Perceptions of medical school leaders towards widening participation: a Japanese survey

INTRODUCTION: Medical school leaders play an important role in shaping admissions policy. However, how they understand diversity, merit, and fairness remains underexplored. This makes it difficult to explain why widening participation (WP) initiatives often struggle to move from principle into practice. METHODS: We conducted a nationwide, cross-sectional survey in Japan. Participants included 328 faculty leaders from 82 medical schools, 183 allied health deans, and 58 education deans. The survey examined views on the socioeconomic background of medical students, support for WP, responses to citizen and educator perspectives on inequity, and the perceived importance of admissions criteria. RESULTS: Responses were obtained from 131 medical school leaders (38.0%), 52 allied health deans (28.4%), and 16 education deans (27.6%). Medical school leaders who responded to this survey supported increasing socioeconomic diversity of students and agreed that WP initiatives are necessary. They also understood socioeconomic disparities in application to medical schools. Support for affirmative action (AA) was lower and more varied. Admissions decisions remained weighted towards cognitive and non-cognitive abilities, and contextual factors such as socioeconomic disadvantage and geographic background were given less emphasis. Allied health and education leaders showed stronger support for WP and AA. Within medical schools, directors of medical education were more supportive than deans. Prioritization of cognitive ability was not positively associated with support for diversity policies, while diversity-related attributes showed moderate positive correlations with diversity policies. DISCUSSION: While medical school leaders appear to support students' diversity in principle, their approach to admissions appears to reflect established notions of merit. This suggests that the challenges of WP are not only technical but also relate to how merit and fairness are understood in practice. Addressing these challenges requires closer engagement with leadership perspectives and the institutional and professional cultures in which admissions decisions are made.