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Growing the Learner Throughout the Application Process

The second workshop session was held virtually on March 6. This session objective was to “explore the health professions education admissions process to ensure a better prepared applicant who knows their options.” Christopher Feddock, an associate vice president at the National Board of Medical Examiners, welcomed participants and gave a brief summary of the previous session. The previous session was focused on the theory of change, he said, and laid the foundation for why the time is right to rethink the admissions process. Considering the desired outcomes of the admissions process, the theory of change helps to identify changes to the process that could achieve these outcomes. In this session of the workshop, learner applicants shared their perspectives on the admissions process, and data were presented on how learners make decisions about health programs. The session ended with a panel discussion to bring in multiple stakeholder perspectives.

THE LEARNER APPLICANT PERSPECTIVE

Sarah Walters, the executive director of HOSA–Future Health Professionals, moderated a discussion with learners who were at different stages of the application process. Walters asked questions and invited the learners to share their views. The U.S. panelists included:

• Mielad Ziaee: Current junior, plans to take a gap year after senior year and then pursue an M.D./Ph.D.
• Emily Hathcock: Current graduate student in M.P.H. program, completed one application cycle for medical school and intends to reapply
• Rachael Thumma: Current sophomore studying neuroscience and behavior, applied for early acceptance to medical school but still considering options
• Tom Punnen: Graduating soon with bachelor’s in neuroscience, entering a gap year to conduct research and plans to apply for a health professional program soon
• Chetana Movva: Current sophomore in a bachelor of science/doctor of osteopathic medicine program

Formative Experiences and Mentors

Walters asked her panelists about the types of information or experiences that informed their career decisions. “I have been very influenced by my social and academic surroundings,” Punnen said. For example, visiting India with his parents sparked an early interest in health disparities and public health. An encounter with a patient suffering from Parkinson’s led Punnen to the research that he is currently conducting. “There isn’t one experience that defined my path,” he said, but experiences have made him realize how much there is to learn. Punnen said he hopes that his upcoming gap year will help him find his niche. The diversity of medicine makes it complex to explore all the different career paths and avenues, he said, so it is important to be open and vulnerable during experiences and to ask mentors for their input on how to shape your future as a learner. Coming into health care, Punnen said that he wasn’t aware of all of the options; gaining experience and engaging with mentors is critical. Mentors who have “been in your shoes” can really help the process of finding a direction and a path forward.

Hathcock agreed that mentors are important and admitted that she wishes she had better access to a network of mentors during her first application cycle. In addition, Hathcock said that more resources for studying for the MCAT would be beneficial. Ziaee noted how mentors can take a

variety of forms; some mentors are a step ahead, while other mentors are already “living your dream.” It is important to have a wide variety of mentors at different stages, he said. For example, someone who has just finished the application process would be better suited to give advice on studying for the MCAT than a physician mentor who took the MCAT many years prior. Ziaee said that matching students with both career professionals and peer mentors helps to create a “board of directors” that the student can rely on for different types of advice. Because health care is so large and complex, it can be enormously helpful to see it through the perspectives of real people. Punnen added that finding mentors can be a challenge, especially when first trying to break into a field. Being persistent and actively searching for experiences and people to connect with was something he found helpful. Once you find that “one person,” he said, it can be easier to make connections and find the answers to questions. Punnen agreed with Ziaee that mentors can take a variety of forms and said that people outside of health care who have gone through similar experiences could also serve a valuable mentoring role.

Role of Social Media

Expanding on the discussion of peer mentors, Walters asked her panelists about the role of social media in creating connections and exposure to different career paths. Ziaee replied that social media has expanded the definition of a mentor because it is possible to get mentorship guidance and the understanding of a different career field without even knowing the person personally. He gets a lot of insight and advice from individuals that he follows on social media. For example, it can be helpful to see another first-generation student with similar life experiences, even if the student is not in the same field. These online mentors, along with real-life mentors, have helped Ziaee see how he can fit into the system of health care.

Movva said that her role within HOSA–Future Health Professionals has given her a unique opportunity to view how social media affects students’ approaches to applications, testing, and school. Social media allows us to understand the perspectives of people we don’t know, as Ziaee discussed, as well to possibly engage and connect with them. Sites like TikTok and Instagram are “incredibly accessible” to students and present information in a digestible format, she said. There are, of course, other formats for presenting information, but social media is where students already are. Although social media gets a bad rap for being distracting, Movva argued that it provides an invaluable resource for students to connect with one another, particularly for students who may have fewer opportunities or resources to connect in more traditional ways. Movva noted that while there is good information online, there is also incorrect or misleading

information. For example, web sources might say that only students with very high test scores are able to get into health professions schools. It is important to be able to filter through sources in order to get the correct information and use it properly, she said.

