Holistic Admission Research Articles

Social Accountability at Southern Illinois University School of Medicine: A Focus on Admission Policy

Given the increasing health disparities across regions and populations, social accountability is not an option but an obligation for health professions schools, including medical schools. In this short communication, the authors report the case of Southern Illinois University School of Medicine (SIU SOM), which has been an exemplary medical school for social accountability, receiving the 2013 AMEE ASPIRE Award in social accountability and the 2018 Josiah Macy Jr. Foundation Award for Institutional Excellence in Social Mission in Health Professions Education. This paper focuses on the school’s admission policies in the discussion of its social accountability. It starts with the background of central and southern Illinois, where the school is located to address the shortage of healthcare professionals in the areas. It discusses the school’s holistic admission policies and two pipeline programs—namely, MEDPREP and McNeese Physician Preparatory Pipeline Program (P4)—that are strategically designed as a long-term physician workforce development plan to address health disparities in rural areas. As of January 30, 2024, 3,233 students have earned the MD (Doctor of Medicine) degree at SIU SOM. In total, 770 alumni (33%) are practicing in primary care. Among 901 graduates practicing in Illinois, 484 (54%) are practicing in SIU SOM service area counties (i.e., central and southern Illinois). Social accountability is the core value and organizational identity of SIU SOM and the guiding principle of the school’s innovation and excellence.

The Impact of Graduate Record Exam Threshold Scores in Disqualifying Underrepresented Ethnic-Racial Minority Applicants for Admission to a Doctor of Physical Therapy Program.

A growing number of graduate-level health professions education programs in the United States are discontinuing the use of the Graduate Record Exam (GRE) in their admissions requirements amidst concerns that its use puts Underrepresented Racial Minority (URRM) applicants at a disadvantage. This retrospective cross-sectional study analyzes the association between ethnic-racial selection and the reasons for disqualification among applicants to a public Doctor of Physical Therapy (DPT) program that used a minimum grade point average (GPA), and Analytic Writing and Quantitative Reasoning GRE minimum threshold scores to qualify applicants. There is evidence across the health professions literature that both GRE scores and GPA are associated with success on licensure examinations and academic performance. However, these variables also tend to disadvantage URRM applicants in gaining admissions to postgraduate health care fields, including physical therapy. All applicants (N = 4,797) to a single DPT program from a 9-year period were included. Racial and ethnic self-selections, GRE scores, and prerequisite GPA were coded for each applicant and classified for meeting qualifying criteria. The URRM applicants were disqualified based on GRE scores alone (P < .001) and in combination of GRE and GPA at a statistically significantly (P < .001) higher rate than Overrepresented Racial Group (ORRG) applicants, although the associations were negligible or weak. Compared with ORRG applicants, URRM applicants were at a statistically significant disadvantage because of the GRE threshold scores requirement. Furthermore, this study demonstrated that use of GRE minimum threshold scores disproportionately reduced URRM applicants in the qualified applicant pool. This investigation can be used as a model to inform holistic admission decisions regarding the use of academic variables to achieve the diversity and success goals of the program.

Integrating Implicit Bias Training for Undergraduate Holistic Admission Reviewers.

The need to create a diverse nursing work-force has increased the use of a holistic admission process across the country. Holistic admission processes alone are insufficient to addressing bias that may have unintentional impact on the review process. Intentionality with implicit bias training is necessary to create a more equitable admission process. Integration of implicit bias training was multipronged and included overview information and individual activities, including the practice of reviewing applicants. Data from the practice reviews were aggregated and used for small group discussion. Since integration of implicit bias training, overall admission rates for underrepresented racial and ethnic applicants increased from 14.5% in 2019 to 29.1% in 2022. While other factors cannot be ruled out in contributing to the increased diversity, the integration of implicit bias education and bias-mitigating strategies throughout the required training for holistic admission reviewers is beneficial to increasing diversity in nursing admissions. [J Nurs Educ. 2024;63(X):XXX-XXX.].

