Socioeconomic status (SES) and admission in medical school: A scoping review

PURPOSE: Historically, medical students have predominantly come from affluent backgrounds, prompting discussions about the need for greater socioeconomic diversity in physician representation. This diversity is crucial for meeting the healthcare workforce's needs and serving varied communities. Over the past decade, medical schools have introduced initiatives to expand access, including new admission tools and process improvements aimed at fostering inclusivity. However, there is not yet an integrated analysis in the literature examining how SES impacts admission disparities and what efforts have been made to alleviate such disparities. METHOD: To address this gap, we conducted a systematic search across major databases, including PubMed, Scopus, Medline, APA PsycINFO, and EconLit. Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension (PRISMA) guidelines, thirty-seven studies published from 2013 to 2024 were identified. Descriptive and thematic analyses were used to explore the data. RESULTS: Thirty-three studies emanated from Western contexts, with only four exploring Asian medical school admissions practices. Over half of the articles employed quantitative methodologies. Thematic analysis revealed the nuanced impacts of various admission tools on selecting applicants from diverse SES backgrounds. Capital barriers emerged as the predominant mechanism through which SES influences admission outcomes. To tackle these issues, most medical schools have adopted two pivotal measures: diversifying admission tools and expanding institutional support and admission policies. These measures are implemented at various stages - pre-, during-, and post-admission process. CONCLUSIONS: This scoping review is the first extensive investigation into the interplay between SES and admission disparities in medical schools. It emphasises considering applicants' SES while maintaining high academic standards and promoting diversity among future medical professionals. Medical schools have explored various approaches to address SES disparities, but careful implementation across different contexts to avoid the risk of discrimination is essential, especially to ensure higher SES applicants are not inadvertently disadvantaged.