Advancing diversity in access to medical studies: Evidence from a prospective cohort

Increasing the diversity of medical students is a challenge and priority in many countries. In France, systems-level changes have been introduced to attract candidates from diverse backgrounds, specifically the traditional pathway to medical studies, the PASS (Parcours Accès Spécifique Santé/Specific Access to Health Training, biomedical sciences-focused) has been supplemented with a second pathway, the LAS (Licence Accès Santé/Bachelor's Degree with Access to Health Studies) combining a broader major with a health-access module. This study is the first to assess the effectiveness of the LAS in increasing the social, geographic, and sex diversity of candidates admitted to Medical or Dental Schools in France.

This prospective cohort included candidates to health studies. Socioeconomic origin was determined according to parents' profession. Primary outcome was admission to Medical or Dental School. Mediation analysis assessed the role of prior academic performance (assessed by the French Baccalaureate grade) between socioeconomic origin and admission.

Among 2,059 candidates (women: 70%), 230/1,534 PASS (15% of admission, women: 55%, upper socioeconomic origin: 68%) and 43/525 LAS (8% of admission, women: 74%, upper socioeconomic origin: 49%) were admitted to Medical or Dental School. In multivariable logistic regression, sex (OR = 0.37 for women, 95%CI [0.26-0.53], p<.001), upper socioeconomic origin (OR = 1.78, 95%CI [1.20-2.64], p<.01), and prior academic performance predicted admission in PASS (OR = 5.57, 95%CI [2.90-10.7], p<.001). In LAS, only prior academic performance was independently associated with admission (OR = 8.93, 95%CI [3.99-20.0], p<.001). Prior academic performance partially mediated the effect of socioeconomic origin on admission in PASS, and fully mediated the effect in LAS.

Introducing the LAS pathway measurably improved diversity among admitted students and reduced socioeconomic and sex-related disparities. In contrast, the historical PASS system continues to reinforce these inequities. By widening the academic lens used for selection, LAS shows that reforms can meaningfully counteract social reproduction while maintaining academic rigor.