Current holistic admission review practices of U.S. doctor of physical therapy programs

BackgroundThe social, cultural, and ethnic diversity of healthcare workers should match that of the U.S. population to improve health outcomes and decrease health disparities. The population’s diversity is increasing, though many health care professions lack diversity in their academic programs. The holistic admissions (HA) process considers an applicant’s unique experiences, achievements, and traits in addition to academic metrics when making admission decisions. HA has been shown to be an effective strategy to increase cohort diversity by considering the whole person instead of focusing on academic metrics.PurposeThis study explored the extent to which U.S. Doctor of Physical Therapy (DPT) programs are implementing HA in their admissions process to diversify their admitted cohorts. The study further examined how programs defined diversity.MethodsUsing a cross-sectional, descriptive research design, 272 accredited DPT programs were invited to complete an online survey to collect data on admissions practices. Cross-tabulation was used to analyze coded responses. Inductive thematic analysis was used for open-ended responses.ResultsThirty-five (71.4%) of the 52 respondents reported they were currently or were planning to use HA in their respective DPT program. Most respondents (88.6%) reported a positive experience, including an increase in student cohort diversity without a decrease in graduation rate. Four themes emerged as the definition of diversity: ethnicity (i.e., under-represented minorities), other demographics, life experiences, and challenges overcome.ConclusionAlthough this study represents a sample of DPT programs, the data show most programs using HA and have experienced increased diversity without a risk to academic performance.

Analysis of social mission at associate degree nursing programs in the United States

Background“Social mission” is the contribution of a health profession's school in advancing health equity and addressing the health disparities of the society in which it exists. AimThis study aimed to understand the state of social mission in associate degree nursing (ADN) programs, and how performance varies across program types. MethodsAbout 533 programs that were members of the Organization for Associate Degree Nursing were invited to fill out an ADN-specific version of the previously developed Social Mission Metrics survey. Survey responses were analyzed using analysis of variance (ANOVA) and t-tests. ResultsForty-four programs completed the self-assessment. The majority reported having curricular content on the topics of social determinants of health, LGBTQ health, advocacy, and public health (72%-95%). Most programs had no holistic admission policy (63%) and did not require anti-bias training for admission committees (54%). Pathway programs were more common among public (76%) than private schools (33%). ConclusionsGreater focus should be placed on topics including admission policies, leadership diversity, and community involvement to enhance the social mission of ADN programs.

Operationalizing Anti-Racism Accountability with Equitable Admissions in Nursing Education Accreditation.

For decades, health professional organizations have recommended increased diversity in the workforce and education. To address persistent inequities in health care, the racial composition of the nursing workforce needs be congruent with the U.S. population. Without first addressing structural inequity in nursing education programs, the nursing profession cannot begin to address structural racism in health care. The lack of nursing student diversity is reflective of barriers in program admissions. This article is a call to nursing accreditation bodies to operationalize anti-racism to improve U.S. nursing workforce diversity by introducing accountability structures that require evidence-based holistic admission review and analysis of admission data to ensure that student cohorts are diverse across nursing programs, thereby ensuring a future workforce that reflects the diversity of the U.S. population.

