Selection tools and student diversity in health professions education: a multi-site study.

Student diversity in health professions education (HPE) can be affected by selection procedures. Little is known about how different selection tools impact student diversity across programs using different combinations of traditional and broadened selection criteria. The present multi-site study examined the chances in selection of subgroups of applicants to HPE undergraduate programs with distinctive selection procedures, and their performance on corresponding selection tools. Probability of selection of subgroups (based on gender, migration background, prior education, parental education) of applicants (N = 1935) to five selection procedures of corresponding Dutch HPE undergraduate programs was estimated using multilevel logistic regression. Multilevel linear regression was used to analyze performance on four tools: prior-education grade point average (pe-GPA), biomedical knowledge test, curriculum-sampling test, and curriculum vitae (CV). First-generation Western immigrants and applicants with a foreign education background were significantly less likely to be selected than applicants without a migration background and with pre-university education. These effects did not vary across programs. More variability in effects was found between different selection tools. Compared to women, men performed significantly poorer on CVs, while they had higher scores on biomedical knowledge tests. Applicants with a non-Western migration background scored lower on curriculum-sampling tests. First-generation Western immigrants had lower CV-scores. First-generation university applicants had significantly lower pe-GPAs. There was a variety in effects for applicants with different alternative forms of prior education. For curriculum-sampling tests and CVs, effects varied across programs. Our findings highlight the need for continuous evaluation, identifying best practices within existing tools, and applying alternative tools.

Gender-based differences in letters of recommendation in applications for general surgery residency programs in Canada.

BACKGROUND: In Canada, residency programs do not have many objective measures for ranking candidates. Instead, ranking relies on subjective measures such as letters of reference, which can be affected by the genders of the writer and the applicant. Our study assesses letters of recommendation for a general surgery program in Canada to categorize differences in reference letters based on the genders of applicant and letter writer. METHODS: We assessed 215 reference letters from 51 general surgery candidates for systematic differences in the descriptors used for male and female applicants and differences based on male and female authorship. RESULTS: Female applicants were more often described as mature, pleasant and flexible. Male applicants were more often described as having initiative, completing research, earning awards and performing extracurricular activities. Female writers were more likely to highlight an applicant's interest, initiative, response to feedback, knowledge of their limits, flexibility, communication, achievement in research and awards, confidence and ability to be a good assistant. Significantly more female applicants had female letter writers, compared with male applicants. CONCLUSION: These differences may affect the acceptance of applicants based on their gender and the genders of people who recommend them. Future research is required to explore how these differences in how applicants are described may affect residency selection committees' perceptions and rankings of applicants.

How is increased selectivity of medical school admissions associated with physicians' career choice? A Japanese experience.

BACKGROUND: During the long-lasting economic stagnation, the popularity of medical school has dramatically increased among pre-medical students in Japan. This is primarily due to the belief that medicine is generally a recession-proof career. As a result, pre-medical students today who want to enter medical school have to pass a more rigorous entrance examination than that in the 1980s. This paper explores the association between the selectivity of medical school admissions and graduates' later career choices. METHODS: A unique continuous measure of the selectivity of medical school admissions from 1980 to 2017, which is defined as the deviation value of medical schools, was merged with cross-sectional data of 122 990 physicians aged 35 to 55 years. The association between the deviation value of medical schools and various measures of physicians' career choices was explored by logistic and ordinary least square regression models. Graduates from medical schools in which the deviation value was less than 55 were compared with those from more competitive medical schools, after controlling for fixed effects for the medical school attended by binary variables. RESULTS: From 1980 to 2017, the average deviation value increased from 58.3 to 66.3, indicating a large increase in admission selectivity. Empirical results suggest that increasing selectivity of a medical school is associated with graduates having a higher probability of choosing a career in an acute hospital as well as having a lower probability of opening their own clinic and choosing a career in primary health care. Graduating from a highly competitive medical school (i.e., deviation value of more than 65) significantly increases the probability of working at typical acute hospitals such as so-called 7:1 hospitals (OR 1.665 2, 95%CI 1.444 0-1.920 4) and decreases the probability of working at primary care facilities (OR 0.602 6, 95%CI 0.441 2-0.823 0). It is also associated with graduates having a higher probability of becoming medical board certified (OR 1.294 6, 95%CI 1.108 8-1.511 4). CONCLUSION: Overall, this paper concludes that increased selectivity of medical school admissions predicts a higher quality of physicians in their own specialty, but at the same time, it is associated with a lower supply of physicians who go into primary care.

