Selection and lottery in medical school admissions: who gains and who loses?

Abstract

Concerns related to fairness of medical school admissions through selection have led some scholars to consider selection as an expensive lottery and suggest that lottery may be fairer. This paper considers the issue of selection versus lottery from the perspectives of three groups of stakeholders: 1) applicants, 2) medical schools, and 3) society. This paper contributes to the discussion by addressing advantages and disadvantages of the use of selection and lottery for these stakeholder groups, grounded in the findings from research. Themes that are discussed are reliability and validity issues, perceived influence on selection outcomes and student uptake, effects on student diversity, financial costs, impact on rejected applicants, transparency, and strategic behaviour. For each stakeholder group both lottery and selection yield a combination of advantages and disadvantages, which implies that none of the currently available admissions strategies completely fulfils stakeholders' needs. Research indicates that selection yields only small gains compared to a lottery procedure, while the student diversity, necessary for serving the increasingly diverse patient population, may be compromised. We argue that society's needs should drive admissions policies rather than institutional gains, which means that until a selection procedure is developed that does not disadvantage certain types of students, a lottery procedure should be preferred.

Diversity and Inclusion in Orthopaedic Surgery from Medical School to Practice

“…Recent increases in medical school diversity can be attributed to changes in selection criteria, recruitment programs, and more equitable entry requirements 15 . Schools have experimented with selection criteria, such as blinding Medical College Admission Test (MCAT) scores, offering combined degrees that do not require the MCAT, and even using a lottery system in certain countries [16][17][18] . While the MCAT historically has been shown to have no cultural bias, some authors have alluded to the differences in average scores being a result of institutional racism 19,20 .…”

Influence of social networks in healthcare on preparation for selection procedures of health professions education: a Dutch interview study

“…8 There is sufficient reason to assume that underrepresentation of non-traditional students is a global phenomenon, as evidence suggests that opportunities to enrol in HPE programmes are not equally available to all eligible students 9 10 : those with non-traditional backgrounds face barriers in selection procedures, and there are indications that they tend to shy away from applying to HPE programmes. [11][12][13][14] The latter is called self-selection. Self-selection refers to students deciding to apply or not based on the information they have 15 and how they estimate their chance of success based on actual and perceived barriers and facilitators.…”

“…These students can also become demotivated by the inequality they perceive. 14 However, the exact mechanisms behind how access to these social networks in healthcare can facilitate potential applicants are not clear. Other studies employing qualitative social network analyses in HPE have shown the importance of social networks of medical students in how they transition from preclinical to clinical training, and their networks’ role in accessing opportunities to learn 29 ; the influence of social networks on academic performance in medical school, 30 and how (not) having family members working in the medical field results in medical students being either ‘insiders’ versus ‘social newcomers’ to medicine.…”

Systematic review of specialist selection methods with implications for diversity in the medical workforce

“…In the absence of evidence of reliable selection methods that increase diversity, moving away from existing MSTS measures may leave URMs worse off [44], particularly if specialty programs revert to methods such as alumni networks, letters of recommendation, or other techniques that are biased towards those with greater resources. While acknowledging the trade-offs between the interests of patients, minorities, and society in general, some have argued that this lack of evidence justifies selection into medical training by a weighted lottery as the only existing method likely to be effective in achieving truly equitable levels of diversity in medical workforces [70].…”