Introduction: Students from rural areas are under-represented in medical schools. Concerns have been raised about rural applicants’ qualifications relative to those of their urban counterparts, and the impact such potential differences in competitiveness may have on their under-representation. Although studies have reported no differences in Grade Point Average (GPA) and Medical College Admission Test (MCAT) scores between applicants with and without rural attributes, to date no study has assessed if performance on the multiple mini-interview (MMI) varies between the two groups.

Methods: The MMI scores of 1257 interviewees for admission to the MD program at the Faculty of Medicine, University ofManitoba, in years 2008 to 2011, were studied for an association with graduation from a rural high school and attributes in the following three domains: rural connections, employment in rural areas, and rural community service.

Results: There were 205 (16.3%) rural high school graduates among interviewed applicants. Rural high school graduates scored significantly lower (mean of 4.4 on a scale of 1 to 7; p<0.05) than urban high school graduates (4.6). Among rural-attribute domains, those with rural community service alone had the highest MMI scores (4.9) while those with rural connections alone had the lowest scores (4.3; p=0.016). After adjusting for demographics, GPA, and MCAT scores in a multiple linear regression model,rural-attribute domains were not significant predictors of an applicant's MMI score. However, graduation from a rural high school was significantly associated with decreased MMI scores (a 0.122 decrease in predicted MMI scores on a scale of 1 to 7).

Conclusion: Despite graduates from rural and urban high schools having comparable GPA, there exists a rural–urban divide in MMI scores that could exacerbate the under-representation of rural students in medical schools.

Aboriginal applicants can also potentially be disproportionately affected, as they were more often from rural high schools than from urban high schools.

Future studies need to determine systematic and institutional reasons, if any, for the differential in MMI scoring that can affect admission decisions for some rural applicants. It is also to be noted that the magnitude of difference is small enough that it may ultimately be irrelevant for future physician performance and practitioner outcomes.