Scoping review of current challenges and circumstances impacting Indigenous applications to Canadian medical schools




Introduction: Considering the relevant 2015 Truth and Reconciliation Commission recommendations, this paper reviews the current state of Canadian medical schools’ Indigenous admissions processes and explores continued barriers faced by Indigenous applicants.

Methods: A summary of literature illustrating disadvantages for Indigenous applicants of current admissions tools is presented. A grey literature search of current admissions requirements, interview processes, and other relevant data from each medical school was performed. Tables comparing differences in their approaches are included. A calculation of Indigenous access to medical school seats compared to the broader Canadian population was conducted. Gaps in execution are explored, culminating in a table of recommendations.

Results: Despite formal commitments to reduce barriers, Indigenous applicants to medical school in Canada still face barriers that non-Indigenous applicants do not. Most programs use tools for admission known to disadvantage Indigenous applicants. Indigenous applicants do not have equitable access to medical school seats. Facilitated Indigenous stream processes first ensure Indigenous applicants meet all minimum requirements of Canadian students, and then require further work.

Discussion: Seven years after the Truth and Reconciliation Commission called on Canadian universities and governments to train more Indigenous health care providers, there has been limited progress to reduce the structural disadvantages Indigenous students face when applying to medical school. Based on best practices observed in Canada and coupled with relevant Indigenous-focused literature, recommendations are made for multiple stakeholders. 

Conclusions: The study was limited by the data available on numbers of Indigenous applicants and matriculants. Where available, data are not encouraging as to equitable access to medical school for Indigenous populations in Canada. These findings were presented at the International Congress of Academic Medicine 2023 Conference, April 2023, Quebec City, Canada.


Metrics Loading ...

Author Biographies

Elizabeth Kliska, McMaster University

Elizabeth Kliska, BA is a medical student at McMaster University.

Andrew MacLean, McMaster University

Andrew MacLean, MSc B.Phil is a medical student at McMaster University. 

Patricia Farrugia, McMaster University

Dr. Patricia Farrugia, BScN, MD, MSc, FRCS(C), Assistant Clinical Professor, Department of Surgery, McMaster University.


Geary A. Ignored to death: Brian Sinclair’s death caused by racism, inquest inadequate, group says. CBC News. Available from: [Accessed on Jan 10, 2022].

Nerestant A. Racism, prejudice contributed to Joyce Echaquan’s death in hospital, Quebec coroner’s inquiry concludes. CBC News. Available from: [Accessed on Mar 8, 2023].

Tang SY, Browne AJ, Mussell B, Smye VL, Rodney P. ‘Underclassism’ and access to healthcare in urban centres. Sociol Health Illn. 2015 Jun;37(5):698–714. DOI:

Wylie L, McConkey S. Insiders’ insight: discrimination against indigenous peoples through the eyes of health care professionals. J Racial Ethn Heal Disparities. 2019 Feb 7;6(1):37–45. DOI:

Crawford B. Hospital asks forgiveness after Indigenous smudging ceremony forced outside into -20 C cold. Ottawa Citizen. Available from: [Accessed on Mar 8, 2023].

Hamdy H, Prasad K, Anderson B, et al. BEME systematic review: Predictive values of measurements obtained in medical schools and future performance in medical practice. Med Teach. 2006;28(2):103–16. DOI:

Association of Faculties of Medicine of Canada. Canadian Medical Education Statistics. Ottawa; 2019. Available from: [Accessed on Mar 8, 2023

The Association of Faculties of Medicine of Canada. Joint Commitment to Action on Indigenous Health. 2019.