Association of applicant demographic factors with medical school acceptance

BackgroundMedical school acceptance rates in the United States (US) have been lower for applicants who identify as Underrepresented-in-Medicine (UiM) compared to non-UiM applicants. The gap between UiM and no-UiM groups is narrowing in recent years. Less well-studied are associations of acceptance decisions with family income and parental education. This study’s purpose is to evaluate the relationships between medical school acceptance and family income, parental education status, racial/ethnic background, Grade Point Average (GPA), Medical College Admission Test (MCAT) score, and participation in extracurricular activities.MethodsThis is a cross-sectional study of first-time US medical school applicants between 2017 and 2020. Acceptance rates for first-time applicants were calculated for first-generation (FG), low-income (LI), and UiM applicants. Associations of these attributes with MCAT scores, science GPAs, and seven categories of extracurricular activities were evaluated. Regression analyses estimated associations between acceptance to medical school with all variables with and without interaction terms (FG*URM, LI*URM, FG*LI).ResultsThe overall acceptance rate for first-time applicants from 2017–2020 was 45.3%. The acceptance rates among FG, LI and UiM applicants were 37.9%, 39.6% and 44.2%, respectively. In univariable logistic regression analyses, acceptance was negatively associated with being FG (OR: 0.68, CI: 0.67–0.70), LI (OR: 0.70, CI: 0.69–0.72), and UiM (OR: 0.95, CI: 0.93–0.97). In multivariable regression, acceptance was most strongly associated with science GPA (OR: 7.15, CI: 6.78–7.54 for the highest quintile) and UiM (OR: 5.56, CI: 5.48–5.93) status and MCAT score (OR: 1.19, CI: 1.18–1.19), FG (OR: 1.14, CI: 1.10–1.18), and most extracurricular activities. Including interaction terms revealed a negative association between acceptance and LI (OR:0.90, CI: 0.87–0.94) and FG was no longer significant (OR:1.10, CI:0.96–1.08).ConclusionsCollectively these results suggest medical school admissions committees may be relying on holistic admission practices. While MCAT and GPA scores continue to predict acceptance, individuals from racially and ethnically UiM backgrounds have favorable odds of acceptance when controlling for MCAT and GPA. However, these positive associations were not seen for low-income and first-generation applicants. Additional preparation for college and the MCAT for these latter groups may help further diversify the medical profession.

Who benefits from elite colleges’ decreased reliance on high-stakes standardized tests? Evidence from a quasi-field experiment

Despite the increasingly popular perception that elite colleges’ reliance on high-stakes standardized tests to select students exacerbates social inequality, researchers have not demonstrated that a reduced emphasis on such tests actually alters individuals’ admission outcomes. Using all applications submitted in 2022 to National Taiwan University, the most prestigious university in Taiwan, we show who among the applicants would have been admitted under the country’s prior college admission system, which was entirely based on high-stakes standardized test scores, and contrast them with those actually admitted in the current system, which emphasizes holistic evaluations and considers many other criteria. The results indicate that for the majority of students the admission outcomes would be unchanged. Even among those whose outcomes would differ, class backgrounds are not clearly related to the direction of change in the outcome. Rather than students of upper- or lower-class backgrounds, women are the unequivocal beneficiary from the decreased reliance on high-stakes standardized tests. The analysis suggests that the better high school grades and more comprehensive application materials submitted by women applicants contribute to a considerable part of the female advantage in a more holistic admission system. Evidence from this quasi-field experiment has implications for how changes in the structural elements of the educational system affect elite college access.

Emphasizing Geographical Ties in Holistic Admission: A Community-Oriented School of Medicine Approach.

Emphasizing Geographical Ties in Holistic Admission: A Community-Oriented School of Medicine Approach.

The Effects of Holistic Admissions on Diversity in Nursing: A Literature Review.

The nursing profession does not reflect the diversity of the population they serve. Many health professions, including nursing, have altered their admissions practices to consider a holistic assessment of individuals. Quantitative data from students are not sufficient to develop a diverse student body. A literature review was conducted using MEDLINE, CINAHL, ERC, ERIC, and Google Scholar. Original research articles on holistic admission (HA) processes and the effects on diversity in nursing were included in the review. Search terms were "holistic admission," "holistic review," and "nursing." There is a paucity of research regarding HA in nursing. The available literature suggests HA increases the odds of developing a more diverse student population. HA should be considered to increase diversity of students. Further research is needed regarding the effects of HA on diversity among nursing students. [J Nurs Educ. 2023;62(10):556-562.].

Barriers and Facilitators to Implementing Holistic Admission Review in Graduate Advanced Nursing Programs.

There are strong recommendations and high demand for the use of holistic admission review (HAR). However, there is no study exploring and identifying barriers and facilitators to implementing HAR in health care education programs. This qualitative descriptive study aimed to understand the key determinants influencing the integration of HAR in graduate advanced nursing programs. Two online focus groups with content analysis were used to identify barriers and facilitators. The findings highlight 39 key determinants of HAR implementation in the graduate advanced nursing program; the determinants included four neutral influencing factors, 18 barriers, and 17 facilitators. These influencing factors aligned with all four domains in the Consolidated Framework for Implementation Research (CFIR) and with 20 of the 39 CFIR constructs. By taking into account the facilitators and barriers, graduate advanced nursing programs may use effective implementation strategies to integrate HAR changes and guide their evolving admissions processes. [J Nurs Educ. 2023;62(10):570-574.].

