Admission to medical school is key to addressing medically underserved communities because over 90% of medical students graduate and become physicians. Yet, members of populations most likely to serve medically underserved communities as physicians remain chronically underrepresented in medical education despite initiatives aimed at increasing their representation among medical students. Meanwhile, traditional determinants of medical school admission fail to fully predict success in medical school, but have a disparate impact on applicants from underrepresented populations. Other determinants are underexplored, especially undergraduate institutional prestige. This study used a quantitative case study approach to examine the relationship between undergraduate institutional prestige, admission to medical school, and potential to serve medically underserved communities via specialty. Using a synthesis of the frameworks of symbolic capital, the iron triangle, and manifest and latent functions as a lens, this study analyzes (1) the relative impact of undergraduate institutional prestige on predicting admission to medical school holding constant the effect of traditional determinants of admission to medical school (i.e., MCAT, GPA), (2) how undergraduate institutional prestige varies by admissions stage, and (3) the relationship between undergraduate institutional prestige and specialty. Overall, findings show that undergraduate institutional prestige is important throughout the medical school admissions process; yet, undergraduate institutional prestige is not related to specialty. Nonetheless, findings imply preferences for applicants from more prestige undergraduate institutions may be contradictory to fulfilling organizational missions concerned with addressing healthcare disparities.

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.

The United States is a nation of peoples with highly stratified degrees of healthcare access and coverage, including many individuals with none at all. Exacerbating the problem of widespread health disparities is a persistent shortage of physicians over recent decades. Of most urgency is the need for doctors within already underserved minority communities. Extant research demonstrates that a more racially diverse student body can effectively address the nation's physician shortage and gross health disparities. Yet, the pool of future physicians of color relative to the increasingly racially diverse U.S. population remains incongruent. For medical school admissions committees, this is a formidable challenge, made ever more difficult by legal affronts to affirmative action in postsecondary admissions. Accordingly, the "disadvantaged status" prompt was inserted into the U.S. medical school application as a race-neutral mechanism with potential to help cull a more racially diverse medical student body. This project addresses the interface of minorities with the "disadvantaged status" essay, as there is a relative paucity of literature on the point of entry to medical school, particularly exploring the voices of applicants of color. Utilizing a Critical Race Theory (CRT) framework, this study expands the existing literature involving: (a) the history of minorities in U.S. medical school and the medical community's response to the stark and persistent absence of diversity among medical students and practitioners; (b) affirmative action in higher education and the race-neutral admissions trend; and (c) the enduring construct of "disadvantage" in regard to minorities within the U.S. education system.

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