Designing admissions policies to meet academic and non-academic selection aims while
ensuring fair access proves challenging [1, 2]. Cleland et al. have previously described
medical school admissions as a wicked problem, recognizing its complexity, describing
selection as dynamic rather than a static solution [3]. Admissions policies are adjusted
continuously in response to evaluations of their effectiveness as well as unintended
consequences, such as effects on equity. The struggle between a meritocratic approach
and the pursuit of equal opportunities is reflected in the rise of widening access
criteria and widening participation initiatives to mitigate the effects of admissions
policies on student diversity.
Over the past years, concerns about inequalities in admissions have yielded an increase
in research investigating the mechanisms through which non-traditional students (e.g.,
first generation higher education students, students from low socioeconomic backgrounds,
etc.) might be disadvantaged and their aspirations affected by admissions practices.
In this issue, Ball and colleagues contribute to our understanding of the experiences
of these students. They observe that non-traditional applicants use social comparison
to assess their suitability for the medical study and chances of success in the admissions
process [4]. Their paper contributes to our understanding of the importance of role
models. Furthermore, it raises questions about the effects being rejected may have
on all applicants, both from non-traditional and traditional backgrounds.
Previous research has shown the importance of role models, especially for non-traditional
applicants who usually lack representation of people ‘like them’ in medical education
and the medical profession [5–9]. The paper by Ball et al. brings to light how role
models contribute to these applicants’ aspirations and confidence to apply to medical
study. In addition, it reflects how non-traditional applicants’ limited sources of
the different types of capital as described by Bourdieu (social capital—e.g. connections
and networks; cultural capital—assets, e.g. competencies, skills, qualifications;
symbolic capital—reputation and prestige, thus strongly dependent on how others see
an individual; and economic capital—an individual’s wealth) can influence their confidence
to apply [10]. A lack of medical connections, especially with similar backgrounds
to theirs, makes it difficult for these applicants to prepare for selection [4, 6,
11] and envision themselves as being successful, all the more because they may encounter
negative and discouraging reactions in their personal environment and have difficulty
relying on their abilities and aspirations [4, 12]. Furthermore, these applicants
have to draw upon sources outside their close network to be able to understand their
position with regards to the selection criteria and their competitors. While other
applicants may be able to draw upon various types of capital such as cultural (knowledge
of the system and how to prepare) and social capital (obtaining relevant work experiences
through their network), non-traditional applicants often have difficulties navigating
the admissions process and lack relatable role models as sources for such capital
[13, 14]. Without expert allies it is not surprising that they strongly rely and focus
on non-social ‘objective’ test data, such as exam results [4]. In many countries,
however, academic achievement is known to be subject to influences from students’
capital as well (e.g., attending a private or public school). As a result, both medical
schools and applicants themselves may underestimate their academic ability. Uncertainty
about their academic ability and strong emphasis on exam results to reassure their
aspirations may deter non-traditional students from applying to medical school [15].
This accumulation of differences in capital between traditional and non-traditional
applicants widens the gap and poses challenges to fair and accessible medical education
[11].
The importance of non-social data to applicants may also have consequences further
along the admissions process. If applicants are rejected, this rejection now becomes
objective information which justifies their uncertainty and may guide future decisions
to reapply. Research about factors influencing applicants’ choices to reapply is scarce,
but personal perseverance and resilience seem important [4, 14]. Similar to the majority
of selection literature, the study by Ball et al. was limited to students who had—eventually—been
successful in selection. Lack of preparation was often their explanation for being
rejected in previous rounds. If this is caused by their lack of knowledge of the admissions
system (due to limited social capital) rather than an issue of poor motivation or
unsuitability, these non-traditional students should not be discouraged to apply again.
Furthermore, how applicants cope with rejection may differ between traditional and
non-traditional students, as well as the resources they need or have available to
do so. Drawing upon their available capital, traditional students may be better equipped
to rebuild their confidence after rejection and reapply to medical school. However,
non-traditional students, having overcome more barriers throughout their educational
pathway (e.g., discrimination experienced by ethnic minority students [16]), may have
built resilience to deal with rejection [5]. How applicants are effected by rejection
warrants further research.
It has been argued that non-traditional applicants may benefit from widening access
activities which include guidance by mentors [4, 11, 14]. I advocate a longitudinal
mentorship in which medical students who identify as non-traditional students themselves
coach applicants. This allows for social comparison with a relatable role model, and
could help these students acquire and utilize capital (e.g., building a relevant network,
gaining understanding of the hidden curriculum) as they navigate both towards and
through medical school [17, 18].
In conclusion, it is important to acknowledge the different admissions experiences,
needs and reactions traditional and non-traditional applicants may have. In using
the terms “non-traditional” and “traditional” students I do not mean to imply that
these are homogenous groups. To ensure fairness and equal opportunities we need more
insight into the variety of the experiences across the entire applicant population.