Journal of Educational Evaluation for Health Professions

Review

Socioeconomic and economic factors affecting access and progression in medical schools: a systematic review and meta-analysis: Arash Arianpoor, Alexia Pena, Annette Mercer, Jennifer Cox, Dimitra Lekkas, Francis Ruel Geronimo, Heidi Waldron, John Randal, Marcus Dabner, Marita Lynagh, Nalini Pather, Nicole Shepherd, Nigel Robb, Rose Berdin, Tim Wilkinson, Wendy Hu, Boaz Shulruf, Pin-Hsiang Huang; J Educ Eval Health Prof. 2026;23:6. Published online April 16, 2026; DOI: https://doi.org/10.3352/jeehp.2026.23.6

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Abstract PDF Supplementary Material: Purpose
Socioeconomic disadvantage remains a major determinant of equitable access to, and progression within, medical education. This systematic review and meta-analysis examines both the impact and the magnitude of financial and economic disadvantage on student selection and progression in medical school.
Methods
Studies were included if they reported associations between socioeconomic indicators (e.g., parental income, occupation, education, geographic deprivation, or premedical debt) and selection or progression outcomes, and were excluded if they lacked clearly defined economic predictors or sufficient data for binary effect sizes. Searches were conducted across PubMed, Scopus, ERIC, Embase, ProQuest, and EBSCO (2005–2025). Study selection employed an active machine-learning screening process. Extracted data included sample characteristics, socioeconomic measures, and outcome types, with risk of bias assessed using the Risk of Bias Instrument. Random-effects meta-analysis was conducted where appropriate.
Results
Thirty-two studies of medical programs were included, yielding 28 effect sizes for selection and 9 for progression. Household economic and educational disadvantage, identified through parental indices, was consistently associated with reduced odds of admission (odds ratio [OR], 0.6; 95% confidence interval [CI], 0.55–0.65) and poorer progression (OR, 0.56; 95% CI, 0.53–0.59). Geographic deprivation also exerted a negative effect, particularly on selection (OR, 0.69; 95% CI, 0.5–0.93).
Conclusion
Socioeconomic disadvantage exerts a pervasive influence across the medical education continuum. Addressing these inequities requires sustained financial, academic, and psychosocial support both before and during their studies. Students’ economic circumstances should therefore be considered in medical school selection policy and curriculum development to further enhance equity within medical schools and the profession.

Corrigendum

Notice of Retraction and Replacement: Insights into undergraduate medical student selection tools: a systematic review and meta-analysis: Pin-Hsiang Huang, Arash Arianpoor, Silas Taylor, Jenzel Gonzales, Boaz Shulruf; J Educ Eval Health Prof. 2024;21:41. Published online December 31, 2024; DOI: https://doi.org/10.3352/jeehp.2024.21.41; Corrects: J Educ Eval Health Prof 2024;21(0):22

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PDF Supplementary Material

Review

Insights into undergraduate medical student selection tools: a systematic review and meta-analysis: Pin-Hsiang Huang, Arash Arianpoor, Silas Taylor, Jenzel Gonzales, Boaz Shulruf; J Educ Eval Health Prof. 2024;21:22. Published online September 12, 2024; DOI: https://doi.org/10.3352/jeehp.2024.21.22; Correction in: J Educ Eval Health Prof 2024;21(0):41

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Abstract PDF Supplementary Material

Purpose
Evaluating medical school selection tools is vital for evidence-based student selection. With previous reviews revealing knowledge gaps, this meta-analysis offers insights into the effectiveness of these selection tools.
Methods
A systematic review and meta-analysis were conducted applying the following criteria: peer-reviewed articles available in English, published from 2010 and which include empirical data linking performance in selection tools with assessment and dropout outcomes of undergraduate entry medical programs. Systematic reviews, meta-analyses, general opinion pieces, or commentaries were excluded. Effect sizes (ESs) of the predictability of academic and clinical performance within and by the end of the medicine program were extracted, and the pooled ESs were presented.
Results
Sixty-seven out of 2,212 articles were included, which yielded 236 ESs. Previous academic achievement predicted medical program academic performance (Cohen’s d=0.697 in early program; 0.619 in end of program) and clinical exams (0.545 in end of program). Within aptitude tests, verbal reasoning and quantitative reasoning predicted academic achievement in the early program and in the last years (0.704 & 0.643, respectively). Overall aptitude tests predicted academic achievement in both the early and last years (0.550 & 0.371, respectively). Neither panel interviews, multiple mini-interviews, nor situational judgement tests (SJT) yielded statistically significant pooled ES.
Conclusion
Current evidence suggests that learning outcomes are predicted by previous academic achievement and aptitude tests. The predictive value of SJT and topics such as selection algorithms, features of interview (e.g., content of the questions) and the way the interviewers’ reports are used, warrant further research.