Choosing a Path

Walter asked panelists to comment on how they have made decisions about their careers and educational programs and what influences informed these decisions. Thumma commented that she has sought out experiences where she can learn firsthand about a potential career path. More specifically, her interest in public policy and insurance led her to an internship with a chief medical officer working with government insurance. It has been an enlightening experience, she said, to see how someone can use a medical degree to make an impact on public policy. Thumma also has an interest in social determinants of health at a community level, so she found an internship with a doctor who works at a free clinic. Thumma’s experiences shadowing the doctor have allowed her to see how he “keeps his clinic afloat” financially while also helping people. Taking advantage of these types of opportunities, she said, has allowed her to interact with a wide variety of people working in health care, from pharmacists to financial managers, and has shown her the numerous ways that people can have an impact.

Ziaee and Punnen discussed their decisions to take a gap year after undergraduate studies. Ziaee said that during school he didn’t have time to do all the things he wanted to do because of the course load; he hopes that taking a gap year will allow him to pursue these interests and build new skills. For example, his current research project requires such skills as coding, data visualization, and writing; these were not skills that were emphasized in his coursework. The purpose of the gap year is to give him the time and flexible space to do the work he wants to do. There is also a financial aspect to the gap year. The path to many health professions is expensive, and some of the costs are not obvious. For example, while tuition is an obvious cost, there are also the less-obvious costs related to things like transportation, interviews, and exams. Ziaee continued, saying the purpose of his gap year is to make him a resilient person so he will be prepared for the realities of his graduate education. Punnan pointed to two reasons for taking a gap year. First, undergraduate school has been tiring and taken a lot of effort and energy. The gap year will serve as a reset to ensure that he is prepared for graduate school. Second, Punnan would like the time and space to explore his interests, such as conducting research and volunteering. Punnan said he still feels “tugged in different directions,” and he hopes that he can find an intersection between his interests where

he can focus his career. However, even if the gap year does not help him find his niche, Punnan is convinced the experience will still be a “formative and valuable one.”

Barriers

Following up on Ziaee’s point about the financial barriers to graduate education, Walters asked the panelists about other barriers they have encountered in their application journey. Hathcock said one major challenge was being in school during the COVID-19 pandemic. The pandemic interrupted her freshman year of college, and she had to finish some very difficult classes online, including organic chemistry. In addition, the pandemic prevented her from forming a strong network of mentors. Not getting into medical school during her first application cycle was disappointing, she said, but she took advantage of the opportunity to pursue her degree in public health, a field in which she had a longstanding interest. Hathcock said that her willingness to be flexible in her career path allowed her to take the barriers that she was facing and “transform them into something meaningful.”

THE GO-BETWEEN: GETTING INTO A DEGREE PROGRAM

StraighterLine is a U.S. company that offers accessible online courses that enable learners to earn college credit and complete prerequisites for advanced education, Cahn said. He introduced Amy Smith, the chief learning officer at StraighterLine, to talk about studies she and her colleagues conducted with learners and program applicants. StraighterLine has about 45,000 students per year, she said, and it serves as a “go-between” space where students can earn credits or apply to a degree-granting program. The company conducted three surveys over 3 years on a variety of topics; in total, there were roughly 3,000 respondents to the surveys.

The first survey looked at learners who earned college credits but did not have a degree. In the survey, respondents were asked about motivating factors that led them to initially enroll in their program. The most-reported motivation was “personal goal” (62 percent), followed by “career advancement” (44 percent), and “love of learning” (42 percent). Motivations varied slightly by age, with younger learners reporting they were also motivated by the prospect of an improved salary.