Reforming medical education admission and training in low- and middle-income countries: who gets admitted and why it matters.

Recent studies reveal public-sector healthcare providers in low- and middle-income countries (LMICs) are frequently absent from work, solicit informal payments for service delivery, and engage in disrespectful or abusive treatment of patients. While extrinsic factors may foster and facilitate these negative practices, it is not often feasible to alter the external environment in low-resource settings. In contrast, healthcare professionals with strong intrinsic motivation and a desire to serve the needs of their community are less likely to engage in these negative behaviors and may draw upon internal incentives to deliver a high quality of care. Reforming medical education admission and training practices in LMICs is one promising strategy for increasing the prevalence of medical professionals with strong intrinsic motivation.

An Analysis of the Optometric Applicant Pool Relative to Matriculants.

SIGNIFICANCE: The interplay of applicants to optometry school and matriculants has not been explored systematically. It is vital that the profession examines these trends to ensure a viable pipeline of future doctors of optometry. PURPOSE: The purpose of this study was to describe the demographics and academic qualifications of entering optometry classes from autumn 2010 through autumn 2018 of U.S.-based optometric institutions' application pool and matriculants (enrollees). METHODS: Data were gathered from reports generated from accredited schools and colleges of optometry in the United States and compiled by the Association of Schools and Colleges of Optometry (publicly available) and the Optometry Centralized Application Service. Metrics included the annual number of verified applicants, the annual number of matriculants, the home region of U.S.-based applicants, and the Optometry Admission Test (OAT) performance and grade point average of verified applicants. RESULTS: The number of verified applicants for autumn 2018 was 0.95% higher than that for autumn 2010, yet the number of matriculants in 2018 compared with 2010 increased by 11.2% with an applicant-to-matriculant ratio in 2010 of 1.53 compared with 1.39 in 2018. Grade point average and academic average OAT scores were stable from 2010 to 2018. The ratios of verified applicants with an academic average OAT score of at least 300 to matriculants were 0.87 for autumn 2018 and 0.92 for autumn 2010. The ratios of verified applicants with a grade point average of at least 3.00 to matriculants were 1.13 for autumn 2018 and 1.23 for autumn 2015. CONCLUSIONS: Evidence supports the conclusion that the applicant pool has remained essentially flat for the last decade, whereas the number of matriculants has increased substantially; thus, the number of qualified applicants to matriculants has logically decreased. In the last 2 years, optometric programs have responded by decreasing their institution's number of matriculants to accommodate the national trends.

Review and analysis of Chilean dental undergraduate education: curriculum composition and profiles of first year dental students.

BACKGROUND: In Chile, dentistry has become a very popular career choice for students, which has resulted in a substantial increase in both, the number of dental graduates and dental schools. Nonetheless, there is a need for change in the way dental schools select and educate their students to keep pace with the rapidly changing nature of societal needs and to tackle the marked health inequalities that exist in the country. The aim of this study was to review and critique dental undergraduate education in Chile, with a particular focus on the curriculum composition and profiles of students admitted to dental schools from 2010 to 2014. METHODS: A descriptive and retrospective design was utilised. Two different methods were undertaken: primary data collection regarding curriculum and secondary data analysis in relation to students' profiles. Descriptive statistics were used to assess the relative proportions of subject modules within the undergraduate dental curriculum and in particular the public health components. The analysis of the student profiles described specific background factors, namely, gender, age, secondary school type, location, rural-urban status and student's year of admission. Also, trends of dental students' intake between 2010 and 2014 were investigated. Logistic regression analysis was undertaken to assess potential associations between the aforementioned background factors and students' choice of dental school. RESULTS: Regarding the curriculum review, a 67% response rate was obtained. The most dominant component of Chilean dental curriculum was the clinical subjects (33%), followed by the basic and biological sciences (16%) and then medical and dental sciences (13%). In relation to the admission of students, the majority attended private schools (72%); most were females (62%); aged 19 years or less (74%); had an urban origin (99%); and came from subsidised private secondary schools (48%). Significant differences were found between students admitted to traditional and private dental schools. CONCLUSIONS: Clinical sciences are the most dominant subjects in the Chilean dental curriculum. Overall, traditional and private institutions had a broadly similar composition in their curriculum with the exception of the public health component. Students from disadvantaged backgrounds were the minority in dental schools across Chile.

