Answer to "Should you take an individual’s context into account during selection?"

It may also be that schools need to completely rethink their approach to increasing diversity, to depend less on comparing the performance of diverse applicants on standardised selection tools, and shift more towards an individualised approach, which gives consideration to applicants’ background and life experiences, and what they can bring to medicine.  This is referred to as contextualised (UK) or holistic (USA) admissions, and is the focus of debates in the UK and the USA amongst other contexts.

A recent study in the UK found evidence that the average performance of the secondary or high school attended by an individual could be used to make contextual offers.

  • Mwandigha LM, Tiffin PA, Paton LW, et al What is the effect of secondary (high) schooling on subsequent medical school performance? A national, UK-based, cohort study BMJ Open 2018;8:e020291. doi: 10.1136/bmjopen-2017-020291

  • See also: Kumwenda B, Cleland JA, Walker K, Lee AJ, Greatrix R.  The relationship between school type and academic performance at medical school: a national, multi-cohort study.  BMJ Open 2017; 2017;7:e016291. doi:10.1136/bmjopen-2017-016291

While Girotti and colleagues showed that conditionalised admissions processes enabled less prepared applicants from underrepresented backgrounds to more readily integrate and succeed in medical school:

  • Girotti J, Park YS, Tekian A. 2015. Ensuring a Fair and Equitable Selection of Students to Serve Society’s Healthcare Needs. Medical Education. 49: 84-92.

However, there is, at this point, very little evidence for the use of holistic or contextualised admissions (HS/CA) (For an exception to this statement, see Kreiter CD. A measurement perspective on affirmative action in US medical education. Medical Education online. 2013 Jan 1;18(1):20531). This leads to a situation where medical schools may be supportive, in principle, of widening access via the use of holistic/contextualised admissions, but lack confidence and understanding about how and when to do so.  Medical schools want more evidence-based guidance in this matter.  To achieve this requires record keeping as to the use of HS/CA in practice.  Knowing what HS/CA has been used, and following up successful applicants admitted via the use of HS/CA through medical education and training is absolutely essential to improve the evidence base.  Good record keeping is essential!