a Scheffé test. RESULTS: In February 2014 nearly half of the applicants (44%) at Göttingen University Medicine had a medical background, most frequently, their parents were physicians. This rate is much higher than reported in the literature. Other socio-demographic baseline data did not differ from the percentages given in the literature. Of all applicants, 20% had previous medical training. The group of applicants with parents who were medical doctors did not show any advantage in either test-scoring (MMI and interview), their individual preparation for the admission test, or in receiving or accepting a place at medical school. Candidates with parents who were medical doctors had scored slightly lower in school exam grades. CONCLUSION: Our results suggest that there is a self-selection bias as well as a pre-selection for this particular group of applicants. This effect has to be observed during future admission procedures.

The interaction of socio-economic status and gender in widening participation in medicine.

CONTEXT: The lack of representation of people from low socio-economic and socio-educational backgrounds in the medical profession is of growing concern and yet research investigating the problem typically studies recruitment and selection in isolation. This study examines the impacts of home and school socio-economic status (SES) from application to selection in an undergraduate medical degree. Socio-cognitive career theory and stereotype bias are used to explain why those from backgrounds of low SES may be disadvantaged, especially if they are female. METHODS: Home and high school SES information for 2955 applicants and 202 medical students at one Australian medical school was related to application rates and performance on three selection tests (high school matriculation, the Undergraduate Medical and Health Sciences Admissions Test [UMAT] cognitive ability test, a multiple mini-interview) and academic performance in medical school. Interactions between gender and SES were assessed using moderated regression analyses. RESULTS: Applicants from backgrounds of low SES were under-represented. They were further disadvantaged at selection by the use of high school matriculation and cognitive ability tests, but not by the interview. They did not perform more poorly in medical school. Although females applied in greater numbers, a significant interaction between SES and gender indicated that female applicants of low SES were the most disadvantaged by the use of cognitive ability testing at selection. A targeted allowance of applicants from regions of low SES overcame this adverse impact to some extent. CONCLUSIONS: Efforts to widen participation that focus on recruitment are insufficient when selection tests have adverse impacts on people from backgrounds of low SES. The addressing of low self-efficacy that arises from socio-cultural factors, together with reductions in stereotype threat, may reduce the current disadvantages imposed by SES in the medical profession.

Socio-economic predictors of performance in the Undergraduate Medicine and Health Sciences Admission Test (UMAT).

BACKGROUND: Entry from secondary school to Australian and New Zealand undergraduate medical schools has since the late 1990's increasingly relied on the Undergraduate Medicine and Health Sciences Admission Test (UMAT) as one of the selection factors. The UMAT consists of 3 sections - logical reasoning and problem solving (UMAT-1), understanding people (UMAT-2) and non-verbal reasoning (UMAT-3). One of the goals of using this test has been to enhance equity in the selection of students with the anticipation of an increase in the socioeconomic diversity in student cohorts. However there has been limited assessment as to whether UMAT performance itself might be influenced by socioeconomic background. METHODS: Between 2000 and 2012, 158,909 UMAT assessments were completed. From these, 118,085 cases have been identified where an Australian candidate was sitting for the first time during that period. Predictors of the total UMAT score, UMAT-1, UMAT-2 and UMAT-3 scores were entered into regression models and included gender, age, school type, language used at home, deciles for the Index of Relative Socioeconomic Advantage and Disadvantage score, the Accessibility/Remoteness Index of Australia (ARIA), self-identification as being of Aboriginal or Torres Strait Islander origin (ATSI) and current Australian state or territory of abode. RESULTS: A lower UMAT score was predicted by living in an area of relatively higher social disadvantage and lower social advantage. Other socioeconomic indicators were consistent with this observation with lower scores in those who self-identified as being of ATSI origin and higher scores evident in those from fee-paying independent school backgrounds compared to government schools. Lower scores were seen with increasing age, female gender and speaking any language other than English at home. Divergent effects of rurality were observed, with increased scores for UMAT-1 and UMAT-2, but decreasing UMAT-3 scores with increasing ARIA score. Significant state-based differences largely reflected substantial socio-demographic differences across Australian states and territories. CONCLUSIONS: Better performance by Australian candidates in the UMAT is linked to an increase in socio-economic advantage and reduced disadvantage.This observation provides a firm foundation for selection processes at medical schools in Australia that have incorporated affirmative action pathways to quarantine places for students from areas of socio-economic disadvantage.

Comparison of pre-medical academic achievement, entrance test and aptitude test scores in admission selection process.

