The association between medical student selection and a ‘fit-for-purpose’ medical workforce in low- and middle-income countries in the Asia–Pacific Region: a scoping review

Early Abstract:

Introduction: Medical schools worldwide have struggled for decades to determine the most effective strategy for selecting students to meet the needs of their healthcare systems. Despite recent changes in the direction of medical education, most medical schools have been slow to respond and adapt their selection. Applying a standard admission strategy across dissimilar contexts, such as the Asia–Pacific region, is challenging due to differing school missions, contexts and health priorities. 
In addition to academic achievements, several selection approaches have been implemented across the globe, with the hope of selecting those who are 'best' suited to be doctors. An equitable and fit-for-purpose selection approach is crucial for meeting priority community needs and ensuring institutional accountability.
This scoping review aims to explore what selection strategies medical schools in Low-and Middle-Income Countries (LMICs) within the Asia–Pacific region use to contribute to a 'fit-for-purpose' workforce. 
Methods: This scoping review was conducted between July 2024 and December 2024 using the methodology outlined by Arksey and O’Malley. 
Inclusion and exclusion criteria were developed to meet the objectives of this review. SCOPUS, EMCARE, OVID Medline, ERIC, and CINAHL databases were searched. Only documents in the English language were considered eligible for inclusion. There was no date restriction applied for the reviewed documents. Grey literature was searched, and unpublished theses, policy documents, abstracts of conference materials, technical reports and guidelines were extracted using the inclusion criteria. The study population consisted of medical students and graduates from LMICs within the Asia–Pacific region. Key concepts searched included selection, recruitment, admission and matriculation. The outcomes of interest were health workforce, medical workforce, fit-for-purpose, medical graduates, doctors and physicians. Five other team members worked independantly and collaboratively to assess the elligibility of relevant studies. Three were very senior medical education experts, one senior dental educator and a senior research fellow whose expertise is in health systems and medical education. 
The Quality Assessment Tool for Studies with Diverse Designs (QATSDD) was used to assess the quality of selected studies. The information extracted from each study was deductively coded using a framework that captured selection approaches, factors informing the selection strategy, and fit-for-purpose workforce considerations. This was followed by inductive coding to extract major themes. 
Results: A total of 5,045 studies were retrieved from the five databases. Ten (62%) studies from the five databases and 6 (38%) from other sources were included. Five major themes emerged from the inductive analysis of the included studies; i) engagement of key stakeholders in the selection approach (political validity); ii) prioritizing the health needs of the communities that medical schools serve (social accountability); iii) responding to the needs of communities in which schools are located (responding to context); iv) ensuring a sustainable selection approach; and v) a purposive and mission-driven strategy. 
Conclusion: This review highlights the different selection approaches that medical schools use within LMICs in the Asia–Pacific region. The engagement of stakeholders in the selection process, premised on a clear mission and purpose, is imperative within each context. A proposed selection framework aimed at contributing to a 'fit-for-purpose' workforce could guide selection approaches in LMICs in the Asia–Pacific region and similar contexts. 
Keywords: fit-for-purpose, low- and middle-income, medical student, medical workforce, political validity, selection, social accountability.