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Live-recorded presentation of the results including background, rationale, hypothesis, select results and analysis.

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Option #3: Brief Overview (Time to read: 15 minutes)

Background:

The stakes in the medical school admissions process are high and research in areas of medical education and medical school admissions process have been intense for decades. Universities spend a lot of time and resources hoping to select applicants most likely to become fantastic doctors in the future, possessing the essential core competencies & frameworks valued in the profession.

Professional misconduct and burnout could be prevented during the selection process by selecting the best-suited applicants for admission. However, professional misconduct and burnout remain of great concern for the profession, its reputation, and the healthcare recipients. Furthermore, previous reports suggest that the admissions process may cause bias against certain applicants and may not be able to detect intrinsic motivation. For example, our last 2 studies suggest that medical school admissions practices in Canada and the US are more likely to select extrinsically motivated applicants and may result in bias against applicants from lower income levels.

Selecting the right candidates during admissions could reduce these problems, and produce higher performers who are happy at their job. Ultimately the goal of any admissions screening process is to select intrinsically motivated applicants, while promoting diversity. Moreover, this is not limited to medicine and can have profound implications for any profession.

To date, researchers have used grades, standardized tests and situational judgment tests with mixed results. The goal of this study was to examine the impact of such practices on diversity and motivation of accepted pool of applicants.

For instance, McMaster University and a few of its researchers have been advocating for the use of situational judgment tests, namely, Multiple Mini Interview (MMI) and Computer-based Assessment for Sampling Personal Characteristics (CASPer), as better tools for selecting future medical doctors. The argument appears to indicate that such tools have better predictive power for detecting future behaviour and are fairer to applicants by reducing the implicit bias in admissions.

The authors of this study agree with McMaster’s researchers that the use of multiple, independent raters in evaluating applicants, along with time constraints, may theoretically improve the reliability and efficacy of any admissions screening process.

However, previous studies have indicated that such situational judgment tests may cause socioeconomic and gender bias. (1-5) Furthermore, such tests do not appear to detect the level of intrinsic motivation of applicants (6,7) and as such, are arguably unable to predict future on-the-job behaviour.

Importantly, to date, no independent studies of applicants accepted to McMaster’s medical school have been conducted to examine whether the admissions process at McMaster has been able to ameliorate the implicit bias in admissions and select intrinsically motivated applicants, to merit the continued use and expansion of situational judgment tests to other universities.

Given the selection methodology utilized by McMaster, a comparison between the accepted pool of applicants at McMaster’s medical school versus those accepted to other Canadian medical schools provides a means for determining the impact of situational judgment tests, GPA and MCAT on diversity and motivation of accepted pool of applicants. 

Key Highlights

• Medical school admissions practices favour higher income applicants: 50% of accepted applicants come from families earning at least $100,000 annually, with 16% from families with income in excess of $200,000 annually.
• Majority (70%) of accepted applicants are partially or completely extrinsically motivated to pursue medicine by status, financial gain, or familial tradition or pressure.
• Majority (54%) of accepted applicants identify themselves as Caucasian with only 26% from all minority groups.
• Selection based on MCAT and GPA appears to favour higher income applicants who score significantly higher than their disadvantaged peers.
• The use of situational judgment tests, CASPer and MMI, at McMaster and other universities that utilize them, does not appear to offer any significant advantage in promoting diversity nor in selecting intrinsically motivated applicants.
• Majority (55%) of accepted applicants to McMaster’s medical school come from families making at least $100,000 annually, with 19% coming from households with annual income in excess of $200,000; similar to applicants accepted to other Canadian medical schools.
• Majority (51%) of accepted applicants to McMaster’s medical school are self-identifying Caucasians; similar to applicants accepted to other Canadian medical schools.
• Majority (69%) of accepted applicants to McMaster’s medical school report they were partially or completely extrinsically motivated to pursue medicine by wealth, status, or familial tradition; similar to applicants accepted to other Canadian medical schools.

Admissions Favours Applicants from Higher Income Households

50% of accepted applicants come from families earning at least $100,000 annually, with 16% from families with income in excess of $200,000 annually.

