This document summarizes a research study exploring how the Northern Ontario School of Medicine's (NOSM) admission process can be modified to obtain a more representative student population of Northern Ontario. The study will analyze approximately 20,000 past student application records to assess if alternative scoring and weighting criteria could improve representation of Indigenous, Francophone, and rural Northern Ontario applicants, while still selecting highly qualified students. Preliminary results are expected by year's end and may help NOSM and other medical schools improve admissions processes and outcomes for cultural/linguistic minority applicants. The research is funded by Ontario's Ministry of Health and Long-Term Care.

1. Exploring the link between the admission process and the social accountability mandate of the Northern Ontario School of Medicine
Barnett, R., Prowse, O., Hanna, M., Hogenbirk, J., Marsh, D.,
Schoales, B., Mian, O.

2. Faculty/Presenter Disclosure
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Faculty: Robert Barnett, Assistant Professor, Health Informatics, Northern Ontario School of Medicine
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Relationships with commercial interests: Administrator with the North East Community Care Access Centre

3. Disclosure of Commercial Support
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This program has received financial support solely from the Ontario Ministry of Training, Colleges and Universities and the Ontario Ministry of Health and Long Term Care.
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Potential for conflict(s) of interest: None

4. Mitigating Potential Bias
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Not Applicable

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Canada

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Ontario

7. Background
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The Northern Ontario School of Medicine’s (NOSM) social accountability mandate aims to be responsive to Northern Ontario’s cultural and geographical diversity.

8. Background
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Northern Ontario is a medically underserved area that is geographically vast and sparsely populated. There are sizable cultural and linguistic minority groups of Indigenous and Francophone peoples distributed throughout Northern Ontario.

9. Background
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There is weak evidence that medical students from ethnic, cultural, or linguistic minorities, and strong evidence that those from rural areas are more likely than other students to practice medicine in their home communities or other similar underserviced areas (Wilson et al. 2009).
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Wilson NW, Couper ID, De Vries E, Reid S, Fish T, Marais BJ: A critical review of interventions to redress the inequitable distribution of healthcare professionals to rural and remote areas. Rural Remote Health 2009, 9:1060.

10. Data
Population Density

11. Main Research Objective
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Research will evaluate how NOSM’s current applicant rating system may be changed to obtain a student population that is more representative of Northern Ontario.
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Funding is provided by Ontario’s Ministry of Health and Long-Term Care.

12. Current Performance
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From 2006 through 2013, 92% of students matriculating from NOSM were from Northern Ontario and 8% were from rural and remote areas from the rest of Canada.
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7% of students were Aboriginal and 22% were Francophone which approaches the historic demographic distribution of the North.
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40% were from the Rural and Remote North of Ontario.

13. Admission Process
Multiple Mini Interviews
Ranking
Narrative & Academic
Context Scoring (Rural & Cultural)

14. Narrative & Academic
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Traditional application process based upon:
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Academic Excellence
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Demonstrated Leadership Qualities
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Description of Applicability for practice in Northern and Rural areas
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Etc.

15. Context Scoring
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Data Driven Evaluation examining some 800,000 data points based upon:
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Geographic analysis of applicant resident history and other exposure to the northern context
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Applicant identification with Aboriginal communities
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Applicant linguistic profile.

16. Multiple Mini Interviews
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Offered to the top 400 applicants as ranked by the previous two steps
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20 interviews with single individuals at ten minutes a piece, ranging in subject matter from the clinical to the practical.

17. Data and Method
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Data collected by NOSM and the Ontario Universities Application Centre in 2005-2014 as part of application and admission processes
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Statistical models (e.g., Constrained Optimization) will be used to assess whether current selection criteria generate the optimal representation of Northern Ontario population in class composition
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Kreiter CD, Stansfield B, James PA, Solow C. A model for diversity in admissions: A review of issues and methods and an experimental approach. Teaching and Learning in Medicine 2003; 15(2):116-122.

18. Data and Method
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Explore and assess alternate scoring and weighting criteria on student rankings
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Criteria pertaining to Applicant Background include:
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Indigenous
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Francophone
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Northern Ontario
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Rural

19. Applicants (n=~2000)
Applicants invited to interviews (n=~300- 400)
Applicants offered admission (n=56-64)
Applicants who accept offer (~65%)
Applicants who do not accept offer
Applicants on waiting list (n=~100)
Applicants on waiting list who are offered admission (n=~20-30)
Applicants who accept offer
Applicants who do not accept offer
Applicants on waiting list who are not offered admission
Applicants who are not offered admission at NOSM
Applicants not invited to interviews (n=1600)
Methods
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Approximately 20,000 student application records will be analyzed
Figure: NOSM admissions process showing applicant flow for a typical year.

20. Results
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Preliminary results will be available by year end.
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Results will inform if and how NOSM’s current ranking process can be modified to achieve a more representative student population while continuing to produce highly qualified physicians.

21. Conclusions
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Findings may help improve the admissions process and outcomes for future applicants to NOSM and other medical schools: particularly cultural/linguistic minority applicants.

22. Thank you
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For more information please contact:
Robert Barnett,
Assistant Professor, Health Informatics, Northern Ontario School of Medicine
Robert.barnett@nosm.ca