The second survey examined the lived experiences of learners in the process of transferring institutions. Around 50 percent of respondents reported “shopping around,” meaning that they explored multiple schools to determine which institution to transfer to, while 47 percent said they did not. Respondents under age 30 were slightly more likely to shop around,

Smith said. She noted that many of the respondents who did look for other options were limited by admissions requirements or location (e.g., needed to stay near family). The survey asked respondents about factors they considered when choosing an institution or program. The highest-ranked factor was tuition or cost of the degree, followed by speed with which the degree could be completed and ability to earn credentials that demonstrate competencies. When asked about their main decision-making factors, 30 percent responded that “personal, clear, timely communication from school” was a main factor that led to their decision. This shows, Smith said, that how institutions communicate with applicants really matters. The survey also looked at learners’ expectations in the transfer process and how their experiences compared with their expectations. Again, learners reported that clear communication was important, with 27 percent saying poor communication from the institution was a challenge or barrier during the transfer process. Those surveyed described an ideal situation where responses to their questions about credits, programs, or other issues would be answered within 1 week. While 55 percent of respondents said that institutions responded to credit transfer or program status inquiries within 1 week, 33 percent said it took institutions between 1 and 6 months to respond, while 8 percent said they were never informed of whether credits would transfer. Smith also noted that applicants of different ages have different preferences for how communication is conducted, so it is important for institutions to have the capacity to use multiple messaging platforms (e.g., texting, phone calls).

Influencing the Learner Applicant: Recruitment & Program Perspectives

Yánez moderated the next panel discussion of predominantly academicians from the United States who advise and communicate with learners at differ points throughout an applicant’s journey. She asked a series of questions and asked one or two panelists to respond to each. Panelists participants included:

• Tony Wynne, executive director, National Association of Advisors for the Health Professions
• Michelle Rogers, program director, Office of Admission, Saint Louis University
• Adrianne Jones, chief admissions officer, Philadelphia College of Osteopathic Medicine
• Kimberly Nicely, interim dean of student success, Medical Education Campus, Northern Virginia Community College
• Jen Perniciaro, senior director, account planning and marketing strategy, Saint Louis University

• Elizabeth Szpilka, director of outreach enrollment and professional advisement, Adelphi University
• Molly Moeller, senior director of admissions and recruitment, Des Moines University Medicine and Health Sciences

Changes over Time

Yánez asked panelists how the admissions process has changed over time. Rogers said that in addition to the obvious technological changes, there are three main changes that she has observed. First, institutions are expecting more from applicants. Admissions looks for exceptional grades and test scores, exceptional letters of recommendation, and exceptional resumes. Along with the academic caliber, Rogers said, applicants are expected to have experiences in volunteering, service, and research. She noted that gap years are becoming more common because students cannot fit in all of the expected activities in the normal school year. Another major change is that colleges and universities are reaching out further to get the right students for the right programs. Schools that offer interprofessional education and strong opportunities outside the classroom benefit from enrolling the “right” students, she said, and marketing these opportunities is part of recruiting these students. Finally, there has been a rise in applicants to direct entry programs, in areas including nursing, physical therapy, and occupational therapy. Direct entry programs can save a student money, time, and energy and can allow them to do other things while in school. Raising awareness of these programs through social media and other avenues is a benefit to students and schools, said Rogers. Nicely agreed that more is expected of applicants now; for example, the admissions process at a nursing school involves looking at whether an applicant has previous licensure at a lower level or other types of experience. This approach, she said, ensures that the school admits high-caliber students who will be successful from start to finish.

Role of Advisors

As previous panelists had discussed, there are a huge number of potential careers in the health professions, but many students are either unaware of these options or uninterested. Yánez asked Wynne for his thoughts on how influencers can help learners consider all potential career options. Wynne’s response centered on the role of an advisor, saying it is “not to change a mind, but to understand the mind.” By talking with students about their expectations and desired outcomes and by being aware of what programs exist and what they require, an advisor can help a student find a career or program that is a good fit. Wynne said there are about 7,000

health professions programs in the United States, and one advisor may be working with up to 300 students at one time. Trying to navigate the huge number of possibilities is difficult for both the students and the advisors, he said, but working closely with health professions societies and associations helps. One issue that is emerging in the admissions process, Wynne said, is the role of artificial intelligence (AI) in the application process and whether and how AI can be ethically used. Another current challenge is the lack of qualifications among students who were taking classes during the COVID-19 pandemic; some students did not do well in an online environment, and that is being reflected in the applications that are coming in. Ultimately, Wynne said, the role of an advisor is to seek to understand a student’s background, goals, and expectations and to work with the student to find a good match.

Goals of Admissions

Yánez asked panelists who work in admissions what they are currently seeing or looking for in applicants and how this has changed over time. Jones replied that there is a big rise in first-generation students across the nation. For these students, the pathway to preparation needs to begin in middle school or before. Jones brought up the Philadelphia College of Osteopathic Medicine. It has affiliation and articulation agreements with schools in the area, and these partnerships help raise awareness of health professions and guide students on a path toward a career. Another shift, she said, has been in the work that goes into an application. As discussed in the first panel of this session, future applicants are taking time off from school to pursue internships, research opportunities, and other experiences. Jones said that, on average, it takes about “2 to 5 years for an application to really become complete.” She encouraged applicants to think about their application as a living, breathing document that represents the culmination of all their hard work.

