In their own words: a comparison of the medical school applications of low and exceptional performing students

Abstract

Background: Medical school admissions committees cannot predict performance. Previous research has studied whether standardized test scores, grade point averages, or letters of recommendation portend success, but an applicant’s reporting of their past experiences and activities has not been well studied. This research aimed to determine the themes present in the applications of low performing medical students and to compare these themes with those in the applications of exceptional performers. Methods: The authors performed a qualitative analysis of the Work and Activities section of the American Medical College Application Service application in low performing medical students (those referred to the student promotions committee where an administrative action occurred). A constant-comparative approach was used that applied an a priori thematic framework developed in exceptional students (those inducted into the Alpha Omega Alpha honor society and Gold Humanism Honor Society). Frequencies of themes were counted and compared in each population by calculating the absolute number of themes and the diversity of themes per applicant. Results: Thirty-nine students met the definition of low performer in graduation years 2017 to 2019. Thematic saturation occurred after 18 applications; 21 files were reviewed. All seven themes present in exceptional performers (teamwork, altruism, success in a practiced activity, wisdom, passion, entrepreneurship, and perseverance) were present in low performers, although at lower frequencies. Three low performer themes were found: witnessing teamwork, description of a future event, and embellishment of achievement. Conclusions: Experience descriptions that prospective students write may predict future performance and could be used by admission committees to inform entry decisions into medical school. Low performers had comparatively lower frequencies of every exceptional performer theme; the difference was most notable in the “perseverance” and “success in a practiced activity” themes. Unique themes were found in low performers. Further studies are recommended to enhance the generalizability of these results.