More underrepresented minority (URM) healthcare professionals are needed to improve health equity. Although holistic review in admissions has the potential to increase URM participation in health professions, recent data suggest that its impact varies substantially. The purpose of the dissertation research described here was to identify interventions to increase diversity among healthcare professionals and explore holistic review use in physician assistant (PA) program admissions to advance understanding of effective practices. PA programs were selected as an important prototype for exploratory studies since the extent of holistic review use in PA programs was unknown; at the same time, URM representation among PA students has decreased over the last 15 years.
A critical review of the literature revealed that various holistic review practices have been used by several health professions programs to successfully increase URM enrollment and that organizational culture may be a factor that promotes success. Following this, 2017 Physician Assistant Education Association survey data were analyzed to assess the frequency of holistic review in PA programs and examine its association with URM matriculation. Results from 221 of the 223 PA programs accredited at the time showed that 77.5% used holistic review, and its use modestly correlated with proportion of first-year students identified as ethnic minorities (rs = .20, p < .01). Of particular interest, some programs using holistic review had substantially higher proportions of URM students than others. This finding laid the foundation for a qualitative multiple case study to explore the role of organizational culture as a hypothesized antecedent to effective holistic admissions processes.
Survey study responses were used to select two PA program ‘cases’ that met criteria consistent with a proposed conceptual framework linking organizational culture that values diversity (or ‘diversity culture’) to holistic admissions associated with high URM enrollment. Directed content analysis of data revealed that diversity culture appears to be a strong driver of practices that support enrolling diverse classes of students.
Overall, this mixed methods program of research advances understanding of holistic review, its utility, and the influence of organizational culture. The research generated important insights with ramifications for current practice and future studies within PA and across health professions programs.