Citations

Citations to this article as recorded by

A Qualitative Study of a New Generation of Irish-Trained Doctors’ Views on Selection for Medicine
Seán Barber, Deirdre Bennett
MedEdPublish.2026; 16: 3. CrossRef
Facilitators and barriers along the pathways from secondary school to medical programmes- results from a national longitudinal study in Aotearoa New Zealand
Sarah Randal, Tim J. Wilkinson, Phillippa Poole, John Randal, Boaz Shulruf
Advances in Health Sciences Education.2026;[Epub] CrossRef
Transparency of Alpha Omega Alpha Selection Processes and Bias Mitigation Across US Medical Schools: A Cross-Sectional Mixed Methods Study
Christine C. Cheston, Neeharika Chanda, Sorraya Jaiprasert, Liam F. Keohane
Journal of General Internal Medicine.2026;[Epub] CrossRef
Predictive Validity of Pre-Clinical Academic Achievements in Comprehensive Basic Science Examination: A Nationwide Cohort of Iranian Medical Students
Farhang Rashidi, Reza Sattarpour, Alipasha Meysamie
Advances in Medical Education and Practice.2025; Volume 16: 1747. CrossRef
Notice of Retraction and Replacement: Insights into undergraduate medical student selection tools: a systematic review and meta-analysis
Pin-Hsiang Huang, Arash Arianpoor, Silas Taylor, Jenzel Gonzales, Boaz Shulruf
Journal of Educational Evaluation for Health Professions.2024; 21: 41. CrossRef

Research articles

Development and validation of the student ratings in clinical teaching scale in Australia: a methodological study: Pin-Hsiang Huang, Anthony John O’Sullivan, Boaz Shulruf; J Educ Eval Health Prof. 2023;20:26. Published online September 5, 2023; DOI: https://doi.org/10.3352/jeehp.2023.20.26

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Abstract PDF Supplementary Material: Purpose
This study aimed to devise a valid measurement for assessing clinical students’ perceptions of teaching practices.
Methods
A new tool was developed based on a meta-analysis encompassing effective clinical teaching-learning factors. Seventy-nine items were generated using a frequency (never to always) scale. The tool was applied to the University of New South Wales year 2, 3, and 6 medical students. Exploratory and confirmatory factor analysis (exploratory factor analysis [EFA] and confirmatory factor analysis [CFA], respectively) were conducted to establish the tool’s construct validity and goodness of fit, and Cronbach’s α was used for reliability.
Results
In total, 352 students (44.2%) completed the questionnaire. The EFA identified student-centered learning, problem-solving learning, self-directed learning, and visual technology (reliability, 0.77 to 0.89). CFA showed acceptable goodness of fit (chi-square P<0.01, comparative fit index=0.930 and Tucker-Lewis index=0.917, root mean square error of approximation=0.069, standardized root mean square residual=0.06).
Conclusion
The established tool—Student Ratings in Clinical Teaching (STRICT)—is a valid and reliable tool that demonstrates how students perceive clinical teaching efficacy. STRICT measures the frequency of teaching practices to mitigate the biases of acquiescence and social desirability. Clinical teachers may use the tool to adapt their teaching practices with more active learning activities and to utilize visual technology to facilitate clinical learning efficacy. Clinical educators may apply STRICT to assess how these teaching practices are implemented in current clinical settings.

