"What Do They Want Me To Say?" The hidden curriculum at work in the medical school selection process: a qualitative study

The authors conducted a qualitative analysis of 210 essays written as part of the medical school admissions process, and developed a conceptual framework to describe the relationships, ideas and concepts observed in the data.Findings of this analysis were confirmed in interviews with applicants and assessors. Analysis revealed a tension between "genuine" and "expected" responses that we believe applicants experience when choosing how to answer questions in the admissions process. A theory named "What do they want me to say?" was developed to describe the ways in which applicants modulate their responses to conform to their expectations of the selection process; the elements of this theory were confirmed in interviews with applicants and assessors.This work suggests the existence of a "hidden curriculum of admissions" and demonstrates that the process of selection has a strong influence on applicant response. This paper suggests ways that selection might be modified to address this effect. Studies such as this can help us to appreciate the unintended consequences of admissions processes and can identify ways to make the selection process more consistent, transparent and fair.Admission to medical school is a serious matter for all parties involved. The task of selecting applicants who wish to become doctors is "a complex problem encumbered by inherent uncertainty" [1], and "daunting... selecting a small number of applicants who are most likely to succeed in medical school from a large pool of seemingly suitable applicants"[2]. Traditionally, selection has been based largely on academic performance, but recent work has focused on making the process more effective and representative of the needs of society [3,4] and has encouraged admissions committees to consider non cognitive attributes as well as academic performance [5].Many medical schools utilize essay questions in student selection, and the essay question has long been included as a component of the Medical Colle