University of Groningen Motivation of Dutch high school students from various backgrounds for applying to study

Objective To explore high school students’ motivation for applying to study medicine and the factors that influence this. To find explanations for under-representation of minority students in medical education, descriptions of motivation of students with different background characteristics were compared. Design Qualitative phenomenological study using semistructured one-on-one interviews. Setting One predominantly white and one mixed high school in a large multicultural city in the Netherlands. The study was conducted in March–December 2015. Participants Twenty-four high school students, purposively sampled for demographic characteristics. Methods The analysis consisted of the coding of data using a template based on the motivation types (autonomous and controlled motivation) described by self-determination theory and open coding for factors that influence motivation. Results The main reasons for pursuing a medical career pertained to autonomous motivation (interest in science and helping people), but controlled motivation (eg, parental pressure, prestige) was also mentioned. Experiences with healthcare and patients positively influenced students’ autonomous motivation and served as a reality check for students’ expectations. Having to go through a selection process was an important demotivating factor, but did not prevent most students from applying. Having medical professionals in their network also sparked students’ interest, while facilitating easier access to healthcare experiences. Conclusions The findings showed a complex interplay between healthcare experiences, growing up in a medical family, selection processes and motivation. Healthcare experiences, often one of the selection criteria, help students to form autonomous motivation for studying medicine. However, such experiences as well as support in the selection process seem unequally accessible to students. As a result, under-represented students’ motivation decreases. Medical schools should be aware of this and could create opportunities to acquire healthcare experiences. High schools could incorporate internships as part of their study counselling programmes and offer tailor-made guidance to each individual student. IntroductIon Concerns exist that the medical profession insufficiently reflects the society it serves. Debates increasingly focus on the disadvantage of under-represented socio-demographic groups due to the use of selection processes to decide who gets admitted to medical programmes. Under-representation of ethnic minority students, 3 students without a medical family background, students who are the first in their family to go to a university, 7 8 lower socioeconomic status (SES) students 5 9 and males 10 in the medical student population can, to some extent, be ascribed to biased selection processes. However, under-representation is not always due to a bias in selection processes 6 14 16 21 25–27 and widening-access efforts targeting selection bias have been till date only moderately successful in resolving disparities. 21 22 24 28 This stresses the need for other measures. A self-selection effect, which refers to students deciding whether to apply based on the information they have, for example, about the selection process, 29 has been suggested Motivation of Dutch high school students from various backgrounds for applying to study medicine: a qualitative study Anouk Wouters, Gerda Croiset, Ulviye Isik, Rashmi A Kusurkar to cite: Wouters A, Croiset G, Isik U, et al. Motivation of Dutch high school students from various backgrounds for applying to study medicine: a qualitative study. BMJ Open 2017;7:e014779. doi:10.1136/