Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Lottery docs? Randomize medical school admissions for fairness

Caspian Kuma Folmsbee, MD
Education
December 9, 2020
161 Shares
Share
Tweet
Share

It’s this simple: The medical school admissions system is bloated and reinforces implicit and systemic biases leading to further social inequity.

Medical schools across the country are going through thousands of applications and making literal life-changing choices for these students. Introducing randomization into the admission process would simplify and address the built-in issues in this process.

Admissions tests do not determine the quality of a doctor’s care.

As the COVID pandemic has shifted many societal norms, perhaps this is an opportunity to improve an overly complicated application process. This approach is not completely novel; McMaster University’s program introduced a partial lottery this year.

A friend from internal medicine residency struggled with test-taking; he failed Step 1. Yet apparent “failure” had little impact on his career trajectory. He became chief resident of a major internal medicine residency and is currently a clinical director for an academic internal medicine clinic in a major metropolitan city.

He is also incredibly compassionate and provides the best evidence-based care I have seen. His apparent failure of tests was not predictive of the dedication and compassion he shows his patients daily.

The Association of American Medical Colleges lists 15 core competencies for applicants to focus on admission into medical school. They note the list was determined after “extensive review of the medical education and employment literatures with input from several blue-ribbon and advisory panels, including Social Sciences Foundations for Future Physicians, Behavioral and Social Sciences Foundations for Future Physicians, Institute of Medicine, 5th Comprehensive Review of the MCAT Review Committee, Accreditation Council for Graduate Medical Education  Outcome Project, the MR5 Innovation Lab, and others.”

The AAMC includes a 27-page handbook for applicants to review and brainstorm how they can best demonstrate these competencies on an application.

For example, the “Service Orientation” competency states the applicant must “Demonstrate a desire to help others and sensitivity to others’ needs and feelings; demonstrates a desire to alleviate others’ distress; recognizes and acts on his/her responsibilities to society; locally, nationally, and globally.”

This usually translates into extensive volunteer work. This also implies time and resources to dedicate to such endeavors and automatically excludes those who work second jobs to support family or who do not have connections into other medical systems.

Under the “Thinking and Reasoning Competencies,” the included sub-headings are “Critical thinking, Quantitative Reasoning, and Scientific Inquiry.” Many of these are evaluated in a standardized test fashion thru the Medical College Admission Test, or MCAT.

Schools often use this score as a cutoff for admissions. One study found a difference in MCAT performance over different ethnic groups. The research shows differences were likely socioeconomic in nature and not biases inherent in the test.

The gap between the number of medical school spots and medical school applicants has grown every year. At Rush Medical College, where I work, they reported 7,485 completed applications competing for 156 spots in the M1 class. For the 2019 year, administrators offered 509 interviews.

The AAMC reports the attrition rate for graduation has been steady at about 3 percent for the past 20 years. The data shows 1.3 percent of this rate is attributed to academic reasons, while the remaining were cited as non-academic reasons.

Given the inherent issues with these competencies and the enormous untapped pool of presumably qualified applications, perhaps instead of spending so much energy ranking all of them, it is possible to remove potential biases in the application system with a lottery system.

Yes, there is uncertainty in introducing a random lottery and its potential effect on physician quality and in medical science. So studies are needed.

One study could take half of a medical school’s spots and designate them as the control arm; this group would receive “usual care.”  These applicants are ranked on traditional measures of application review, interviews, and meeting discussions.

The intervention arm would be applicants who meet some baseline characteristics but were not deemed high enough to be allocated in the control arm. The 15 core competencies are used, but the goal is to use the competencies to determine a baseline.

This baseline could be developed simply by looking at applicants who were on the lower tier of rank lists. That would create a pool of applicants which would then be randomly lotteried. The lottery would be run, and then those applicants would be combined with the traditionally ranked group. This would create the final list of medical students who were accepted.

This research experiment needs outcomes. What is the marker of a successful doctor? In contrast to the uncertainty of how undergrad traits determine a good physician, using metrics that signal a successful physician- such as board certification, fellowship matching, resident evaluations, or chief resident placement could be the hard outcomes.

The control arm would clearly have applicants that would be perceived as traditional “top tier.”

This could lead to useful information if the intervention group has the same overall outcomes as the control.

By design, this system would not interfere with any medical schools’ ongoing affirmative action policies. For example, saving spots for underrepresented minors is still the practice. The lottery system would be another tool to help reduce deep societal inequities.

If the lottery ends up not affecting doctors’ quality, there are numerous potential benefits both in the short and long term. Immediately administrative resources of time and energy would not have to be spent ranking students so meticulously.

Once they know they have met the lottery’s baseline requirements, these students can instead focus on actual personal growth tailored to their own needs.

At Rush University, applicants average 1,496 hours of community service. My own application for medical school noted 50 hours of volunteer service.

More importantly, this system would address application inequity and give everyone an even playing field. Yes, this system can be frightening.

Physicians tend to want to take control, whether that is to help a patient feel better or do everything to advance the profession.

