Selection for health professions education leads to increased inequality of opportunity and decreased student diversity in The Netherlands, but lottery is no solution: A retrospective multi-cohort study

Abstract

Background

Concerns exist about the role of selection in the lack of diversity in health professions education (HPE). In The Netherlands, the gradual transition from weighted lottery to selection allowed for investigating the variables associated with HPE admission, and whether the representativeness of HPE students has changed.

Method

We designed a retrospective multi-cohort study using Statistics Netherlands microdata of all 16-year-olds on 1 October 2008, 2012, and 2015 (age cohorts, N > 600,000) and investigated whether they were eligible students for HPE programs (n > 62,000), had applied (n > 14,000), and were HPE students at age 19 (n > 7500). We used multivariable logistic regression to investigate which background variables were associated with becoming an HPE student.

Results

HPE students with ≥1 healthcare professional (HP) parent, ≥1 top-10% income/wealth parent, and women are overrepresented compared to all age cohorts. During hybrid lottery/selection (cohort-2008), applicants with ≥1 top-10% wealth parent and women had higher odds of admission. During 100% selection (cohort-2015) this remained the case. Additionally, applicants with ≥1 HP parent had higher odds, those with a migration background had lower odds.

Conclusions

Odds of admission are increasingly influenced by applicants’ backgrounds. Targeted recruitment and equitable admissions procedures are required to increase matriculation of underrepresented students.

Keywords:

• Selection
• admission
• diversity
• inequality of opportunity

Acknowledgements

The authors thank the Equal Opportunities Alliance of the Ministry of Education, Culture, and Science for providing funds to support this research. The authors also wish to thank all involved people working at Statistics Netherlands, Studielink, and the Universities of The Netherlands (UNL) for their cooperation in making this research project possible. Finally, the authors also wish to thank their colleagues at Amsterdam UMC, location VUmc, Team Research in Education and Prof. Vinod Subramaniam, President of the University of Twente, for their valuable feedback on our manuscript. We would also like to extend our gratitude to the Nationaal Regieorgaan Onderwijsonderzoek, which provided funding for the PhD project within which this project is executed.

Disclosure statement

The authors report no conflict of interest.

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This work was supported by Nationaal Regieorgaan Onderwijsonderzoek, which provided funding for the PhD project within which this project is executed (grant number 40.5.18650.007). The Equal Opportunities Alliance of the Ministry of Education, Culture and Society provided partial funding for this specific cohort study.

Notes on contributors

Lianne Mulder

Lianne Mulder, MA, MPhil, is a PhD student at Amsterdam UMC, Research in Education, Faculty of Medicine, Vrije Universiteit Amsterdam, The Netherlands; and LEARN! Faculty of Psychology and Education, Vrije Universiteit, Amsterdam.

Anouk Wouters

Anouk Wouters, PhD, is Assistant Professor at Amsterdam UMC, Research in Education, Faculty of Medicine, Vrije Universiteit Amsterdam, The Netherlands; and LEARN! Faculty of Psychology and Education, Vrije Universiteit, Amsterdam.

Jos W. R. Twisk

Jos W. R. Twisk, PhD, is Professor at the Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam,Amsterdam Public Health, Amsterdam, The Netherlands.

Andries S. Koster

Andries S. Koster, PhD, is Associate Professor of Pharmacology at the Department of Pharmaceutical Sciences of Utrecht University, Utrecht, The Netherlands.

Eddymurphy U. Akwiwu

Eddymurphy U. Akwiwu, MSc, is a PhD student at the Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health, Amsterdam, The Netherlands.

Jan H. Ravesloot

Jan H. Ravesloot, PhD, is Professor at the Department of Medical Biology, Amsterdam UMC, Faculty of Medicine, University of Amsterdam, The Netherlands.

Gerda Croiset

Gerda Croiset, MD, PhD, is Dean of Education and Training at the Wenckebach Institute for Education and Training, University Medical Center Groningen, Groningen, The Netherlands.

Rashmi A. Kusurkar

Rashmi A. Kusurkar, MD, PhD, is Associate Professor and Research Programme Leader at Amsterdam UMC, Research in Education, Faculty of Medicine, Vrije Universiteit Amsterdam, The Netherlands; and LEARN! Faculty of Psychology and Education, Vrije Universiteit, Amsterdam.