Anderson M, Lavallee B. The development of the First Nations, Inuit and Métis medical workforce. Med J Aust. 2007 May 21;186(10):539–40. DOI:

The Association of Faculties of Medicine of Canada. Update report: Joint commitment of action on Indigenous Health. 2020

Levac D, Colquhoun H, O'Brien KK. Scoping studies: advancing the methodology. Implementation Sci. 5, 69 (2010). DOI:

Mian O, Hogenbirk JC, Marsh DC, Prowse O, Cain M, Warry W. Tracking Indigenous applicants through the admissions process of a socially accountable medical school. Acad Med. 2019 Aug;94(8):1211-1219. DOI:

Simone K, Ahmed RA, Konkin J, Campbell S, Hartling L, Oswald AE. What are the features of targeted or system-wide initiatives that affect diversity in health professions trainees? A BEME systematic review: BEME Guide No. 50, Med Teach. 2018;40:8, 762-780, DOI:

UBC Faculty of Medicine. Admission requirements. MD Undergrad Education, Available from

Northern Ontario School of Medicine. Admission requirements. Available from

Anderson M. Summary of AFMC/UBC Workshop on admissions & support of Aboriginal students in medicine. Vancouver; 2005.

Henderson R, Walker I, Myhre D, Ward R, Crowshoe L. An equity-oriented admissions model for Indigenous student recruitment in an undergraduate medical education program. Can Med Educ J. 2021 Mar 4; DOI:

McGill University. Indigenous Candidate Pathway. Office of Admissions. Available from

Prevost H. Un programme universitaire pour former des médecins autochtones. Radio Canada. Available from: [Accessed Jan 5, 2022].

Fletcher C. Reflexions sur le programme des facultes de medecine pour les premieres nations et les Inuits au Quebec. Quebec; Available from:

Fenton JJ, Fiscella K, Jerant AF, et al. Reducing medical school admissions disparities in an era of legal restrictions: adjusting for applicant socioeconomic disadvantage. J Health Care Poor Underserved. 2016;27(1):22–34. DOI:

Gay SE, Santen SA, Mangrulkar RS, Sisson TH, Ross PT, Zaidi NLB. The influence of MCAT and GPA preadmission academic metrics on interview scores. Adv Heal Sci Educ. 2018;23(1):151–8. DOI:

Jerant A, Fancher T, Fenton JJ, et al. How medical school applicant race, ethnicity, and socioeconomic status relate to multiple mini-interview–based admissions outcomes. Acad Med. 2015 Dec;90(12):1667–74. DOI:

Langer T, Ruiz C, Tsai P, et al. Transition to multiple mini interview (MMI) interviewing for medical school admissions. Perspect Med Educ. 2020 Aug 24;9(4):229–35. DOI:

Pau A, Chen YS, Lee VKM, Sow CF, Alwis R De. What does the multiple mini interview have to offer over the panel interview? Med Educ Online. 2016 Jan 1;21(1):29874. DOI:

Brownell K, Lockyer J, Collin T, Lemay J-F. Introduction of the multiple mini interview into the admissions process at the University of Calgary: acceptability and feasibility. Med Teach 2007 Jan 3;29(4):394–6. DOI:

Hofmeister M, Lockyer J, Crutcher R. The acceptability of the multiple mini interview for resident selection. Fam Med 40(10):734–40. Available from:

Razack S, Faremo S, Drolet F, Snell L, Wiseman J, Pickering J. Multiple mini-interviews versus traditional interviews: stakeholder acceptability comparison. Med Educ. 2009;43(10):993–1000. DOI:

Raghavan M, Martin BD, Burnett M, et al. Multiple mini-interview scores of medical school applicants with and without rural attributes. Rural Remote Health. 13(2):2362. Available from:

Moreau K, Reiter H, Eva KW. Comparison of aboriginal and nonaboriginal applicants for admissions on the multiple mini-interview using aboriginal and nonaboriginal interviewers. Teach Learn Med. 2006;18(1):58–61. DOI:

Rees EL, Hawarden AW, Dent G, Hays R, Bates J, Hassell AB. Evidence regarding the utility of multiple mini-interview (MMI) for selection to undergraduate health programs: a BEME systematic review: BEME Guide No. 37. Med Teach. 2016;38(5):443–55. DOI:

University of Manitoba. Student experience. Available from: [Accessed Feb 10, 2022].

