Policy to practice: Social accountability in medical school admissions-A scoping review

Medical schools worldwide are integrating social accountability into admissions to address health inequities, improve workforce distribution and enhance population health outcomes. While foundational frameworks exist, implementation outcomes of specific admissions policies remain underexplored. This scoping review maps how social mission mandates are operationalized within medical school admissions and examines reported impacts on applicant diversity, geographic representation and workforce alignment.

We conducted a scoping review using the Joanna Briggs Institute and Arksey & O'Malley frameworks. MEDLINE, Embase, Web of Science, ERIC and Education Source were searched from inception to 8 August 2024. Studies were included if they examined MD admissions incorporating defined social mission objectives and reported selection or enrolment outcomes. Screening and data extraction were performed in duplicate, and findings were synthesized descriptively and categorized inductively, and we reported findings following PRISMA-ScR guidelines.

Seventeen studies (1994-2022) met inclusion criteria, spanning North America, Australia, Oceania, Europe, Africa and the Caribbean. Although searches ran to 8 August 2024, the newest eligible studies meeting our inclusion criteria were published in 2022. Three main categories of social accountability emerged: (1) Geographic and Practice Location, with admissions strategies targeting rural and underserved regions and reporting improved local retention; (2) Sociodemographic Equity, emphasizing admissions pathways for applicants from Indigenous, low-income, racialized and marginalized groups; and (3) Workforce Composition, focusing on recruiting future primary care and generalist physicians for underserved areas. Despite promising outcomes, including increased diversity, rural representation and generalist intent, several studies reported implementation challenges, inconsistent alignment with institutional missions, and limited long-term outcome tracking.

Social mission-driven admissions frameworks can advance physician workforce equity and alignment with community needs. However, their success depends on sustained investment, supportive institutional structures and integration across the education continuum.