The ranks of the medical profession have typically been filled by Anglo-Saxon males. A slow change in attitude appears to be leading toward a desire to increase diversity in the medical profession. Previous attempts to allow for increased representation of those underrepresented in medicine failed due to legal challenges. The Association of American Medical Colleges, an organization which oversees medical education, residency training, and research of both American and Canadian allopathic medical schools, has introduced Holistic Review as a method for creating a diverse population in a medical school class; this study investigates the way medical schools are incorporating these strategies into their medical school admissions policies and how effective these policies are in increasing diversity in medical school classes. The implication encourage admissions committees to modify the importance of certain selection criteria in an ongoing effort to increase diversity in their medical school classes.

Making decisions about whom to admit to medical school and how to create diversity in the process has come under increased scrutiny. An additional layer of complexity is introduced when committees utilize the AAMC's prescribed holistic review in addition to their institutional diversity policies. This comparative case study explores how two medical schools (one public and one private) are charged with implementing holistic review when challenged by the institutional culture which may resist a holistic approach. Through interviews, meeting observations, and document analysis, the study examines how and when diversity is introduced into the admissions process, and how diversity policies function in the overall medical school environment. Applying a framework of institutional isomorphism (DiMaggio & Powell, 1983), the study found that medical schools are highly concerned about a decrease in MCAT scores and coursework grades, which could negatively impact medical school rankings. It could also contribute to institutional inertia when introducing a new review process, causing resistance by admissions committee members. Additionally, admissions committees and leadership may differ regarding philosophical and historical factors that create bias within the process resulting in isomorphic change. Isomorphic change is a result of the ambiguity and the lack of institutional buy-in on various levels (DiMaggio & Powell, 1983). Virtual adoption (Birnbaum, 2000) is a result of an increased focus emulating processes of peer medical schools that misalign the school's priorities, creating confusion about how to address the national shortage of diverse physicians. Future research needs to account for additional influences on admissions decisions, including the impact of the current Fisher v. University of Texas case that may redefine how diversity is measured in medical school admissions.

abstract: More underrepresented minority (URM) healthcare professionals are needed to improve health equity. Although holistic review in admissions has the potential to increase URM participation in health professions, recent data suggest that its impact varies substantially. The purpose of the dissertation research described here was to identify interventions to increase diversity among healthcare professionals and explore holistic review use in physician assistant (PA) program admissions to advance understanding of effective practices. PA programs were selected as an important prototype for exploratory studies since the extent of holistic review use in PA programs was unknown; at the same time, URM representation among PA students has decreased over the last 15 years. A critical review of the literature revealed that various holistic review practices have been used by several health professions programs to successfully increase URM enrollment and that organizational culture may be a factor that promotes success. Following this, 2017 Physician Assistant Education Association survey data were analyzed to assess the frequency of holistic review in PA programs and examine its association with URM matriculation. Results from 221 of the 223 PA programs accredited at the time showed that 77.5% used holistic review, and its use modestly correlated with proportion of first-year students identified as ethnic minorities (rs = .20, p < .01). Of particular interest, some programs using holistic review had substantially higher proportions of URM students than others. This finding laid the foundation for a qualitative multiple case study to explore the role of organizational culture as a hypothesized antecedent to effective holistic admissions processes. Survey study responses were used to select two PA program ‘cases’ that met criteria consistent with a proposed conceptual framework linking organizational culture that values diversity (or ‘diversity culture’) to holistic admissions associated with high URM enrollment. Directed content analysis of data revealed that diversity culture appears to be a strong driver of practices that support enrolling diverse classes of students. Overall, this mixed methods program of research advances understanding of holistic review, its utility, and the influence of organizational culture. The research generated important insights with ramifications for current practice and future studies within PA and across health professions programs. / Dissertation/Thesis / Doctoral Dissertation Nursing and Healthcare Innovation 2019

abstract: This study determined if differences exist among the health professions advising community between factors (academic and non-academic) used as selection criteria in medical school admissions, as well as the impact of the holistic review in admissions on new admissions initiatives with respect to personal and professional backgrounds of advisors. The study examined the differences based on the gender, race and ethnicity, age, years of advising experience, institution size and type, classification and region of the population. Statistical analyses were conducted using comparison of means tests: one-sample t-tests and one-way ANOVA to determine the significance of differences for each of the variables. Significant differences were found to exist among the health professions advising community based on gender, race and ethnicity, institution type, classification of appointment, institution size and type. The findings of the study suggested that the personal and professional background of a health professions advisor did impact the perception of importance among the academic and non-academic factors used in the selection of medical students. The medical school admissions community should appreciate the unique viewpoints of the broader health professions advising community when building relationships and finding opportunities to collaborate. / Dissertation/Thesis / Ed.D. Educational Administration and Supervision 2012