Educational renewal of physician training in Australia and New Zealand: Multiple educational innovations in a complex environment.

AIM: The Royal Australasian College of Physicians is renewing its specialty training programs and shifting towards competency-based medical education. Our aim is to improve the quality and rigor of training and graduate outcomes, and promote high standards of physician practice to serve the health of patients, families, and communities in a changing healthcare environment. METHODS: We are progressing holistic change and multiple educational innovations in a complex environment. Numerous stakeholders, a disparate training landscape and a largely volunteer supervisor workforce pose challenges in supporting effective implementation. This paper describes our progress and experience with three key components of our education renewal program: curricular renewal, a new selection process and faculty development. It offers reflections on the practical challenges, lessons learned and factors critical for success. CONCLUSIONS: Our experience highlights opportunities for training organizations to maximize their influence over workplace training experiences and outcomes by taking a systems approach to the design, delivery and evaluation of the components of education renewal. We found that design, development and delivery of our multiple educational innovations have benefited from co-design approaches, progressive and concurrent development, continual exploration of new strategies, and implementation as soon as viable with a commitment to iterative improvements over time.

A public health e-learning master's programme with a focus on health workforce development targeting francophone Africa: the University of Geneva experience.

BACKGROUND: Shortage of a competent public health workforce is as a worldwide problem. The situation is especially bad in sub-Saharan Africa. In 2008, the World Health Organization and the Global Health Workforce Alliance launched a call for proposals for a public health training programme with an emphasis on health workforce development specifically targeting Africa. Our article presents the development, implementation and evaluation of an e-learning Master of Advanced Studies in Public Health on Workforce Development. The project was developed in collaboration with academic partner institutions of 10 French-speaking African countries and local/regional/HQ WHO offices. METHODS: A five-step approach was adopted. First, a needs assessment study was done in the target countries, with identification of priority health issues. Second, student and tutor selection was done in collaboration with local WHO offices, health authorities and partner universities. Third, the e-platform was developed and a training workshop for tutors was organized. Fourth, the learning objectives were derived from the needs assessment study and an interactive educational approach was adopted. Fifth, the participation of students, their perception of the programme, their performance on assignments and community outcomes were monitored. RESULTS: The needs assessment allowed the identification of 12 priority health issues (trauma related to road accidents, maternal and child health, HIV/AIDS, mental heath, food and malnutrition, health resource management, infectious diseases, access to essential drugs, chronic diseases, health promotion, ageing and violence/conflicts) of which 10 were studied through the lens of the key public health disciplines (epidemiology, human resources, health project/service planning, health policy, communication, health economics/management, informatics and ethics/human rights), each validated through a certifying examination. Student participation, measured through connection hits (total: 58 256; mean: 168/student/module) and posted messages (total: 5994; mean: 18/student/module), was good, and global satisfaction was high (7.7/10). Twenty-nine students out of 37 obtained their master's degree from the University of Geneva. Outcomes reported include career development, strengthening of inter-country networks and common projects. CONCLUSIONS: Keys to the success of the programme were the enthusiasm and commitment of students, the availability of the coordination team, the simplicity of the electronic platform and the support of local/regional/WHO offices. Yet, the sustainability of the programme is not assured.

A study on the correlation between program contact hours and the successful matriculation into college.

Area Health Education Centers (AHECs) play an important role in the recruitment and training of students to serve as practicing health care professionals in rural, primary care, and medically underserved communities. To analyze the relationship between the accumulated contact hours of past students in AHEC programs and their known matriculation into college. 5,189 students, whom participated in Indiana AHEC Network programs, were grouped into eight categories based on accumulated contact hours and matched against two college matriculation databases. The relationship between the number of accumulated contact hours and known college matriculation was statistically significant. The analysis of the data suggests two significant break points in which the number of accumulated contact hours appears to be correlated with increased known college matriculation. The findings indicate accumulated contact hours are significantly correlated with known college matriculation. Furthermore, two significant break points in contact hours at the 5 and 20 contact hours demonstrated increased correlations between program contact hours and known college matriculation. The results of this analysis between participation in area health education center programming and matriculation into higher education may be transferable to other areas of health education.

