University of Northern Colorado Scholarship & Creative Works @ Digital UNC Dissertations Student Research 5-8-2017 The Disadvantaged Status in the American Medical College Application Service: Medical Students Reflect on Their Experiences Adam M. Lowrance Follow this and additional works at: https://digscholarship.unco.edu/dissertations Recommended Citation Lowrance, Adam M., "The Disadvantaged Status in the American Medical College Application Service: Medical Students Reflect on Their Experiences" (2017). Dissertations. 417. https://digscholarship.unco.edu/dissertations/417 This Text is brought to you for free and open access by the Student Research at Scholarship & Creative Works @ Digital UNC. It has been accepted for inclusion in Dissertations by an authorized administrator of Scholarship & Creative Works @ Digital UNC. For more information, please contact [email protected]. © 2017 ADAM M. LOWRANCE ALL RIGHTS RESERVED UNIVERSITY OF NORTHERN COLORADO Greeley, Colorado The Graduate School THE DISADVANTAGED STATUS IN THE AMERICAN MEDICAL COLLEGE APPLICATION SERVICE: MEDICAL STUDENTS REFLECT ON THEIR EXPERIENCES A Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Adam M. Lowrance College of Education and Behavioral Science Department of Leadership, Policy and Development: Higher Education and P-12 Education Higher Education and Student Affairs Leadership May 2017 This Dissertation by: Adam M. Lowrance Entitled: The Disadvantaged Status in the American Medical College Application Service: Medical Students Reflect on Their Experiences has been approved as meeting the requirements for the Degree of Doctor of Philosophy in College of Education and Behavioral Sciences in Department of Leadership, Policy and Development: Higher Education and P-12 Education, Program of Higher Education and Student Affairs Leadership Accepted by the Doctoral Committee ______________________________________________________ Matthew Birnbaum, Ph.D., Research Advisor ______________________________________________________ Florence M. Guido, Ph.D., Committee Member _______________________________________________________ Spencer C. Weiler, Ph.D., Committee Member _______________________________________________________ Eugene Sheehan, Ph.D., Faculty Representative Date of Dissertation Defense March 23, 2017 Accepted by the Graduate School _________________________________________________________ Linda L. Black, Ed.D. Associate Provost and Dean Graduate School and International Admissions ABSTRACT Lowrance, Adam M. The Disadvantaged Status in the American Medical College Application Service: Medical Students Reflect on their Experiences. Published Doctor of Philosophy dissertation, University of Northern Colorado, 2017. The option to identify as disadvantaged in the American Medical College Application Service (AMCAS) primary application may lead to unclear expectations for applicants. Despite its inception more than a decade ago, there are no published materials containing either a comprehensive definition, or explanation of the role of the Disadvantaged Status in student selection. Research on the Disadvantaged Status is similarly lacking. The purpose of this interpretivist case study was to explore how current students made meaning of the option to identify as disadvantaged when they were applying to medical schools. Through this research I uncovered meanings applicants ascribed to the disadvantaged term, how they determined whether they were disadvantaged, and how they decided whether or not to apply as such. Through open-ended interviews with 15 students at a medical school in the Northeast, document analysis of their AMCAS files, and with a theoretical framework that included symbolic interactionism, social comparison theory, stigma, and impression management, it became clear that deciding whether or not to apply as a disadvantaged applicant in the AMCAS primary application is both complex and fragile. Simply having experienced hardships during childhood was insufficient for many participants in this study to determine whether or not they were disadvantaged or should apply as such. The process of determining whether or not to apply as a disadvantaged applicant was iii confounded by a myriad of factors represented by the following nine themes: experience with disadvantage, resources, ambiguity, audience, pride, stigma, ethics, right to identify, and impression management. I concluded this dissertation with what I considered to be the most significant implications, in particular, that not all applicants are using the Disadvantaged Status consistently. I made recommendations for staff at the Association of American Medical Colleges, faculty and staff at medical schools and undergraduate institutions, and future applicants. I closed this dissertation with my final thoughts on this research experience. iv ACKNOWLEDGEMENTS This dissertation is the culmination of many years of education, training, and research; there are many people who have supported me along the way. To the participants, thank you for your willingness to share. I hope your insight will inform research and practice for years to come. To the admissions personnel at the study site who made this possible, I wish I could thank you by name, without your support, I would not have been able to conduct this research. To Dr. Matthew Birnbaum, my advisor and friend, thank you for encouraging me when I needed it most, and for the many rounds of revisions we went through together. To Drs. Flo Guido, Spencer Weiler, and Eugene Sheehan, thank you for being a part of this research process, and for asking the difficult questions that strengthened this study. To Amy Addams & Sarah Conrad, directors at the AAMC, thank you for your encouragement. Your enthusiasm motivated me to move forward with this study. To Karen DiMario, thank you for sharing your expertise and teaching me the art of holistic evaluation. I am forever indebted to your mentorship. To Drs. Lise Eliot & Ted Lorenc, thank you for treating me as a colleague. I strive to work on behalf of medical students with as much passion and dedication as both of you. To Dr. Tobias Guzman, thank you for your mentorship and friendship. You are an exemplar of leadership and social justice in higher education and I am fortunate to have learned from you. To Carol Steward and the Graduate School, thank you for your guidance and in depth review. This final product reflects your attention to detail. To Dr. Chris Cobb, the greatest friend and cohort-mate, your support, even when we lived multiple time zones apart has meant everything. To Denise and Dennis Tower, thank you for your encouraging words; you lifted my spirits whenever we spoke. To my grandmother, Carrol Lowrance, our weekly phone conversations have been a cherished part of my life. I am so lucky to be your grandson. v To my parents, Dr. Lynn and Ken Lowrance, I will never be able to thank you for all you have done for me. Your love and support is among my most treasured gifts. Finally, to my wife, Dr. Dyane Tower, to thank you properly would require me to write an additional dissertation. For your patience, support, and sacrifices, I will love you always. vi TABLE OF CONTENTS CHAPTER I INTRODUCTION .............................................................................................................. 1 Why Disadvantage Matters ........................................................................................... 2 Background ................................................................................................................... 4 American Medical College Application Service .................................................... 4 Holistic Review ....................................................................................................... 5 Medical College Admission Test ............................................................................ 6 Disadvantage ........................................................................................................... 7 Purpose Statement ....................................................................................................... 10 Research Question ...................................................................................................... 11 Methodological Considerations .................................................................................. 12 Data Collection ........................................................................................................... 12 Significance of the Study ............................................................................................ 12 Chapter Summary ....................................................................................................... 14 CHAPTER II LITERATURE REVIEW ................................................................................................. 16 Part I: Access .............................................................................................................. 16 Historical Perspective ........................................................................................... 17 vii Access to Medical Education Today ..................................................................... 30 Part II: Self-Presentation in the American Medical College Application Service Application ....................................................... 57 Theoretical Frame ................................................................................................