TUESDAY,JULY30,2019| THEGLOBEANDMAILO A 9proach,” which is common at Canadian uni-
versities. He said it involves looking in great
detail at all aspects of the candidate, not just
their academic record, and paying particular
attention to barriers that may have affected
their grades or extracurricular activities. (Dr.
Martin said Manitoba chose not to take the
holistic approach because it relies on the
judgment of individual evaluators and can
be susceptible to bias.)
The drive to consider racial and socio-eco-
nomic equality in admissions is also leading
major changes in the U.S. college system. The
College Board now includes what’s being
called an adversity score in SAT test results,
based on demographic factors such as crime
and poverty levels in a student’s neighbour-
hood and school district. The board said it
could no longer ignore the extent to which
differences in wealth and race were reflected
in test scores, which are very influential in
the admissions process. The method for cal-
culating the score has not been released, but
it’s based on public information, not answers
submitted by students.
For students, the application process re-
mains slightly mysterious, to prevent some-
one from gaming the system.
Fatemeh Bakhtiari, a second-year medical
student at the U of M, was born in Afghan-
istan and came to Canada as a child. Growing
up in Winnipeg, her family was not wealthy.
Her mother worked as a grocery clerk and
her father was a truck driver. Ms. Bakhtiari
excelled in school and at university set her
sights on medicine. But she didn’t have
many of the advantages that other appli-
cants could rely on, such as a family member
who is a doctor. She also had to work part-
time in restaurants and retail while studying.
“I had no idea where to start,” she said. “If
it wasn’t for Google, I don’t where I would’ve
been.”
She remembers answering questions on
her application about her family income and
whether she identifies as a visible minority
or LGBTQ, but she didn’t understand why
those questions were being asked. She said
she has no idea whether her answers had any
role in her success. She said her GPA was
strong, she wrote her MCAT three times to
improve her score and felt very confident
about her interview performance.
“I don’t know the scoring system or how it
works,” Ms. Bakhtiari said. “I don’t know if it
was my MCAT, my GPA or my interview that
got me through. They don’t tell you.”
At the white-coat ceremony where new
medical students are welcomed and take the
Hippocratic Oath, the U of M’s dean of the
faculty of medicine, Brian Postl, said the
school was proud of the diversity of Ms. Bak-
htiari’s class. More than half are women, 10
per cent are Indigenous, 20 per cent are from
rural areas and 50 per cent are from families
with incomes of less than $75,000. Ms. Bak-
htiari said she believes the diversity of her
class is valuable for two reasons: Diverse
groups have been shown to be more innova-
tive, and physicians should reflect the pop-
ulation they serve.
Manitoba’s diversity initiatives started
more than 30 years ago with attempts to get
more Indigenous people into medicine.
About a decade ago, the medical school also
began to see rural candidates as particularly
desirable. Canada was facing a staffing crisis
in rural and remote hospitals and medical
offices, and researchers began trying to iden-
tify what made a medical student more likely
to stay and practise in a rural area. A key fac-
tor was having grown up in a small town or
farming community. That’s when Manitoba
began using an arithmetic modifier to place
students with a rural background at an ad-
vantage.
The university was following a path laid by
the Northern Ontario School of Medicine
(NOSM), which opened in 2005 with a man-
date to turn out doctors for the region – and
made no bones about giving priority to stu-
dents with a rural or remote upbringing.
Roger Strasser, until recently the dean and
chief executive officer of the NOSM, said his
program gets about 2,000 applications a
year. It whittles those down to 320, who are
invited for interviews based on a three-
pronged score comprising a grade-point av-
erage, a personal statement and what’s
called a context score, derived from answers
about a person’s background and upbring-
ing. The algorithm for deriving the context
score is confidential, Dr. Strasser said, but he
was transparent about its key implication.
“Applicants who’ve grown up in Northern
Ontario or other remote, rural, Indigenous or
francophone settings, they get the highest
score. The people who are not Indigenous or
francophone or come from big cities like To-
ronto get the lowest score,” Dr. Strasser said.