Promoting Health Equity Through Holistic Admissions in Occupational Therapy Education.

As the U.S. population shifts away from a White majority, it is imperative that the health care workforce reflect the diversity of client populations served. Increased diversity in the health care workforce fosters access to more personalized, culturally responsive, and client-centered care, thereby facilitating improved outcomes and reduced health disparities. Occupational therapy education programs function as gatekeepers for diversity and need to be accountable for representation in the profession and to produce graduates who reflect the diversity of the broader population. Holistic admission practices, which ensure that no single factor excludes an applicant from admission, are recognized as a meaningful strategy for increasing student diversity in higher education and provide a pathway to create a representative workforce with the ability to improve care disparities and client outcomes. As one of the largest occupational therapy programs in the country, and located in a diverse urban area, the University of Southern California's Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy has embraced the profession's responsibility toward greater health equity through holistic admissions. In this column, we discuss holistic admission best practices and report diversity outcomes resulting from enactment of these practices within our occupational therapy education program.

Holistic admission in nursing: Policy, process, and a pandemic.

• Limited use of holistic review by nursing constrains knowledge of development. • Expert consultation and review of current process is a necessary first step. • Updates included creating quantitative and qualitative metrics and admission rubric. • Online data systems developed to support submission and review of applications • COVID-19 necessitated modifications to review process, chiefly virtual interviewing.

Dismantling racist ideologies in nursing academia to enhance the success of students identifying as Black, Indigenous and students of colour.

Dismantling racist ideologies in nursing academia to enhance the success of students identifying as Black, Indigenous and students of colour.

Factors influencing nursing students' continued success in a baccalaureate nursing program in Indonesia.

Holistic admission processes are needed to promote diversity in nursing students. Previous research had identified different variables related to the average grade point at the end of the first semester. There is a need to examine if those variables are associated with ongoing student success. The purpose of this study was to analyze experience, attributes, and academic variables for an association with nursing student success. Student success was defined as being an active student at the end of the first year and at the end of the second year of a baccalaureate nursing program in Indonesia. Binary logistic regression analysis was used to determine what relationship, if any, the variables had with student success, measured at the end of the first and second academic years. The data of 341 nursing students enrolled in August 2018 was analyzed. The variables accounted for 40.3% of the variance at the end of the first year and 24.3% of the variance at the end of the second year. There was a significant (p < .05) relationship between being enrolled at the end of the first year and 1) academic variables of first semester grade point average and the admission score of Raven's Advanced Progressive Matrices, and 2) attribute variables of reason for entering nursing and brief calling presence scale. A significant relationship was found between being enrolled at the end of the second year and the attribute variable of grit score. No variables had a strong correlation with other variables. Holistic admission processes and promoting student success can create the future of the nursing workforce. Improving the diversity in admitted nursing students will enhance the diversity in the nursing workforce. To promote the success of all students, a variety of support interventions will need to be developed. As students' calling and grit may play a role in student success, a better understanding is needed. In addition, more research is needed to explore how developing calling and grit throughout the nursing program can impact student success.

Holistic Admissions in Higher Education: A Systematic Literature Review

Rich learning environments that celebrate differences and prepare students for today’s global society are cultivated when a diverse student population is actively sought. By evaluating students on factors beyond grades and standardized tests using holistic admission processes, institutions can admit a more diverse student body and enhance students’ experiences. This paper explores the academic literature on holistic admission, the intricacies of the approach, and the impact these alternative evaluation practices have on campus diversity. This review gives a snapshot of the history of holistic admission, outlines the approach, and provides examples of the impact holistic admission practices have on student diversity.

