Am I Disadvantaged? How Applicants Decide Whether to Use the Disadvantaged Status in the American Medical College Application Service

Abstract

Purpose To add to the limited research on the Disadvantaged Status, a component in the American Medical College Application Service (AMCAS) primary application, the authors explored how applicants to a medical school between 2014 and 2016 determined whether they were disadvantaged and whether to apply as such. Method The authors used case study methodology to explore the experiences of students at a medical school in the Northeast. The authors derived data from transcripts of semistructured interviews with students and the students’ AMCAS applications. Transcripts and applications were analyzed using a constant comparative approach and considered in the context of social comparison and impression management theories. Results Overall, the 15 student participants (8 used the Disadvantaged Status) had difficulty determining whether they were disadvantaged and how applying as such would affect their prospects. Contributing factors included ambiguity around both the term disadvantaged and its use in the admissions process. Simply experiencing hardship during childhood was insufficient for most participants to deem themselves disadvantaged. Participants’ decision processes were confounded by the need to rely on social comparisons to determine whether they were disadvantaged and impression management to decide whether to apply as such. Conclusions The ambiguous nature of the Disadvantaged Status, comparisons with even more disadvantaged peers, and uncertainty about how shared information might affect admission decisions distorted participants’ understandings of identity within the context of the application. The authors believe that many applicants who have experienced significant hardships/barriers are not using the Disadvantaged Status.

The Relationships among Self-Designated Disadvantage, Socioeconomic Disadvantage, and Academic Performance in Medical School: A Multi-Institutional Study

“…Other authors have raised concerns that applicants with significant hardship may be reluctant to use the SDA prompt. 22 Our data suggest a 'protective' effect of high SED on performance of SDA+ students (compared with low SED/ SDA+ students). We speculate high SED students may have developed additional resilience, grit, or success strategies through socioeconomic adversity 43 or academic enhancement programs for low-income students such as Mathematics, Engineering Science Achievement programs (MESA), 44 Federal TRIO Programs (TRIO), 45 and Summer Health Professions Education Programs.…”

“…28 As noted above, it is also possible that some applicants with significant hardships or barriers were reluctant to report SDA, due to concerns about negative reactions among application screeners. 22 Lastly, matriculants with missing data (13.5% of study sample) had higher academic metrics, which raises concern about generalizability.…”

“…21 A recent qualitative study highlighted the problematic definition of disadvantaged in the American Medical College Application Service (AMCAS) application and the challenges it poses for applicants. 22 In a previous simulation using data from applicants to the University of California Davis School of Medicine (UC Davis), we assembled eight indicators from the AMCAS application to create a continuous, multi-component scale of socioeconomic disadvantage (SED), a granular and potentially more reliable measure of disadvantage. 23 Students scoring 20 or greater on this 0-100 scale were considered socioeconomically disadvantaged (high SED) based on the receiver operating characteristics (ROC) as described below (see Methods).…”

Bias Against International Medical Graduates in the Hematology/Oncology Fellowship Recruitment Process: Findings From a Nationwide Survey of Fellowship Program Directors

“…12,13 In addition to race and ethnicity, diversity may include an applicant's experiences with overcoming cultural, language, socioeconomic, physical, or cognitive barriers. 13 Understanding and highlighting such factors help not only individuals who are URiM but also others who experience significant hardships affecting their social and educational advancement. With this in mind, although there is no standardized tool for measuring disadvantageness in medical education, perceptions of disadvantageness in the medical school and postgraduate training selection process are an important marker of how applicants and educators view DEI, particularly as institutions continue to redefine the groups that comprise DEI efforts.…”

“…11 As an example, the American Medical College Application Service has incorporated disadvantageness into the primary application for US medical schools, where applicants have the option to self-select the status disadvantaged to denote social, economic, educational, or other factors that may cause an applicant to be disadvantaged in the selection process; the inclusion of disadvantageness in the American Medical College Application Service application was specifically intended to augment DEI in the medical school selection process. 12,13 In addition to race and ethnicity, diversity may include an applicant's experiences with overcoming cultural, language, socioeconomic, physical, or cognitive barriers. 13 Understanding and highlighting such factors help not only individuals who are URiM but also others who experience significant hardships affecting their social and educational advancement.…”