Applicant Selection to a Regional Medical Training Program: A Structural Analysis of Interviewer Assessments

Abstract

Introduction:  For regional campuses with specific program foci, assessing applicant fit necessarily extends beyond academic and professional factors. Based on assessments of applicants to a regional Rural Physician Leadership Program (RPLP), this study explores the relationship of academic and socio-demographic factors with interviewers’ ratings of: (1) likelihood of eventually practicing in a rural area of the state; and (2) overall acceptability to medical school. Methods:  The study population consisted of 163 first-time RPLP applicants interviewed independently from 2009-2016 by two faculty members at both main and regional medical campuses.  Path analysis was used to calculate direct, indirect, and total effects of applicants’ socio-demographic and academic characteristics on interviewers’ composite ratings. This study protocol (#17-0198-X3B) was approved as exempt by the governing Institutional Review Board; the authors report no conflicts of interest. Results: The combined influence of being an in-state resident with rural Appalachian origins, combined with undergraduate GPA, explained 40.7% of the variance in applicants’ predicted likelihood of practicing in rural Kentucky. In terms of applicant acceptability, the strongest direct effects were exerted by academic factors, GPA and total MCAT score, and the sole preceding endogenous variable: likelihood of rural in-state practice.  However, two other background factors were modestly but significantly directly associated with overall acceptability:  (1) age; and (2) residence. Specifying likelihood of rural practice as an intervening variable explained 42.5% of the variance in applicant acceptability and provided a good fit to the sample data (X2 = 3.19, df = 4 , p = .526, CFI = 1.000, RLI = 1.018, RMSEA = .000). Conclusions: Interviewers appear to be assessing programmatic, mission-specific “fit” within the broader context of applicants’ abilities to navigate a demanding professional training curriculum. Future research should examine graduates’ eventual practice locations and intermediate academic performance as empirical validity of faculty interviewers’ assessments. Similarly, pre-professional pipeline efforts should better coordinate with training programs to provide consistent opportunities to nurture interest in mission-specific outcomes.