At the Crossroads of Possibilities and Preferences: Determinants and Consequences of Aspirations for Medical Programs in Sweden

• In Event: Contextual Determinants of Choice and Access to Medical Studies: An International Perspective

Abstract

Objectives

In Sweden, medical programs are, like in most western countries, extremely selective (Börjesson et al., 2016; Thomsen et al., 2017; Olsson, 2019). To enter, students must first fulfil basic requirements, but also specific ones (advanced courses in mathematics, biology and chemistry in upper-secondary). Then, students must apply to such programs, and be selected among the applicants. This last step is solely based on GPA and SAT. The grade thresholds in medical programs are the highest among all programs in Swedish HE. This does not mean that all the highest performing students apply to medical programs, or, conversely, that students with insufficient grades or requirements do not apply. The objective of this study is to decompose the factors that determine access to medical programs. By using data on all applicants to HE, we aim to disclose what structures the possibility and will to enter a medical program.

Theoretical framework

This study is grounded theoretically in Bourdieusian sociology, considering HE as fields, where access is determined both by a specific asset (capital) and the ability to use that asset (habitus). This framework guides understanding of variations in educational choice behavior and aspirations (Bourdieu 1984, 1996).

Data and Methods

We use longitudinal register data on all individual applicants to HE in Sweden in the years 2001-2020 and their ranked choices of programs. We link this data with information on applicants, backwards (previous educational achievements, social background, gender, etc.) and onwards (HE registrations and successive labor market positions). We use regression analysis to measure the influence of individual and educational characteristics of students in their application practice.

Results

We identify four groups of applicants: those who applied successfully to medical programs, those who applied unsuccessfully to medical programs and ended up in non-medical programs, those who applied unsuccessfully to medical programs but ended up becoming physicians via studies abroad, and those who did not apply to medical programs but had grades and requirements that would have granted them a position. Given this typology of applicants, we analyze the main differences between these groups in terms of gender, social background and previous educational achievements. Our preliminary results show that access to medical programs is highly discriminatory educationally (and in consequence socially). Students without the necessary grades who still apply are more often from higher social origin. We then study the consequences of these different paths regarding the likelihood to complete the program, reach a higher income level and end up in a specific occupation (including different specialties among physicians).

Significance

Medical students have been a well-studied population by sociologists, starting with the seminal works of Hughes (1956) and Merton (1957). Yet, little is known about the population of students who wanted to enter medical schools but could not, and those who could have entered but did not want to. By examining this submerged part of the medical education iceberg in different national contexts, the papers in this symposium contribute to a broader understanding of social inequalities and social stratification in education, health care, and society.

Authors

• Emil Bertilsson, Uppsala University

• Yann Renisio, Sciences Po