Nicely said that community colleges aim to serve those who want to be in the health professions but don’t have the time or money to go away to a university. When looking at a student’s application, there are a number of factors that are considered. Grades and test scores can be indicative of a student’s ability to keep up with the rigor of a program, while experiences working or interning in a field indicates an understanding of the profession the student is pursuing. If students already have a license at a lower level, they may be able to get credits that allow them to move upward more quickly. These considerations, along with interviews, give the admissions team a holistic view of the student and his or her capacity to succeed in the program and the workforce. Moeller added that when looking at applicants, admissions considers skills in communication, interpersonal

interaction, and professionalism. These attributes are essential to success in the health professions, and there is a need to identify candidates who already have these skills and those who are coachable in these areas.

Identifying Qualities in Applicants

Following on Moeller’s observation about the essential qualities of health professions applicants, Yánez asked panelists about creative and innovative ways to identify desired qualities in applicants. Moeller responded that in recent years admission departments have spent a lot of time “meeting candidates where they’re at.” The COVID-19 pandemic forced the admissions process to be nimble and flexible, and these changes have endured. With a lack of testing results and interrupted classes, admissions began focusing on the competencies that candidates need to be successful and honed the interview process in order to bring out these competencies. Admissions continues to take a holistic look at candidates and to remove barriers. For example, interview opportunities for candidates have remained virtual in order to ensure access, and a structured interview process was developed to ensure equity across candidates and across programs. Most importantly, the admissions process has been reframed as something that candidates participate in; “it’s us together with them, it’s not us fighting them,” she said. This collaborative process means there may be opportunities to have conversations about a different health profession being a better fit for a particular student, and to work with the student to guide the shift.

Perniciaro agreed about applicants being considered part of the admissions process and said that today’s applicants are searching for a program or institution that “matches their vibe.” As part of the marketing team at St. Louis University, Perniciaro said she tries to convey the energy and values of the institution on social media and in other arenas to help narrow and filter candidates who will be right for the program. Potential applicants who are attracted to the institution from social media posts may feel more naturally aligned with the program, she said. Previous panelists spoke of the importance of finding a good match between applicant and program; conveying the vibe of an institution is one approach to creating suitable matches.

Szpilka agreed with others on how the culture or vibe of an institution helps to attract those students who would be a good fit. Applicants to Adelphi University often have narrowed down their choices to a couple of schools and then are trying to decide where they could see themselves being comfortable. Szpilka said she makes an effort to reach out to potential students to help them feel comfortable and answer their questions. It’s important for an institution to know who they want to attract, who they are attracting, and how they will support students once they enroll, she said.

Future of Advising and Admissions

“If you could design a system where every health profession has all the students they need for a strong workforce, as well as students who are well matched with their interests and aptitudes, what would that system look like?” Yánez asked. Wynne said that in a perfect world, an advisor could sit down with a learner and access a database of all the health professions programs. Based on data entered about the student, the system could generate a list of schools that appear to be a good fit. Having to do this work one-by-one is “very complicated,” he said.

Szpilka remarked how the ideal system would start engaging with students at younger ages and would help students make connections between their interests and the opportunities that exist. Rogers agreed that early awareness is critical, but she emphasized the importance of focusing early engagement on encouraging students to think about the classes they like, why they like them, and what they may want to do after graduation. In addition, experiential learning for students is key—“being able to see what you’re going to do for the next 40 years of your life” is an enormous benefit to a young learner. Yánez added that younger students may not know what their aptitudes are and said that standardized metrics can help identify talents and strengths, and could be useful in decision making. Moeller added that there are new products that leverage AI for predictive analytics for admissions and science aptitude testing as early as high school. This can be used to help students identify health sciences careers they may not otherwise have been aware of.

Another aspect of an ideal system, Moeller said, would be to redirect students toward programs that are a better fit. For example, if a student applies and does not get into a program, could there be a smooth system of helping to see the rejection as an opportunity to explore other health professions careers? Many learners do not get into their first choice program or their first-choice residency or fellowship, Jones said; reframing denials as opportunities to find programs or institutions that are a better match for the learner could keep the applicant in the health professions. Rogers said that admissions is hard and sometimes subjective and that in an ideal world all learners would be exposed to the huge variety of health professions opportunities and would be able to find their best matches.

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