OBJECTIVE: To compare the awards of various pre-medical academic achievements with aptitude test scores obtained by candidates taking the Entrance Test 2011, and to identify demographic differences in the trend, if any. METHODS: The cross-sectional study involved a 22-item aptitude test administered to all the students taking the Medical College Admission Test conducted by the University of Health Sciences, Lahore, on September 13, 2011. The Matriculation, Intermediate, EntranceTest and AptitudeTest scores of all the students along with their demographic variables were entered into SPSS 16 and statistically analysed by using parametric tests. A p value of < 0.05 was considered statistically significant. RESULTS: Out of the 32,746 students, 22,935 (70%) were females. Students who scored more than 75% marks (n = 4,723; 14%) also scored higher marks in the Aptitude Test (p < 0.05). Female candidates in general scored higher marks in the Entrance Test (p < 0.05) and in the Aptitude Test (p < 0.05). Overall, students from the economically and academically underdeveloped districts of Punjab scored less marks in the Entrance Test (p < 0.05) and the Aptitude Test (p < 0.05).The difference in Entrance Test and Aptitude Test marks of students from underdeveloped districts was greater than that of students for the developed districts (p < 0.05). However, in Matriculation and Intermediate examinations, students from the underdeveloped districts scored higher marks than the developed districts (p < 0.05). Students scoring higher marks in Matric and Intermediate, scored low marks in the Aptitude Test (p < 0.05). CONCLUSION: The Entrance Test and Aptitude Test scores correlated poorly with Intermediate and Matriculation scores. There is a need to strengthen the underdeveloped areas academically. Besides, the predictive value of the Aptitude Test scores related to future performance of candidates selected needs to be ascertained with further studies.

Do racial and ethnic group differences in performance on the MCAT exam reflect test bias?

The Medical College Admission Test (MCAT) is a standardized examination that assesses fundamental knowledge of scientific concepts, critical reasoning ability, and written communication skills. Medical school admission officers use MCAT scores, along with other measures of academic preparation and personal attributes, to select the applicants they consider the most likely to succeed in medical school. In 2008-2011, the committee charged with conducting a comprehensive review of the MCAT exam examined four issues: (1) whether racial and ethnic groups differ in mean MCAT scores, (2) whether any score differences are due to test bias, (3) how group differences may be explained, and (4) whether the MCAT exam is a barrier to medical school admission for black or Latino applicants. This analysis showed that black and Latino examinees' mean MCAT scores are lower than white examinees', mirroring differences on other standardized admission tests and in the average undergraduate grades of medical school applicants. However, there was no evidence that the MCAT exam is biased against black and Latino applicants as determined by their subsequent performance on selected medical school performance indicators. Among other factors which could contribute to mean differences in MCAT performance, whites, blacks, and Latinos interested in medicine differ with respect to parents' education and income. Admission data indicate that admission committees accept majority and minority applicants at similar rates, which suggests that medical students are selected on the basis of a combination of attributes and competencies rather than on MCAT scores alone.

Preparation courses for a medical admissions test: effectiveness contrasts with opinion.

OBJECTIVES: The Undergraduate Medicine and Health Sciences Admissions Test (UMAT) is used to rank applicants for admission to many medical schools. This study aimed to determine the effects of preparation courses on UMAT performance and on students' perceptions of their performance. METHODS: We asked students who sat the UMAT twice across two consecutive years to complete an online survey. The survey was administered in 2010 and 2011 to gather information on preparation activities, costs of preparation activities and students' opinions regarding their expected performance. Survey responses were compared with student scores on the second taking of the UMAT, adjusted for prior UMAT scores and university performance. RESULTS: The study (cohort: n = 263) was sufficiently powered to investigate two forms of preparation: courses offered by MedEntry (a UMAT preparation provider), and tutoring offered by the students' halls of residence. Neither was found to significantly affect UMAT score (p = 0.09 for MedEntry courses; p = 0.50 for halls of residence tutoring). There was no relationship between total time or money spent preparing and UMAT performance. However, students taking MedEntry courses and students spending more money on UMAT preparation were more likely to predict an improved score (p < 0.001 for both). A total of 85% of students improved their score on the second sitting, irrespective of preparation. CONCLUSIONS: The use of either of two common forms of UMAT preparation does not translate to an improvement in UMAT score. However, in accordance with confirmation bias theory, the association between money spent on preparatory courses and self-assessed predicted score suggests that students' belief in the effectiveness of such courses may be confounded by their financial outlay.

Causal effects of single-sex schools on college entrance exams and college attendance: random assignment in Seoul high schools.

Despite the voluminous literature on the potentials of single-sex schools, there is no consensus on the effects of single-sex schools because of student selection of school types. We exploit a unique feature of schooling in Seoul-the random assignment of students into single-sex versus coeducational high schools-to assess causal effects of single-sex schools on college entrance exam scores and college attendance. Our validation of the random assignment shows comparable socioeconomic backgrounds and prior academic achievement of students attending single-sex schools and coeducational schools, which increases the credibility of our causal estimates of single-sex school effects. The three-level hierarchical model shows that attending all-boys schools or all-girls schools, rather than coeducational schools, is significantly associated with higher average scores on Korean and English test scores. Applying the school district fixed-effects models, we find that single-sex schools produce a higher percentage of graduates who attended four-year colleges and a lower percentage of graduates who attended two-year junior colleges than do coeducational schools. The positive effects of single-sex schools remain substantial, even after we take into account various school-level variables, such as teacher quality, the student-teacher ratio, the proportion of students receiving lunch support, and whether the schools are public or private.