In comparison, the median family household income in Canada is $70,336/year, according to Statistics Canada.

McMaster’s Medical School Admissions Process Appears to Favour Applicants from Higher Income Households Similar to Other Canadian Universities

McMaster’s medical school admissions process does not appear to show any significant advantage in its ability to promote wealth diversity compared to other Canadian medical schools.

Similar to other Canadian medical schools, a significant proportion (19%) of accepted applicants to McMaster medical school are from families with income in excess of $200K/year.

Caucasians are the Most Represented Group at Medical Schools Across Canada

Caucasians are the Most Represented Group at McMaster Medical School

McMaster’s medical school admissions process does not appear to show any significant advantage in its ability to promote racial/cultural diversity, compared to other Canadian medical schools.

Majority (51%) of accepted applicants to McMaster are self-identifying Caucasians, similar to other Canadian medical schools.

MCAT CARS Favours Applicants from Higher Income Households

MCAT CARS scores directly correlate with wealth.

Applicants from families with income in excess of $200K/year have significantly higher scores on the Critical Analysis and Reasoning Skills (CARS) or the Verbal Reasoning section of the Medical College Admission Test (MCAT), compared to those from families earning $40-200K/year, which in turn have significantly higher scores compared to those from families earning below $40K/year.

GPA Favours Applicants from Higher Income Households

GPA directly correlates with wealth.

Applicants from families earning over $200K/year have significantly higher GPA scores, compared to those from families earning $40-200K/year, which in turn have significantly higher GPA scores, compared to those from families earning below $40K/year.

MMI Appears to Favour Applicants from Higher Income Households

Multiple Mini Interview (MMI) does not appear to show any significant advantage in its ability to promote wealth diversity, compared to other admissions screening processes.

A significant proportion (17%) of accepted applicants screened using MMI are from families with an income in excess of $200K/year.

CASPer Appears to Favour Applicants from Higher Income Households

CASPer does not appear to show any significant advantage in its ability to promote wealth diversity, compared to other admissions screening processes.

A significant proportion (20%) of accepted applicants screened using CASPer are from families with an income in excess of $200K/year.

Extrinsic vs. Intrinsic Motivation

How Intrinsic Motivation Enhances Performance and Diversity

Over 40 years of research(8) has demonstrated that intrinsically motivated individuals:

• Perform better
• Persist longer
• Experience less burnout
• Enjoy greater life and job satisfaction

Intrinsic motivation does not correlate with:

• Gender
• Socioeconomic status
• Cultural background
• Racial background

For a comprehensive review of the literature along with references refer to Ryan, R. M., & Deci, E. L. (2017). Self-Determination Theory: Basic Psychological Needs in Motivation, Development, and Wellness. New York, NY, US: Guilford Press.

Majority of Accepted Applicants are Extrinsically Motivated

Majority (70%) of accepted applicants are partially or completely extrinsically motivated to pursue medicine by status, financial gain, or familial tradition or pressure.

Only 24% are intrinsically motivated and are willing to pursue medicine without external rewards. This population includes 21% indicating “To heal and be of service, even if it means to volunteer without pay.” and 3% indicating “To advance scientific discovery, even if it means to volunteer without pay.”

6% indicated "other".

McMaster’s MD Admissions Process Appears to Select Extrinsically Motivated Applicants Similar to Other Canadian Universities

McMaster’s medical school admissions process does not appear to show any significant advantage in its ability to select intrinsically motivated applicants, compared to other Canadian medical schools.

Similar to other Canadian medical schools, majority (69%) of accepted applicants by McMaster are partially or completely extrinsically motivated to pursue medicine by status, financial gain, or familial tradition or pressure.

MCAT CARS Appears to Select Extrinsically Motivated Applicants

MCAT CARS does not appear to be able to select intrinsically motivated applicants.

Majority of applicants (63 to 69%) selected using MCAT CARS are partially or completely extrinsically motivated to pursue medicine by status, financial gain, or familial tradition or pressure.

GPA Appears to Select Extrinsically Motivated Applicants

GPA does not appear to be able to select intrinsically motivated applicants.

