A person walks past a large sign and campus map on Union Street on the campus of Queen's University in Kingston in January, 2021.Fred Lum/The Globe and Mail
Queen’s University plans to introduce a lottery to its medical student selection process in the hope it will make admissions more open to candidates from diverse and low-income backgrounds.
The university in Kingston said the lottery component, set to be announced Tuesday, is unique among Canadian medical schools and will be in place starting this fall.
The lottery will occur early in the application process, not for the final selection. To reach the lottery stage, students must first exceed threshold cutoffs for grade point average, scores on the Medical College Admissions Test and the Casper test of ethical judgment.
A random lottery selection will winnow the pool of qualified applicants that exceed the cutoff scores to approximately 600 to 750 students. They will proceed to a series of online mini-interviews known as the MMI. From there, the top candidates are invited to an in-person panel interview, typically granted to about 300 to 400 students a year.
Queen’s School of Medicine admits only about 115 candidates every year from roughly 5,000 applications, so the process is highly competitive. Health sciences dean Jane Philpott said the admissions process has historically put up barriers to students who, for various reasons including socio-economic disadvantage, haven’t been able to develop a portfolio of accomplishments that gets them to the interview stage.
“This actually levels the playing field,” Dr. Philpott said of the lottery. “You still have to be exceedingly intelligent and be able to do well at school. But amongst those who can meet that bar, you have an equal chance of being offered an interview.”
In recent years, as the number of applicants increased, the cutoff thresholds for grades and standardized test scores has risen, partly to manage the volume of files. Dr. Philpott said many capable students who could make excellent physicians were being eliminated at an early stage – before they could show their qualities in an interview.
Under the new system, the file review, which looks at all aspects of an application including work and volunteer experience, will occur throughout, but a final evaluation will take place at the end of the admission process. The reason, according to Queen’s administrators, is that the file review can introduce bias and subjective judgments. It has also been seen in the past to favour applicants with additional educational, travel and volunteer experiences that are more common among students of privileged backgrounds.
“We don’t necessarily want to just pick people that are exactly like the people that are doing the file reviews,” Dr. Philpott said. “There are lots of young people out there who have perhaps had some socio-economic struggles. They need a chance to be able to get into medical school, and we want to give them that opportunity.”
Peggy DeJong, Queen’s assistant dean responsible for admissions to the MD program, said the school is trying to make data-driven and equitable decisions.
Under the new system, roughly 8 per cent of spaces at the MMI stage will be reserved for students of lower socio-economic status, although the number could fluctuate from year to year. Students who qualify would be entered into the first lottery to reach the MMI stage. If they aren’t successful, they would be entered into a second, smaller lottery with students who fit certain socio-economic background criteria.
The criteria were devised independently for a fee-waiver program used in the Ontario medical school admission system. They include student income, parental income, spousal income if applicable, student debt and a personal statement.
A 2020 study of Canadian medical student demographics, conducted through an online survey, found they had parents with significantly higher levels of education and who were more likely to be professionals or high-level managers compared with the Canadian population. They were more than twice as likely as the general population to have a family income greater than $100,000 a year.
Dr. DeJong said she was impressed by a lottery model that was used in medical school selection in the Netherlands. In that case, however, the lottery was used for final admission decisions, whereas in this case it’s only to get to an interview stage.
McMaster University used a lottery system in part of its med school admission process during the pandemic in 2020.
“We did not want to move to a lottery to admission, because I think that would be quite distressing and it would really reduce autonomy over the process to get into medical school,” Dr. DeJong said.
“We do know that when we look at the diversity of our class and looking at the data points, we’re often losing people in the admissions pathway and screening people at that initial step between application and file review.”