Admissions adaptations to widespread disruption:  a multiple case study of Canadian medical school responses to a constellation of social phenomena

Lawrence Grierson; Asiana Elma; Aimun Q Shah; Jean-Michel Leduc; Kulamakan Kulasegaram; Alice Cavanagh; Amar Farkouh; Justin Lam; Dilshan  Pieris; Sophie Boies; Augustine Okoh; Roberta Soares; Jenny Zhao; Mark D Hanson

doi:10.36834/066n3310

Authors

Lawrence Grierson McMaster University
Asiana Elma McMaster University
Aimun Q Shah McMaster University
Jean-Michel Leduc Universite de Montreal
Kulamakan Kulasegaram University of Toronto
Alice Cavanagh University of Toronto
Amar Farkouh Universite de Montreal
Justin Lam Western University
Dilshan Pieris McMaster University
Sophie Boies Universite de Montreal
Augustine Okoh McMaster University
Roberta Soares Universite de Montreal
Jenny Lee Zhao Queen's University
Mark D Hanson University of Toronto

DOI:

https://doi.org/10.36834/066n3310

Abstract

Background: Social phenomena can disrupt education systems, promoting rapid adaptations that shift which values are prioritized in institutional processes. Between 2020 and 2023, a constellation of such phenomena impacted Canadian medical education admissions systems. In this study, we used the Theory of Social Innovation to explore how the adaptive responses shifted, uprooted, or entrenched institutional values in selection systems across the country.

Methods: We used a multiple case study approach to catalogue adaptations made at Canadian medical schools. Our original focus was on pandemic-driven changes but was expanded to include other phenomena raised by participants. Initial exploratory cases examined distinctive 2020 adaptations at Université de Montréal (cancelled interviews), University of Toronto (virtual interviews), and McMaster University (partial lottery). These were followed by an explanatory case bounded to the Association of Faculties of Medicine of Canada’s Network on Admissions.

Results: We interviewed 37 individuals from 13 medical schools and reviewed 67 case-relevant documents. Adaptations responded to the pandemic, widespread calls for racial justice, and the rise of artificial intelligence, and included virtual interviews, actuarial approaches, and dedicated pathways for structurally excluded groups. Participants regarded these phenomena as opportunities to affirm and rebalance institutional values, while emphasizing the impact of landscape-level influences on local decisions.

Conclusions: These findings prompt Canadian medical schools to consider how recent disruptions may have moved their selection policies away from their intended purposes and whether shifts are locally desirable. Reflection on change can promote values-based decision making in the face of social phenomena.

Author Biographies

Lawrence Grierson, McMaster University

Lawrence Grierson is an Assistant Professor with the Department of Family Medicine, a Senior Scientist with the Program for Educational Research and Development, an Education Scientist with the Micheal G. DeGroote School of Medicine and MacCARE Community and Rural Education Program, and the Associate Director of the Graduate Program in Health Sciences Education, all at McMaster University (Hamilton, Canada). He holds a PhD in Kinesiology (McMaster University) and leads paraller programs of research concerned with applied health professions education and theoretical motor control.
Asiana Elma, McMaster University

Asiana Elma is Research Coordinator, Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Canada and Doctoral Candidate, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
Aimun Q Shah, McMaster University

Aimun Q. Shah is Research Coordinator, Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
Jean-Michel Leduc, Universite de Montreal

Jean-Michel Leduc is Associate Clinical Professor, Department of Medical Microbiology, Infectious Diseases and Immunology, and Researcher-Investigator, Centre de Recherche en Pédagogie de la Santé, Faculty of Medicine, Université de Montreal, Montreal, Canada.
Kulamakan Kulasegaram, University of Toronto

Kulamakan Kulasegaram is Director and Associate Professor, Office of Education Scholarship, Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada and Scientist, Wilson Centre, Temerty Faculty of Medicine, University of Toronto, Canada.
Alice Cavanagh, University of Toronto

Alice Cavanagh is Family Medicine Resident, Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
Amar Farkouh, Universite de Montreal

Amar Farkouh is Medical Student, Faculty of Medicine, University of Montreal, Montreal, Canada.
Justin Lam, Western University

Justin Lam is Paediatrician and Education Scientist, Department of Paediatrics, Schulich School of Medicine & Dentistry, Western University, London, Canada, and Department of Paediatrics, London Health Sciences Centre, London, Canada.
Dilshan Pieris, McMaster University

Dilshan Pieris is Family Medicine Resident, Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
Sophie Boies, Universite de Montreal

Sophie Boies is Research Assistant, Montreal North Island Integrated University Health and Social Services Centre, Montreal, Canada.
Augustine Okoh, McMaster University

Augustine Okoh is Research Assistant, Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
Roberta Soares, Universite de Montreal

Roberta Soares is Research Assistant, Montreal North Island Integrated University Health and Social Services Centre, Montreal, Canada.
Jenny Lee Zhao, Queen's University

Jenny Lee Zhao is Research Assistant, Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Canada and Medical Student, School of Medicine, Queen’s University, Kingston, Canada.
Mark D Hanson, University of Toronto

Mark D. Hanson is Professor, Department of Psychiatry, Temerty Faculty of Medicine, Hospital for Sick Children, University of Toronto, Toronto, Canada.

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