Ninety-two per cent of NOSM students
have grown up in Northern Ontario, and the
other 8 per cent are from rural and remote
parts of the rest of Canada. About 2 per cent
of applicants are Indigenous, but in the past
few years the selection system has been
tweaked to increase the number of success-
ful Indigenous applicants, including giving
them training to succeed in the interview
process. The class went from about 7-per-
cent Indigenous over the school’s first dec-
ade to about 12 per cent for the past three
years, Dr. Strasser said.
He said one of his biggest challenges as
dean is the criticism from families in Toron-
to, who believe their children are excluded
from his school.
“My response is, if you look at the num-
bers, this is just the reverse of the way it is for
people from Northern Ontario applying to
med school in Toronto or the other big cities.
So in a sense, you could say it’s true, there is,
let’s call it a bias, but what we’re doing is just
countering the bias that’s built into the ad-
missions process of other medical schools,”
Dr. Strasser said.
It has become conventional wisdom, sup-
ported by research, to say medicine is done
better when doctors come from diverse back-
grounds, Dr. Martin said. A cohort of physi-
cians with a broad range of life experiences
are better able to understand the needs of
the population.
The applicants selected under Manitoba’s
diversity initiative all meet the school’s ad-
missions criteria, but they might not other-
wise have reached the top of the admissions
heap. The flip side, however, is that some
people who’ve worked hard and achieved a
great deal won’t get in, Dr. Martin said. That’s
difficult for some to reconcile.
Even his own colleagues, worried about
their children’s prospects, have cornered
him on this matter. The conversations were
uncomfortable, he said.
“We in medicine have generally been
white, socio-economically advantaged and
male. And that’s not who we serve,” he said.
“It’s my mission to pick people who are
suited to the profession and can meet the
needs of the population.”FatemehBakhtiari,asecond-yearmedical
studentattheUniversityofManitoba,stands
intheHealthSciencesCentreinWinnipeg
earlierthismonth.Ms.Bakhtiariwasbornin
AfghanistanandimmigratedtoCanadaasa
child.GrowingupinWinnipeginafamilyof
modestmeans,shelackedmanyofthe
advantagesthatotherprospectivemedical
studentshad,despiteherstronggradesand
competitiveMCATscore.
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̈{MA¢Ý ̈QAne[A-Ó[ ̈ ̈A··[AÝ ̈¢ÓFAMILYHISTORY
Wereyouraisedbyasingleparentduetodivorce,death
ofaparent,orateenparent?
Wereyoueverachildoryouthincare?
Areyouaparenttakingcareofoneormorechildrenon
yourown?
Didyourparentsorguardiansgraduatefromcollegeor
university?
WereyouoryourfamilyadmittedtoCanadawithrefugee
status?ECONOMICINFORMATION
Didyouoryourfamilyeverhavetouseafoodbank?
Duringtheseconddecadeofyourlife,wastheannual
grossincomeinthehouseholdinwhichyoulivedbetween
$40,000-$75,000?
Duringtheseconddecadeofyourlife,didyouhaveto
worktocontributetofamilyincome?
Willyourparent(s)bepayingforthetuitionfeesifyouget
acceptedtoourmedicalschool?
Doyoucurrentlyreceivestudentaid?OTHERSOCIOCULTURALDETERMINANTS
DoyouconsideryourselftobeamemberofaVisible
Minority?
DoyouidentifyasFirstNations,Métis,Inuitorother
NorthAmericanIndigenousancestry?
IsyourprimarylanguageotherthanEnglishorFrench?
Doyouhaveaparticipationoractivitylimitationthathas
animpactonyourday-to-daylife?
Wereyouraisedorareyoulivinginahouseholdinwhich
therewas/isapersonlivingwithsubstanceabuse?SOURCE:DR.BRUCEMARTIN,
UNIVERSITYOFMANITOBAADMISSIONS