Characteristics of Medical School Applicants: A Single-Institution Study

Medical schools aim to admit talented learners who are honest, patient centered, and caring, in addition to possessing the required cognitive skills.1 The Association of American Medical Colleges (AAMC) describes core competencies for medical students in three categories: science, preprofessional, and thinking and reasoning.2 Preprofessional competencies include service orientation, social skills, cultural competence, oral communication, resilience, and dependability. We hypothesized that medical schools with a rural presence recruit applicants with backgrounds and characteristics that specifically foster the desire to practice rural medicine.3-5 Brody, recognized by the American Academy of Family Physicians as number two in the nation and number one in the state in producing graduates pursuing family medicine,6 only admits students from the state of North Carolina.

Prior successful initiatives aimed at increasing the rural physician workforce have included programs oriented toward rural practice that were operated by medical schools located in urban settings.7 Several urban medical schools have also described success with increasing the number of graduates entering rural practice by opening satellite campuses in rural areas.8-11 For campuses or schools located in rural areas, there is a need to identify applicants who will be actively engaged in the communities in which they live, embarking to make positive change. Considering the nation-wide decline in medical student applicants who have a rural upbringing,12 there must be an intentional approach to recruit the rural applicant to medical school with attention paid to rural background and other characteristics that may lead to the desire to practice rural medicine.3-5, 13 Because of Brody’s unique orientation toward primary care and service to rural communities, we sought to determine how expectations for applicants among academic personnel, and community members overlap with AAMC core competencies.

This qualitative study utilized a convenience sample of academic and community members in rural eastern North Carolina. The study coordinator (K.L.) worked with the director of outreach for the school of medicine to identify and contact community participants. There were no incentives for participation. Choice of study participants was based on prior knowledge of and interaction with the participants in other community settings. Participants were recruited through phone or email contact by the study coordinator. The two academic discussion groups included Brody faculty, staff and students. Table 1 gives a description of the study participants.

The Institutional Review Board at East Carolina University approved this study. After participants were identified, each group was scheduled to meet separately, so there was no mixing of participants. At each discussion session, researchers explained the intent of the project, including an overview of the current applicant screening process at Brody. Discussion groups were led by authors (K.M.C., K.L.). Large sticky note pads and pens were provided to scribe responses. Group members were given the prompt, “What do you see as traits or characteristics of your ideal doctor?” They were not provided the AAMC competencies. Participants in each group were able to scribe and share for 1 hour. Discussion group results were reviewed, coded, and themed by authors (K.M.C., K.L.), and any disagreements resolved by one author (P.A.). The authors achieved alignment with the AAMC competencies by consensus, with disagreements also resolved by one author (P.A.).

We used a summative approach to content analysis to analyze the data recorded on sticky notes.14,15 We then compared the results to the AAMC core competencies for entering medical students.2

The total number of responses across groups was 243, representing 15 unique characteristics. The characteristics, as well as frequency counts for each term are shown in Table 2. Characteristics that were more commonly reported, which the authors defined as those with 20 or more comments, included good communicator (18%), knowledgeable (13%), dedicated (13%), compassionate (12%), respectful (11%), and community oriented (9%). Responses for these characteristics were 43, 32, 31, 29, 27, and 23 respectively (Table 3). The following top study responses aligned with stated AAMC competencies: good communicator with oral communication, knowledgeable with critical thinking, dedicated with ethical responsibility to self and others, compassionate with social skills and respectful with reliability and dependable.

The results of this study demonstrate characteristics a rural community and its medical school find as important traits of a physician. While study findings aligned with AAMC competencies in many ways, being community oriented was an additional competency that was identified. In rural areas, community orientation is important to prepare students for the leadership role they will assume in the community, and to help them understand the community’s health needs.16 In addition, introducing the medical school to the community can advance community goals, inform medical school initiatives, and impact health and academic outcomes.17,18 Results from this study, although from a single institution study with small discussion groups, suggest the importance of applicants to medical school being community oriented. This has special significance for rural, community-based medical schools with a goal to increase numbers of physicians going into primary care specialties.

Limitations of this study include a convenience sample of participants at a single institution, and use of a single prompt to capture responses. Also, confounders could be introduced because the participants were selected by the authors (K.M.C., K.L.) and Brody’s outreach director. However, prior research has suggested that unpacking the components of an agreed-upon composite goal (eg, “successful physician”) is an important precursor to optimizing medical school admission criteria and processes.19 Brody students possibly introduce bias as they are already rurally minded. The study would have been strengthened if discussion groups were held with students from other institutions and disciplines.

This study demonstrates characteristics that a rural community and its medical school consider when admitting applicants to their medical program. Further research should be done to determine if being community oriented should be a defined core competency for entering medical students.