Majority of applicants (57 to 71%) selected using GPA are partially or completely extrinsically motivated to pursue medicine by status, financial gain, or familial tradition or pressure.

While statistically insignificant in this study, higher GPA scores appear to correlate with extrinsic motivation. 

MMI Appears to Select Extrinsically Motivated Applicants

Multiple Mini Interview (MMI) does not appear to show any significant advantage in its ability to select intrinsically motivated applicants.

Similar to applicants selected without MMI, a significant proportion (70%) of accepted applicants selected using MMI are partially or completely extrinsically motivated to pursue medicine by status, financial gain, or familial tradition/pressure.

CASPer Appears to Select Extrinsically Motivated Applicants

CASPer does not appear to show any significant advantage in its ability to select intrinsically motivated applicants.

Similar to applicants selected without CASPer, a significant proportion (69%) of accepted applicants selected using CASPer are partially or completely extrinsically motivated to pursue medicine by status, financial gain, or familial tradition or pressure.

Conclusions According to the Results of the Study

• McMaster’s medical school admissions process does not appear to offer any significant advantage over other Canadian medical schools’ admissions process in promoting diversity.
• McMaster’s medical school admissions process does not appear to offer any significant advantage over other Canadian medical schools’ admissions process in selecting intrinsically motivated applicants.
• CASPer and MMI do not appear to offer any significant advantage in promoting diversity or selecting intrinsically motivated applicants at McMaster and other Canadian universities that utilize them, compared to those that do not utilize such tools during their admissions process.
• MCAT CARS, GPA, CASPer, and MMI appear to favour applicants from higher income households.

About the survey:

The survey was completed using Qualtrics survey software with a representative sample of 426 Canadian medical school students and residents in comparison with a randomly selected survey of 314 students and residents from McMaster medical school. A probability sample of the same size would yield a margin of error +/- 5%, 19 times out of 20.

About SortSmart®:

SortSmart Candidate Selection Inc. (“SortSmart”) is the pioneer of motivation-based applicant screening. It develops applicant screening software for university admissions and employee selection with an emphasis on selection based on intrinsic motivation. SortSmart’s mission is to promote diversity and reduce barriers to access in higher education. Its software is designed to decrease the time and resources required to select the best fit applicants. SortSmart is the only company that offers the use of its software to educational institutions and their applicants at no cost.  For more information, including media inquiries, contact us at info [at] sortsmart.com

References:

1. Jean-Michel Leduc, Richard Rioux, Robert Gagnon, Christian Bourdy & Ashley Dennis (2017) Impact of Sociodemographic Characteristics of Applicants in Multiple Mini-Interviews, Medical Teacher, 39:3, 285-294.

2. Jerant A, Fancher T, Fenton JJ, Fiscella K, Sousa F, Franks P, Henderson M. How Medical School Applicant Race, Ethnicity, and Socioeconomic Status Relate to Multiple Mini-Interview-Based Admissions Outcomes: Findings From One Medical School. Acad Med. 2015 Dec;90(12):1667-74.

3. Ross M, Walker I, Cooke L, Raman M, Ravani P, Coderre S, McLaughlin K. Are Female Applicants Rated Higher Than Males on the Multiple Mini-Interview? Findings From the University of Calgary. Acad Med. 2017 Jun;92(6):841-846.

4. Henderson MC, Kelly CJ, Griffin E, Hall TR, Jerant A, Peterson EM, Rainwater JA, Sousa FJ, Wofsy D, Franks P. Medical School Applicant Characteristics Associated With Performance in Multiple Mini-Interviews Versus Traditional Interviews: A Multi-Institutional Study. Academic Medicine: July 2018 - Volume 93 - Issue 7 - p 1029–1034.

5. Fern Juster. What Impact Does an SJT Have on Diversity Recruitment at a US Allopathic Medical School with a Commitment to Diversity and Inclusion? April 2016, Canadian Conference on Medical Education (CCME), Montreal, Canada.

6. SortSmart American Medical School Admissions Research. https://sortsmart.com/blog/united-states-medical-school-admissions-study

7. SortSmart Canadian Medical School Admissions Research. https://sortsmart.com/blog/canadian-medical-school-admissions-study

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