Creating a Class of Medical Students in France: A Contextual Perspective on Students' Choices and Admissions

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

Abstract

Objectives

This paper examines the creation of a class of medical students (Stevens, 1987) in a French university. It aims to test an original theoretical framework emphasizing the combined effects of networks, institutions and markets on choices and admissions in HE focusing on the specific case of medical studies in the context of an important educational reform.

Theoretical framework

We draw on a theoretical framework emphasizing the contextual character of HE choices and admissions (Perna, 2006). Inspired by work in organizational and economic sociology, this perspective foregrounds the importance of three key contexts – networks, institutions and markets – and of students’ modes of engagement with them depending on their gender, social class, ethnicity and race. Each context is viewed as emphasizing specific processes – identification within networks (Portes, 1988), rationalization within institutions (Lamont et al., 2014) and consumer attachment within markets (Cochoy et al., 2017) – influencing transition to HE.
Data and methods

Our analysis is based on a case study of one large French medical school. We had access to admissions data on all 15,000 applicants, including information on their socio-demographic profile (gender, SES, place of birth, citizenship) and academic background (high school grades, secondary schools attended). We used these data to compare applicants’ profiles and how they were ranked by university staff and by the national admission platform. We also conducted a survey of enrolled students (N=982) and interviewed 40 of them with questions on students’ school trajectories, study plans, searches, applications and admissions results, as well as on interactions with family, friends and teachers and use of institutional and market devices during the choice process.

Results

We find strong variations in choice strategies and chances of admission according to gender, SES and type of high school attended. Analyses of the survey and interview data show strong identification processes with parents and relatives who are health specialists among upper-class male students and some ethnic minority students. The analyses also show significant differences according to students’ school context (Olivier et al., 2018), with those in private schools receiving greater amounts of institutional and market information and advice on track choices, HE and medical studies, resorting more frequently to private preparations for admission and applying strategically to a greater number of HE institutions. We also show that the evaluation by university staff of application files is almost entirely based on grades in scientific subjects and significantly favors students from private high schools. Concomitantly, a national quota policy boosts some low-income students’ rankings who would not have been offered a seat otherwise.

Significance

Analysis of choice and admission processes in medical studies where a large proportion of students come from upper-class backgrounds shows that these students benefit from early support for their plans, significant information and advice, effective institutional and market preparation and advantages in admission. This paper improves understanding of how students’ differential engagement with networks, institutions and markets depending on their social characteristics contributes to categorical inequality (Massey, 2008), that is, the unequal access of social groups to wealth, power and status.

Authors

• Agnes van Zanten, SciencesPo/CNRS

• Alice Olivier

• Léon Marbach, Stanford University

• Audrey Chamboredon, Sciences Po

• Christophe Birolini