Table 2.

Potential target groups for equitable admissions policies in the context of Health Professions Education in The Netherlands: definitions and rationale for inclusion

Target group	Summary of rationale for inclusion (extensive rationale available upon request)
Applicants from regions with a low participation rate in university education	Research by the authors  (unpublished) shows that regions of the Netherlands with a low participation in university education bring forth very few HPE students.
Applicants from regions with a shortage of university-educated health professionals	Research by the authors  (unpublished) shows that (mainly) rural regions of the Netherlands where there is a shortage of healthcare professionals, bring forth limited numbers and low proportions of HPE students compared to urban regions. Increased admission of applicants from these areas could lead in the long term to combatting healthcare shortages, as Dutch research shows that many medical specialists return to provide healthcare in their region of origin [77].
Applicants with a low or average socio-economic status (SES) background	SES is a key determinant of educational attainment and access to higher education [78]. Internationally, prior academic attainment has traditionally been the primary focus of selection into medical school [31]. Dutch HPE students disproportionately come from the highest SES groups. Almost 80% of HPE students who enrolled between 2016-2018 had at least one parent with a top-20% income. In comparison: this was only the case for 55% of all youth of the same age. More than 68% of HPE students belonged to the wealthiest 30% of households, which was the case for only 43% of their age-related peers. Logistic regression analysis showed that applicants with at least one parent in the top-10% wealth decile had significantly higher odds of admission (OR 1.28 [1.10–1.49]) than applicants whose parents belonged to wealth percentiles 0-70 [54].
Applicants with at least one parent on social welfare	Out of Dutch HPE students who enrolled between 2016-2018, 2.8% had at least one parent on social welfare, compared to 6.9% of their age-related peers [54].
Applicants without college/university-educated parents	It is estimated that approximately 23-24% of all university students in the Netherlands is a first-generation student. Amongst students with a so-called ‘non-western migration background’, this estimated percentage is 59% [79].
Applicants whose parents are not registered healthcare professionals	Applicants with at least one registered healthcare professional (HP) parent have significantly higher odds of admission in selection-based admission [54]. Students with HP parents are also overrepresented in HPE: In 2018, 25% of HPE students had at least one HP parent. This was the case for only 8.3% of their age-related peers [54].
Applicants with an underrepresented migration background	Students with a Turkish, Moroccan, Surinamese or Dutch Caribbean (TMSD) migration background make up only 5.7% of the Dutch HPE student population, despite making up 10.1% of their age cohort. In addition, TMSD applicants had significantly lower odds of admission (OR 0.72 [0.57–0.91]. This could not be explained by the socio-economic status of their parents [54].
Applicants who are asylum status holders (people with a recent refugee background who have received a (temporary) residence permit)	The odds of admission for asylum status holders are unknown. However, some general barriers to university admission for refugees are well-known: language proficiency [80], lack of information about the study, selection criteria and the admissions procedure [81], and their educational background which often differs from traditional applicants without a refugee history [82]. Refugees may be unable to bring their diplomas when they flee, making it harder to prove their qualifications to enroll in higher education [81, 83].
Men	The proportion of male HPE students decreased from 34.6% in 2011 to 28.6% in 2018 [54]. This is mainly due to lower application rates (between 2016-2018, men made up 31.6% of the applicant pool), but they were also disadvantaged in the selection procedure: women had significantly higher odds of being admitted (OR 1.35 [1.19–1.53].
Applicants with a visible or invisible disability	Approximately 17% of Dutch medical students have a visible or invisible disability (incl. dyslexia and dyscalculia) [84]. No significant differences were found in the odds of admission compared to applicants without a disability. However, international research points to several barriers for this target group. For example, they can encounter discrimination or stigmatization [85, 86], educational demands which make participation impossible [85], incorrect assumptions and stereotypes about disabilities [85], and lower expectations [86]. They may feel restricted to request certain accommodations, due to fear to be seen as less capable [86].