Students' perceptions of the Undergraduate Medicine and Health Sciences Admissions Test (UMAT).

AIM: Medical schools are still evaluating the place of general cognitive tests in medical student selection. This study explored medical student perceptions of UMAT, and how they prepared for taking the test. METHOD: Medical students at The University of Auckland and University of Otago in New Zealand were invited to complete a mixed-modality survey. RESULTS: Students had reservations, with 56% reporting UMAT is not an important test for medical students' selection and 67% that it is not a fair test. Eighty-one percent believe it is a stressful or very stressful test. The degree of importance or stress related to the weighting of UMAT in selection decisions. More than half of students spent more than $100 on books and $400 on courses to prepare for UMAT, in addition to the costs of sitting the test. CONCLUSION: At present, the majority of medical students in New Zealand who responded to the survey do not see UMAT as an acceptable test of non-cognitive attributes. It is costly to students and also stressful.

The role of socioeconomic status in SAT-grade relationships and in college admissions decisions.

This article examines the role of socioeconomic status (SES) in the relationships among college admissions-test scores, secondary school grades, and subsequent academic performance. Scores on the SAT (a test widely used in the admissions process in the United States), secondary school grades, college grades, and SES measures from 143,606 students at 110 colleges and universities were examined, and results of these analyses were compared with results obtained using a 41-school data set including scores from the prior version of the SAT and using University of California data from prior research on the role of SES. In all the data sets, the SAT showed incremental validity over secondary school grades in predicting subsequent academic performance, and this incremental relationship was not substantially affected by controlling for SES. The SES of enrolled students was very similar to that of specific schools' applicant pools, which suggests that the barrier to college for low-SES students in the United States is a lower rate of entering the college admissions process, rather than exclusion on the part of colleges.

The applicant pool: the genesis of the physician pipeline.

As medical schools across the nation consider the recent call made by the Association of American Medical Colleges to increase numbers of medical school students by 30% by 2015, it is important to explore the characteristics of the applicant pool. Understanding the make-up of the pool of recent applicants to the University of Kentucky College of Medicine can assist us in defining areas where the pool could be expanded in the future. Reviewing data from 2002-2006, we will examine the Kentucky county of origin of our applicants and matriculants. We will describe demographic characteristics of our applicants and matriculants with regard to gender, race and ethnicity, and international backgrounds. We will also look at factors that may discourage or dissuade prospective applicants from seeking admission to medical school including undergraduate grades, denial of the initial application to medical school, and cost considerations.

Admission to medical schools in Sri Lanka: predictive validity of selection criteria.

OBJECTIVE: To assess the extent to which current selection criteria predict success in Sri Lanka's medical schools. METHODS: The study sample consisted of all students selected to all six medical schools in two consecutive entry cohorts. The aggregate marks of these students at the General Certificate of Education (GCE) Advanced Level examination, the district of entry, admission category, candidate type (school/private) and gender, were identified as entry point variables. Success in medical school was measured in four ways: the ability to pass the first summative examination and the final examination at the first attempt, and obtaining honours in either examination. Multivariate analysis using logistic regression was used to assess the extent to which these entry point factors predict variability in outcome measures. RESULTS: Aggregate scores among the 1740 students in the study sample ranged from 212 to 356, with a median of 285. The male:female ratio was 1.4:1. Private candidates (taking the examination for the third time) accounted for 22% of students. Being a school candidate, female and having a higher aggregate score, were the only independent predictors of success for all four outcome measures. The aggregate score alone accounted for only 1-7% of the variation in performance in medical school. CONCLUSIONS: Marks obtained at the A Level examination (the only academic criterion currently used for selection of medical students in Sri Lanka) is a poor predictor of success in medical school.

A comparison of applicant and matriculant trends, and rising costs of medical education in United States medical schools and at the University of Kentucky College of Medicine.

This paper addresses fluctuations in the applicant and matriculant pools both across United States medical schools and at the University of Kentucky College of Medicine (UKCOM) for 1992-2002. It also presents data regarding the increasing costs of a medical education. Over the past decade, both nationally and at the UKCOM, there has been an over-all reduction in the number of applicants to medical school. In this changing applicant pool, the percentage of female matriculants has increased both nationally and at the UKCOM. However, the number of underrepresented minorities applying to and matriculating in the US and at the UKCOM has dropped since the mid-1990s. Although the applicant pool has decreased in size over the time period examined, the academic quality of applicants as measured by the undergraduate grade point average and Medical College Admission Test scores has increased both nationally and at UKCOM. Costs of a medical education have risen over time, as has the debt burden of medical school graduates due to increasing undergraduate debt, consumer debt, and medical school tuition. Potential causes for and implication of these changing trends are discussed.