Online

Howe, Alison K.

Leadership and Developmental Sciences

2020

Ph. D.

Increasing diversity in the medical workforce is necessary to address public health needs and reduce health disparities, particularly in low-income and minority communities. The populations that experience these inequalities are the same populations that remain underrepresented in medicine. Research has demonstrated that social-concordance in the physician-patient dyad is associated with better patient outcomes and that students from underserved communities are more likely to return to practice in underserved areas. Despite academic medicine's continued commitment to admitting and training diverse individuals to address health disparities and increase cultural competency in medical students, a three-decade trend of the majority of medical students coming from socioeconomically privileged backgrounds continues. Research addressing access to medical education has focused mainly upon silos of gender, race, ethnicity, sexual orientation, and socioeconomic status and, therefore, does not realistically contextualize the backgrounds and experiences of applicants. The three papers in this dissertation represent an exploration of these issues within a national sample of applicants to United States medical schools (n=47,958) in 2018-2019. In the first manuscript, a person-centered quantitative analytical approach guided by the theory of intersectionality informed the creation of a 5-class advantage status typology and found that over half of applicants were classified into the most advantaged typology. The second paper builds upon this work to incorporate applicant demographic qualities and describe the composition of most-likely typology membership to explore further the interplay between demographics, privilege, and oppression. Privileged identity intersections correlated with belonging in advantaged typologies, while those historically associated with inequality had higher odds of mixed and disadvantaged typology membership. The third article examines the probability of typology membership against measures of success within the medical school application process. Findings demonstrated that advantaged applicants had higher academic metrics, applied broadly, and had higher odds of acceptance to at least one medical school. However, this association lessened when adjusting for applicant Medical College Admission Test scores, a standardized exam widely used by medical schools to assess applicant readiness. This exploratory research study contributes needed context to understand socioeconomic and sociodemographic diversity of the medical school applicant pool and heterogeneous outcomes in the admissions process. Exploring and describing these effects using methods that allow multiple applicant traits to co-exist is a first step toward enhancing medical school admissions' understanding of how to mitigate barriers to the accessibility of medical education. Reducing or eliminating these barriers may increase the diversity of medical students, thereby shaping the physician workforce to improve public health and effectively address health inequalities.