Basco, W.T., Jr., Gilbert, G.E., & Blue, A.V.(2002). Determining the Consequences for Rural Applicants When Additional Consideration is Discontinued in a Medical School Admission Process. Academic Medicine, 77, S20-S22.

PURPOSE: Surveys completed by the Association of American Medical Colleges in 1993 and 1994 (unpublished) revealed that more than 60% of responding medical schools offered extra consideration at some point in the admission process to candidates likely to enter primary care, and rural applicants were frequently listed as one of those groups. Therefore, admission practices that favor applicants from rural areas are a logical component of a medical school's effort to produce rural practitioners. The purpose of this study was to evaluate the extent of the impact of discontinuing additional consideration to applicants from rural areas at one publicly-owned medical school in the Southeast. We tested the hypothesis that failure to adjust for rural applicant status has a marked adverse effect on the pre-interview ranks of rural applicants, resulting in fewer rural applicants' gaining admission interviews.

METHOD: At the medical school evaluated in this study (the Medical University of South Carolina College of Medicine), applicants are initially ranked employing a formula incorporating the undergraduate GPA, an adjustment to that GPA based on the selectivity of the applicant's undergraduate institution, and the Medical College Admission Test (MCAT) scores. This formula is unique to the medical school and produces a score called the academic profile (AP). The AP score has an empirical range of 2.58 to 14.90. The school's decision to adjust for selectivity was based on internal calculations comparing how medical students who graduated from undergraduate institutions having different selectivity strata performed during the medical school curriculum. Some adjustments were made to the AP score of all special-consideration applicants (i.e., rural applicants and URM applicants). The participants we chose for this study were the 1996, 1997, 1998, and 1999 in-state applicants. We calculated the AP score and resulting pre-interview rank of applicants (a) without adjustment for being a rural applicant, and (b) with adjustment for being a rural applicant. We also calculated the proportion of rural applicants who would have received admission interviews with adjustment for being a rural applicant and without, using the total number of interviews completed in the years evaluated as the reference point. Analyses were conducted separately for each class because the cohorts had varying proportions of rural applicants from year to year. Because of the multiple statistical tests we completed, we adjusted for the number of comparisons made (Bonferroni method).

RESULTS: There were 2,033 in-state applicants with complete data (not missing MCAT scores) in the four cohorts. Rural applicants comprised between 8.5% and 9.7% of applicants, depending on the year. MCAT science scores for rural applicants were significantly lower in three of the four, but Verbal Reasoning scores were not significantly different between rural and non-rural applicants. Mean GPAs were not significantly different either. In three of the four years, rural applicants were half as likely to have attended undergraduate schools in the more competitive Barron's categories, but these differences reached statistical significance in only one year-1998. Without the adjustment for rural applicant status, the median ranks of rural applicants were lower than those for non-rural applicants in all four years. Across all four years the adjustment for being a rural applicant had a marked positive effect for rural applicants while having minimal effects on non-rural applicants. The adjustment for rural status did not ensure an admission interview for every rural applicant, but it did mean that a large majority of the rural applicants received admission interviews in all four years. Without the adjustment, fewer than half of the rural applicants would have received admission interviews in two of the years evaluated-1997 and 1999.

CONCLUSION: This study illustrates the potential adverse effect of the changing environment in medical school admission upon the matriculation of rural applicants. We found a marked reduction in the proportion of rural applicants offered admission interviews when additional consideration and score adjustment were not applied. Rural applicants are a desirable group to the school studied and many other medical schools because data consistently show such applicants to be more likely to enter primary care and rural practice. The most significant limitation to this study is that it involved students who applied to only one Southeastern medical school. However, our applicants come from a wide variety of undergraduate schools (130 in the four cohorts evaluated here). In addition, we feel that our results are probably reflective of the experiences and applicant mixes of many publicly-owned medical schools. Nevertheless, replication of these calculations with applicants to other medical schools would certainly help assess the overall impact that discontinuing additional consideration policies may have on rural applicants.

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