A Matthew Effect?: Undergraduate Institutional Prestige, Admission to Medical School, and Medically Underserved Communities

Abstract

Admission to medical school is key to addressing medically underserved communities because over 90% of medical students graduate and become physicians. Yet, members of populations most likely to serve medically underserved communities as physicians remain chronically underrepresented in medical education despite initiatives aimed at increasing their representation among medical students. Meanwhile, traditional determinants of medical school admission fail to fully predict success in medical school, but have a disparate impact on applicants from underrepresented populations. Other determinants are underexplored, especially undergraduate institutional prestige. This study used a quantitative case study approach to examine the relationship between undergraduate institutional prestige, admission to medical school, and potential to serve medically underserved communities via specialty. Using a synthesis of the frameworks of symbolic capital, the iron triangle, and manifest and latent functions as a lens, this study analyzes (1) the relative impact of undergraduate institutional prestige on predicting admission to medical school holding constant the effect of traditional determinants of admission to medical school (i.e., MCAT, GPA), (2) how undergraduate institutional prestige varies by admissions stage, and (3) the relationship between undergraduate institutional prestige and specialty. Overall, findings show that undergraduate institutional prestige is important throughout the medical school admissions process; yet, undergraduate institutional prestige is not related to specialty. Nonetheless, findings imply preferences for applicants from more prestige undergraduate institutions may be contradictory to fulfilling organizational missions concerned with addressing healthcare disparities.