Predicting success in nurse anesthesia programs: an evidence-based review of admission criteria.

Nurse anesthesia programs strive to minimize attrition due to academic reasons and maximize student success. The authors examined the evidence for evaluating applicants to nurse anesthesia programs that may help predict success in the program and on the National Certification Examination for Nurse Anesthetists. A search strategy guided gathering of evidence from peer-reviewed journals. Evidence from non-anesthesia graduate nursing programs was included because of the suspected lack of evidence specifically examining nurse anesthesia programs. Eight sources involved solely graduate nurse anesthesia programs, 9 involved graduate nursing programs without stu-graduate nursing programs with student registered Nurdent registered nurse anesthetists, and 2 pertained to nurse anesthetists. Most of the evidence sources were descriptive studies. The evidence overall supports current commonly used admissions criteria such as undergraduate grade point averages. The requirement for applicants to take the Graduate Record Examination should be examined closely. Programs should also consider the length of time the applicant has been out of a formal educational setting. Based on these findings, programs may cautiously explore revising the admission policy. Further investigations are proposed to explore the predictive value of various admission criteria.

Admissions Interviews: How History Can Pave the Way Toward a Holistic Future in Military PA Program Admissions and Hiring.

Admissions processes for graduate health professions, including physician assistant (PA) and medical school, were built over time through trial and error. Admissions process research was not common until the early 1990s, and it seemingly began because the system of admitting applicants solely on the basis of the highest academic metrics resulted in unacceptable attrition rates. Recognizing interpersonal attributes were unique from academic metrics and critical to success in medical education, admissions interviews were added as a component of the admissions process and have since become nearly ubiquitous for medical and PA applicants. Understanding the history of admissions interviews informs ways to optimize admissions processes for the future. The PA profession was originally comprised entirely of military veterans with extensive medical training during their service; the number of service members and veterans matriculating has significantly decreased and is not reflective of the percentage of veterans in the US. Most PA programs receive applications in excess of available seats; yet, based on the 2019 PAEA Curriculum Report, the all-cause attrition rate is 7.4%. Given the large pool of applicants available to select from, it is valuable to identify students who will succeed and graduate. This is especially critical for the Interservice Physician Assistant Program, the US Military's PA program, to optimize force readiness by ensuring sufficient PAs are available. Utilizing a holistic admissions process, considered best practice in admissions, is an evidence-based way to decrease attrition and support increased diversity, including increasing the number of veterans becoming PAs, by considering the breadth of an applicant's life experiences, personal attributes, and academic metrics. The outcomes of admissions interviews are high-stakes for the program and applicants, as they are often the final step prior to admissions decisions. Additionally, there is considerable overlap between the principles of admissions interviews and job interviews, the latter of which may occur as a military PA's career unfolds and they are considered for special assignments. Though numerous different interview modalities exist, multiple mini-interviews (MMI) are highly-structured, effective, and are supportive of a holistic admissions approach. Through examining historical admissions trends, identifying a modern way to select applicants through holistic admissions can support decreased student deceleration and attrition and increased diversity, optimizing force readiness and supporting the success of the PA profession into the future.

When standardized testing is not standardized.

Standardized testing has been utilized by K-12 schools, undergraduate and graduate programs, as well as employers. Historically, it has been seen as an efficacious way to identify the best performing candidates to receive program entry or move forward in a hiring process. However, there is significant evidence mounting about the limitations of standardized testing and, yet, we persist with them because of their relative ease. The purpose of this perspective paper is to begin a conversation about the place of standardized tests in dental education and its relationship to institution goals related to diversity, equity, and inclusion.

Does Community College Attendance Affect Matriculation to a Physician Assistant Program? A Pathway to Increase Diversity in the Health Professions.

