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

PURPOSE: One-third of medical school applicants attend a community college (CC), and they represent a diverse group of applicants. However, they have a lower likelihood of being accepted to medical school. Using application-level data, this study examines how an applicant's CC attendance impacts the likelihood of application acceptance and how 3 medical school characteristics moderate this association. METHOD: Data examined were from 2,179,483 applications submitted to at least one of 146 U.S. Liaison Committee on Medical Education-accredited medical schools by 124,862 applicants between 2018 and 2020. The outcome was application acceptance. The main measures were applicants' CC attendance (no, lower [> 0%-19% of college course hours], or higher [≥ 20%]) and 3 medical school characteristics: geographic region, private versus public control, and admissions policy regarding CC coursework. Multilevel logistic regression models estimated the association between CC attendance and the likelihood of application acceptance and how this association was moderated by school characteristics. RESULTS: Among applicants, 23.8% (29,704/124,862) had lower CC attendance and 10.3% (12,819/124,862) had higher CC attendance. Regression results showed that, relative to no CC attendance, applications with lower (adjusted odds ratio [AOR] = .96; 95% confidence internal [CI], .94-.97) and higher (AOR = .78; 95% CI, .76-.81) CC attendance had significantly decreased odds of acceptance when the 3 school characteristics were included. Each of the 3 medical school characteristics significantly moderated the association between an applicant's CC attendance and the likelihood of application acceptance. CONCLUSIONS: The negative association between CC attendance and medical school application acceptance varies by medical school characteristics. Professional development for admissions officers focused on understanding the CC pathway and potential biases related to CC attendance would likely be beneficial in terms of trying to attract and select a diverse cohort of medical students in a holistic and equitable manner.

Holistic Review in Medical School Admissions and Selection: A Strategic, Mission-Driven Response to Shifting Societal Needs.

Medical schools and residency programs have always sought excellence in the areas of education, research, and clinical care. However, these pursuits are not accomplished within a vacuum-rather, they are continually and necessarily influenced by social, cultural, political, legal, and economic forces. Persistent demographic inequalities coupled with rapidly evolving biomedical research and a complex legal landscape heighten our collective awareness and emphasize the continued need to consider medicine's social contract when selecting, educating, and developing physicians and physician-scientists.Selection-who gains access to a medical education and to a career as a physician, researcher, and/or faculty member-is as much art as science. Quantitative assessments of applicants yield valuable information but fail to convey the full story of an applicant and the paths they have taken. Human judgment and evidence-based practice remain critical parts of implementing selection processes that yield the desired outcomes. Holistic review, in promoting the use of strategically designed, evidence-driven, mission-based, diversity-aware processes, provides a conceptual and practical framework for marrying the art with the science without sacrificing the unique value that each brings.In this Commentary, the authors situate medical student selection as both responsive to and informed by broader social context, health and health care needs, educational research and evidence, and state and federal law and policy. They propose that holistic review is a strategic, mission-driven, evidence-based process that recognizes diversity as critical to excellence, offers a flexible framework for selecting future physicians, and facilitates achieving institutional mission and addressing societal needs.