Outcomes of a holistic admissions process in a baccalaureate nursing program

A holistic admissions process was developed and implemented in a baccalaureate nursing program to improve student selection and student success. The goals were to increase multiple aspects of student diversity and to identify students with the potential for success and those who reflect the mission, vision, and core values of the school. A holistic admissions task force was formed in 2016 at the college of nursing (CON). The team created three measures of admission criteria: 1) open-ended essay questions providing for students to discuss relevant life experiences, 2) an online self-assessment of student attributes, and 3) overall and preprofessional grade point average (GPA) as metrics. Following the inception of the holistic admission process, student outcome data were reviewed with each admission cycle and the process was adjusted over time. Holistic admissions is a method of evaluating multiple dimensions of applicants for admission. Student success is impacted by many factors including teaching, individual behaviors, student support, and college progression and graduation standards.

Selection process for admission to an academic nursing programme – A meta-synthesis

BackgroundStudent nurse selection has been a topic of debate for years. Poor nursing care has been attributed to uncaring attitudes, lack of motivation and poor training and mentoring. Student nurse selection requirements and the steps involved in the process have been a revolving debate. Internationally, the recruitment and selection process are being refined to align with recommendations from the Francis Inquiry to include a values assessment. ObjectiveTo select, review and interpret evidence-based studies on student nurse selection; and develop and provide recommendations for nurse educators when selecting first-year student nurses as a holistic, integrative process fitting with caring and providing quality care. DesignQualitative meta-synthesis. Data sourcesElectronic databases were used during data collection: Ebscohost, ScienceDirect, SAGE, Cinahl and Sabinet (SAePublications). Qualitative articles published in English or Afrikaans reporting on student selection processes and experiences were included in the data collection process. Review methodsQualitative articles were systematically identified using the STARLITE principles. The articles were critically appraised for quality by employing the CASP method. ResultsFourteen articles were included. Thirteen of the articles were published in English. One PhD thesis was included, a seminal work conducted on student nurse selection in South Africa. Data analysis revealed three main themes: a reliance on the interview, alternative selection methods, and attributes as criteria for nursing selection. Within these themes, many different methods of student selection emerged. The benefits and challenges of these methods were identified, and a holistic admission process was ultimately most successful in selecting the correct student nurse. ConclusionsThe findings indicate there are many different student nurse selection processes. A holistic admission process is needed to select the best student nurse that displays caring attributes and provides quality nursing care.

Admission characteristics that influence DNP students' first-semester success: A retrospective study.

Students apply to Doctor of Nursing Practice(DNP) programs with varying demographic, academic, and professional characteristics. Programs are challenged with selecting and retaining students. Suggestions regarding which admission criteria and student characteristics are influential for success have been inconsistent. Recently, holistic admission practices have been employed to increase diversity, but little is known on the relationship between holistic admissions and student success. To investigate which demographic, academic, and professional characteristics influence DNP students' first-semester success. Retrospective study using online DNP student application materials at a medium-sized, mid-Atlantic private university. Investigators used a self-developed Audit Tool to identify characteristics of enrolled DNP students' application materials (n = 245). Categorical and continuous data were analyzed using χ2 and Independent Samples t-tests to determine which characteristics influenced success. Analysis revealed none of the items related to student characteristics were associated with first-semester academic success. Further research is needed. Studies exploring additional individual characteristics and time frames may be more predictive of first-semester academic success.

When Holistic Admissions Review Is Not Enough: Barriers to Diversity.

Patient populations are increasingly diverse; however, the health care workforce often fails to reflect the diversity of the populations it serves. Holistic admission review (HAR) has been proposed as a strategy to diversify the student body and create a more diverse workforce. This article describes the development, application, and evaluation of a holistic admissions process for freshman undergraduates admitted directly to a College of Nursing located in a nonaffirmative action state. There was an increase in the diversity of applicants; however, the selected metric of SAT (Scholastic Aptitude Test)/ACT (American College Test) scores resulted in a decrease in the number of qualified applicants. This decrease disproportionately affected underrepresented students, illustrating that the inability to consider race, ethnicity, or gender continues to restrict the admission of a diverse student body even with HAR. Our findings highlight the need to consider all aspects of HAR, particularly the effect of the chosen metrics on the applicant pool. [J Nurs Educ. 2022;61(7):375-382.].