McMaster University. Who should apply? Available from: [Accessed Feb 10, 2022].

McMaster University. Undergraduate medical program - Class statistics. 2022. Available from:

Alexander K, Cleland J. Satisfying the hydra: the social imperative in medical school admissions. Med Educ. 2018 Jun;52(6):587–9. DOI:

Girgulis K, Rideout A, Rashid M. Performance of Black and Indigenous applicants in a medical school admissions process. Can Med Educ J. 2021 Dec 29;12(6):35-42. DOI:

Ohler Q. Access to Aboriginal doctors a struggle for Indigenous population. Global News. Available from: [Accessed on Mar 8, 2023

Association of American Medical Colleges. MCAT scheduling fees. Available from: [Accessed on Jan 15, 2022].

Dalhousie University Medicine. Deadlines. Available from

Memorial University Faculty of Medicine. Preparing Your Application. Available from

Centre Du Patrimoine. Proof of Métis Ancestry. Available from

Government of Canada. Are you eligible for Indian status. Available from

University of Toronto MD Program. Indigenous Student Application Program. Available from

University of Saskatchewan College of Medicine. Indigenous admissions pathway entry fall 2022 admission requirements. Available from

Truth and Reconciliation Commission of Canada. Truth and Reconciliation Commission of Canada: Calls to Action. 2015. Available from:

United Nations Declaration on the Rights of Indigenous Peoples. 2007. Available from:

Larkins S, Michielsen K, Iputo J, et al. Impact of selection strategies on representation of underserved populations and intention to practise: international findings. Med Educ. 2015 Jan;49(1):60–72. DOI:

Mensah MO, Sommers BD. The policy argument for healthcare workforce diversity. J Gen Intern Med. 2016 Nov 18;31(11):1369–72. DOI:

Young ME, Razack S, Hanson MD, et al. Calling for a broader conceptualization of diversity. Acad Med. 2012 Nov;87(11):1501–10. DOI:

Roher SIG, Yu Z, Martin DH, Benoit AC. How is Etuaptmumk/two-eyed seeing characterized in Indigenous health research? A scoping review. Munce SEP, editor. PLoS One. 2021 Jul 20;16(7):e0254612. DOI:

Jeffrey T, Kurtz D, Jones C. Two-Eyed Seeing: current approaches, and discussion of medical applications. BC Med J. 2021 Oct; 63(8): 321-325.

The Association of Faculties of Medicine of Canada. FMEC 2020: one vision forward. 2020;138. Available from:

Fielding S, Tiffin PA, Greatrix R, et al. Do changing medical admissions practices in the UK impact on who is admitted? An interrupted time series analysis. BMJ Open. 2018;8(10). DOI:

Reiter HI, Lockyer J, Ziola B, Courneya CA, Eva K. Should efforts in favor of medical student diversity be focused during admissions or farther upstream? Acad Med. 2012;87(4):443–8. DOI:

Stegers-Jager KM, Steyerberg EW, Lucieer SM, Themmen APN. Ethnic and social disparities in performance on medical school selection criteria. Med Educ. 2015;49(1):124–33. DOI:

Wilkinson TM, Wilkinson TJ. Selection into medical school: from tools to domains. BMC Med Educ. 2016 Dec 3;16(1):258. DOI:

Association of American Medical Colleges. MCAT Scheduling Fees. Available from: [Accessed on Jan 15, 2022].




How to Cite

Kliska E, MacLean A, Farrugia P. Scoping review of current challenges and circumstances impacting Indigenous applications to Canadian medical schools. Can. Med. Ed. J [Internet]. 2024 Feb. 12 [cited 2024 Jun. 15];15(2):65-77. Available from:



Reviews, Theoretical Papers, and Meta-Analyses