PURPOSE: To explore whether community college (CC) applicants were a significant contributor to the diversity of matriculants to physician assistant (PA) programs and whether CC applicants were less likely to matriculate to PA programs than non-CC applicants. METHOD: The authors used national data from the 2016-2017 application cycle. They categorized applicants to PA programs into 5 pathways: HS-CC (applicant attended CC while in high school), first-CC (applicant attended CC before a 4-year university), 4Y-CC (applicant attended CC while at a 4-year university), post-CC (applicant attended CC after graduating from a 4-year university), and no-CC (applicant never attended CC). The authors used Pearson chi-square and Kruskal-Wallis H tests and the appropriate post hoc tests to assess whether applicants in the 4 CC pathways were more diverse in terms of their race, ethnicity, gender, rurality, and socioeconomic status than those in the no-CC pathway. They used logistic regressions to assess associations between the CC pathways and matriculation to a PA program. RESULTS: Among the 8,577 matriculants in the 2016-2017 application cycle, more than 75% attended a CC at some point. First-CC and post-CC matriculants were more likely to be Black (P < .001) or Hispanic (P < .001) and come from a disadvantaged background (P < .001) than no-CC matriculants. After adjusting for applicant demographics, academic performance, rurality and socioeconomic status, and application strategy, first-CC applicants had 17% lower odds of matriculating to a PA program than no-CC applicants (P < .001). CONCLUSIONS: CCs are an important pathway to the PA profession, with 3 of 4 matriculants having a CC background. However, lower matriculation rates among similarly qualified applicants who transferred from a CC to a 4-year university than among applicants with no-CC background suggest that PA programs are missing important opportunities for increasing student diversity and thereby the profession.

Predictive Ability of Multiple Mini-Interviews in Admissions on Programmatic Academic Achievement: A Systematic Review.

BACKGROUND: Multiple mini-interviews (MMI) are emerging as the preferred interview format for admittance to health professions training programs. OBJECTIVE: Evaluate the evidence regarding MMI as a predictor of programmatic academic achievement in graduate health professions train¬ing programs. METHODS: Using the PRISMA method, two literature searches on PubMed and Google Scholar of publications from 2004-2019 were completed, identifying 7 unique references pertinent to the review's objective. Head-to-head comparative analysis was completed between articles that had similar outcomes in addition to cumulative analysis of all included studies. RESULTS: Of the 7 articles included in this systematic review, all had at least one statistically significant correlation between MMI used for admissions and programmatic academic achievement in graduate health professions training programs. Outcomes assessed were highly variable and included specific assessments, cumulative program GPA, and clinical performance. Studies from four unique health professions--dentistry, medicine, physician associate, and pharmacy--were included in the review. CONCLUSIONS: Evidence indicates that MMI are an effective, valid, and reliable admissions interview format to identify future programmatic academic achievement of graduate health professions training students in specific scenarios. A head-to-head analysis comparing MMI with more traditional interview formats, particularly on an entire pool of qualified applicants, would be beneficial to assess for superiority.

Examination of Similarities and Quantitative Analysis of Trends Between Admissions Variables and Academic Outcomes.

PURPOSE: The purpose of this study was to analyze similarities and trends between admissions variables and academic outcomes of physician assistant (PA) graduate programs to better understand the correlations between them. METHODS: First, multiple admissions variables were examined individually to determine whether and, if so, why they were similar to each of the following 3 academic outcomes: students' first-time Physician Assistant National Certifying Exam scores and overall and first-term graduate school grade point averages (GPAs). Afterward, trends between those individual academic outcome variables and the independent variables associated with any admissions criteria found to share similarities with individual academic outcomes were analyzed using simultaneous multiple linear regression models. Each model used at least 562 students from a sample set of 566 across 3 different PA graduate school programs. RESULTS: Undergraduate GPAs and Graduate Record Examination (GRE) Verbal Reasoning and Quantitative Reasoning scores shared similarities with each academic outcome, and those similarities were included in each regression model. In each model, the undergraduate GPA beta coefficient was greater than the value of the GRE beta coefficients. CONCLUSIONS: Based on the beta coefficient values, the undergraduate GPA variable appeared to be the nonbinary and non-age-independent variable that trended upward the strongest alongside increases in each academic outcome when other variables were controlled for.