What impacts students’ satisfaction the most from Medicine Student Experience Questionnaire in Australia: a validity study: Pin-Hsiang Huang, Gary Velan, Greg Smith, Melanie Fentoullis, Sean Edward Kennedy, Karen Jane Gibson, Kerry Uebel, Boaz Shulruf; J Educ Eval Health Prof. 2023;20:2. Published online January 18, 2023; DOI: https://doi.org/10.3352/jeehp.2023.20.2

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Abstract PDF Supplementary Material

Purpose
This study evaluated the validity of student feedback derived from Medicine Student Experience Questionnaire (MedSEQ), as well as the predictors of students’ satisfaction in the Medicine program.
Methods
Data from MedSEQ applying to the University of New South Wales Medicine program in 2017, 2019, and 2021 were analyzed. Confirmatory factor analysis (CFA) and Cronbach’s α were used to assess the construct validity and reliability of MedSEQ respectively. Hierarchical multiple linear regressions were used to identify the factors that most impact students’ overall satisfaction with the program.
Results
A total of 1,719 students (34.50%) responded to MedSEQ. CFA showed good fit indices (root mean square error of approximation=0.051; comparative fit index=0.939; chi-square/degrees of freedom=6.429). All factors yielded good (α>0.7) or very good (α>0.8) levels of reliability, except the “online resources” factor, which had acceptable reliability (α=0.687). A multiple linear regression model with only demographic characteristics explained 3.8% of the variance in students’ overall satisfaction, whereas the model adding 8 domains from MedSEQ explained 40%, indicating that 36.2% of the variance was attributable to students’ experience across the 8 domains. Three domains had the strongest impact on overall satisfaction: “being cared for,” “satisfaction with teaching,” and “satisfaction with assessment” (β=0.327, 0.148, 0.148, respectively; all with P<0.001).
Conclusion
MedSEQ has good construct validity and high reliability, reflecting students’ satisfaction with the Medicine program. Key factors impacting students’ satisfaction are the perception of being cared for, quality teaching irrespective of the mode of delivery and fair assessment tasks which enhance learning.

Citations

Citations to this article as recorded by

Mentor‐Student Relationship and Graduate Students' Satisfaction With Mentors: A Moderated Mediation Model
Xingzi Chen, Jiaqian Song, Hanjing Wen, Liuyi Zhang
Journal of Advanced Nursing.2026; 82(5): 4933. CrossRef
Linking quality perception to satisfaction in private universities: a mediated marketing model
Sk. Shahabuddin Ahmmed, Md. Sharif Hassan, Mohammad Bin Amin, Julinawati Binti Suanda, Shamsad Ahmed, Veronika Fenyves
Cogent Business & Management.2025;[Epub] CrossRef
Mental health and quality of life across 6 years of medical training: A year-by-year analysis
Natalia de Castro Pecci Maddalena, Alessandra Lamas Granero Lucchetti, Ivana Lucia Damasio Moutinho, Oscarina da Silva Ezequiel, Giancarlo Lucchetti
International Journal of Social Psychiatry.2024; 70(2): 298. CrossRef

Equal Z standard-setting method to estimate the minimum number of panelists for a medical school’s objective structured clinical examination in Taiwan: a simulation study: Ying-Ying Yang, Pin-Hsiang Huang, Ling-Yu Yang, Chia-Chang Huang, Chih-Wei Liu, Shiau-Shian Huang, Chen-Huan Chen, Fa-Yauh Lee, Shou-Yen Kao, Boaz Shulruf; J Educ Eval Health Prof. 2022;19:27. Published online October 17, 2022; DOI: https://doi.org/10.3352/jeehp.2022.19.27

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Abstract PDF Supplementary Material: Purpose
Undertaking a standard-setting exercise is a common method for setting pass/fail cut scores for high-stakes examinations. The recently introduced equal Z standard-setting method (EZ method) has been found to be a valid and effective alternative for the commonly used Angoff and Hofstee methods and their variants. The current study aims to estimate the minimum number of panelists required for obtaining acceptable and reliable cut scores using the EZ method.
Methods
The primary data were extracted from 31 panelists who used the EZ method for setting cut scores for a 12-station of medical school’s final objective structured clinical examination (OSCE) in Taiwan. For this study, a new data set composed of 1,000 random samples of different panel sizes, ranging from 5 to 25 panelists, was established and analyzed. Analysis of variance was performed to measure the differences in the cut scores set by the sampled groups, across all sizes within each station.
Results
On average, a panel of 10 experts or more yielded cut scores with confidence more than or equal to 90% and 15 experts yielded cut scores with confidence more than or equal to 95%. No significant differences in cut scores associated with panel size were identified for panels of 5 or more experts.
Conclusion
The EZ method was found to be valid and feasible. Less than an hour was required for 12 panelists to assess 12 OSCE stations. Calculating the cut scores required only basic statistical skills.

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