Medical Students' Perception of Their "Distance Traveled" and Its Role in Medical School Applications: A National Qualitative Study.

Abstract

Purpose: The holistic review of applicants conducted by medical schools includes an assessment of their distance traveled (e.g., hardships overcome) to get to this point on their educational journey. 1 What medical students consider to be distance traveled and how they think it should be included has not been explored. This qualitative study seeks to address this gap in knowledge and centers the voices of medical students by attending to how they conceptualize their own distance traveled. Method: We conducted semistructured interviews with U.S. medical students through purposeful sampling methods. Recruitment targeted medical students enrolled at schools that referenced the term “distance traveled” as part of their holistic review process on their admissions webpage. The Social-Ecological Model framework was used to develop questions to elicit participants’ experiences that contributed to their distance traveled and drew insights about how students felt medical schools should incorporate distance traveled into their holistic reviews of applicants. Interviews ranged from 60 to 75 minutes. Transcribed interviews were analyzed according to interpretive description. Results: A total of 31 medical students representing a wide range of demographic backgrounds (e.g., 13 (42%) identified as underrepresented in medicine, 27 (87%) were first-generation students) from 7 medical schools were included in the study. Overall, participants defined distance traveled as an applicant’s hardships (e.g., being the primary caregiver for a family member) and privileges (e.g., having physician parents) they experienced. Participants thought including distance traveled in the holistic review of applicants would provide the necessary context medical schools need to assess applicants’ relative success and their passion for becoming a physician. For example, some students had to work multiple jobs during undergrad to support themselves and their families, leaving them little remaining time to study, volunteer, or lead student organizations. Second, participants believed these experiences should be assessed in an open format (e.g., free word response, open-ended interview question) by specifically asking students to share how their hardships/privileges affected other aspects of their application. Third, students felt that the components of a medical school application (e.g., disadvantage essay, personal statement) had vague prompts that led many applicants to not write about their distance traveled for fear they would be seen as showing weakness rather than resiliency. Discussion: Medical students felt asking specifically about applicants’ hardships and privileges was important to learn about their distance traveled. As medical schools have begun incorporating distance traveled in their holistic reviews, our study represents the first attempt to understand distance traveled from the perspective of applicants. Significance: Medical students believe understanding an applicant’s distance traveled is a crucial component of the holistic review process. In our sample, distance traveled was defined as the hardships and privileges an applicant has experienced—and learning about it provides the necessary context to equitably assess the other components of their application. There was a clear paradox between how students felt distance traveled should be elicited and how many medical schools are currently learning about an applicant’s distance traveled. Addressing this inconsistency to better assess applicants’ distance traveled could be one way to create a more equitable admissions process. Acknowledgments: The authors wish to thank Dr. Steven Gay from the University of Michigan for his contributions to the narrative of this project.