However, if the lottery reveals that doctors remain as dedicated as they have always been, perhaps it is a tool to free up resources, combat biases, and move toward a more just world.

Caspian Kuma Folmsbee is an internal medicine physician.

Image credit: Shutterstock.com

Prev

Mental health in our youngest healers [PODCAST]

December 8, 2020 Kevin 1
…
Next

Alone and frightened is the way COVID patients die

December 9, 2020 Kevin 0
…

Tagged as: Medical school

Post navigation

< Previous Post
Mental health in our youngest healers [PODCAST]
Next Post >
Alone and frightened is the way COVID patients die

Related Posts

  • Medical school admissions: Patience is a virtue

    Joshua Newman
  • Trust the process of medical school admissions

    Paul Lee and Samuel Wu
  • AAMC’s video interview tool for admissions is poised to introduce further bias to medical school admissions

    Zonía R. Moore
  • Getting into medical school: Q&A with an admissions officer

    Karen Murray, MD
  • A dean of admissions on affirmative action in medical school

    Noreen Kerrigan, MPA
  • End medical school grades

    Adam Lieber

More in Education

  • The secret to success in medical school: self-awareness and courage

    Kaelor Gordon
  • Is mandating pre-medical training widening disparities in the U.S. physician workforce?

    Deepak Gupta, MD and Sarwan Kumar, MD
  • Equalizing the future of medical residencies: standardizing work hours and wages

    Deepak Gupta, MD and Sarwan Kumar, MD
  • From studying to baby kicks: Navigating motherhood in medical school

    Natalie Eichner-Seitz
  • The power of advocacy: a medical student’s journey to helping an uninsured immigrant

    Fabiola Plaza
  • From AI to love: the key to a better future in medical education

    Stevan Walkowski, DO
  • Most Popular

  • Past Week

    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • From physician to patient: one doctor’s journey to finding purpose after a devastating injury

      Stephanie Pearson, MD | Physician
    • Breaking the stigma: Addressing the struggles of physicians

      Jean Antonucci, MD | Physician
    • Breaking the cycle of misery in medicine: a practical guide

      Paul R. Ehrmann, DO | Physician
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • Why are doctors sued and politicians aren’t?

      Kellie Lease Stecher, MD | Physician
  • Recent Posts

    • Unlock the power of physician compensation data in contract negotiations [PODCAST]

      The Podcast by KevinMD | Podcast
    • From pennies to attending salaries: Why physicians should teach their kids financial literacy

      Michele Cho-Dorado, MD | Finance
    • From solidarity to co-liberation: Understanding the journey towards ending oppression

      Maiysha Clairborne, MD | Physician
    • Changing the pediatric care landscape: Integrating behavioral and mental health care

      Hilary M. Bowers, MD | Conditions
    • Contract Diagnostics is the only firm 100 percent dedicated to physician contract reviews

      Contract Diagnostics | Sponsored
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 3 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Pregnant, Black? Here's Your Drug Test
  • Progestin-Only Birth Control Linked to Small Increase in Breast Cancer Risk
  • Fatty Acid Tube Feeding May Backfire for Preemie Breathing Disorder
  • Case Reports Detail Vision Loss Linked to Recalled Artificial Tears
  • Admin Trumps Med Students: Anti-Abortion Group Allowed on Campus

Meeting Coverage

  • Outlook for Itchy Prurigo Nodularis Continues to Improve With IL-31 Antagonist
  • AAAAI President Shares Highlights From the 2023 Meeting
  • Second-Line Sacituzumab Govitecan Promising in Platinum-Ineligible UC
  • Trial of Novel TYK2 Inhibitor Hits Its Endpoint in Plaque Psoriasis
  • Durable Vitiligo Responses With Topical Ruxolitinib
  • Most Popular

  • Past Week

    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • From physician to patient: one doctor’s journey to finding purpose after a devastating injury

      Stephanie Pearson, MD | Physician
    • Breaking the stigma: Addressing the struggles of physicians

      Jean Antonucci, MD | Physician
    • Breaking the cycle of misery in medicine: a practical guide

      Paul R. Ehrmann, DO | Physician
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • Why are doctors sued and politicians aren’t?

      Kellie Lease Stecher, MD | Physician
  • Recent Posts

    • Unlock the power of physician compensation data in contract negotiations [PODCAST]

      The Podcast by KevinMD | Podcast
    • From pennies to attending salaries: Why physicians should teach their kids financial literacy

      Michele Cho-Dorado, MD | Finance
    • From solidarity to co-liberation: Understanding the journey towards ending oppression

      Maiysha Clairborne, MD | Physician
    • Changing the pediatric care landscape: Integrating behavioral and mental health care

      Hilary M. Bowers, MD | Conditions
    • Contract Diagnostics is the only firm 100 percent dedicated to physician contract reviews

      Contract Diagnostics | Sponsored
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds

MedPage Today Professional

An Everyday Health Property Medpage Today iMedicalApps
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Lottery docs? Randomize medical school admissions for fairness
3 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...