Article Text

Original research
Influence of social networks in healthcare on preparation for selection procedures of health professions education: a Dutch interview study
  1. Lianne Mulder1,2,
  2. Anouk Wouters1,2,
  3. Suzanne Fikrat-Wevers3,
  4. Andries S Koster4,
  5. Jan Hindrik Ravesloot5,
  6. Gerda Croiset6,
  7. Rashmi A Kusurkar1,2
  1. 1Amsterdam UMC location Vrije Universiteit Amsterdam, Research in Education, De Boelelaan 1118, Amsterdam, The Netherlands
  2. 2LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
  3. 3Institute of Medical Education Research Rotterdam, Erasmus MC, Rotterdam, The Netherlands
  4. 4Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
  5. 5Amsterdam UMC location University of Amsterdam, Department of Medical Biology, Meibergdreef 9, Amsterdam, The Netherlands
  6. 6Wenckebach Institute for Education and Training, University Medical Centre Groningen, Groningen, The Netherlands
  1. Correspondence to Ms Lianne Mulder; l.m.a.mulder{at}


Objectives Health professions education (HPE) students are often not representative of the populations they will serve. The underrepresentation of non-traditional students is problematic because diversity is essential for promoting excellence in health education and care. This study aimed to understand the perceptions of traditional and non-traditional students regarding facilitators and barriers in preparing for HPE selection procedures, and to determine the role of social networks in their decision-making and preparations to apply.

Methods A qualitative study was conducted with 26 Dutch youth who were interested in university-level HPE programmes. Semistructured interviews and sociograms were analysed using thematic analysis, adopting a constructivist approach.

Results Twenty-six high school students participated, with traditional and non-traditional backgrounds, with and without social networks in healthcare and higher education. Two themes were constructed. First, four high-impact facilitators helped to overcome barriers to apply and in preparation for selection: access to a social network connection working or studying in healthcare, to correct information, to healthcare experience and to a social network connection in higher education. Lack of information was the main barrier while access to social network connections in healthcare was the main facilitator to overcome this barrier. However, this access was unevenly distributed. Second, access alone is not enough: the need for agency to make use of available facilitators is also essential.

Conclusions The themes are discussed using intersectionality. Traditional students with access to facilitators develop their self-efficacy and agency within social structures that privilege them, whereas non-traditional students must develop those skills without such structures. Our findings provide recommendations for the ways in which universities can remove barriers that cause unequal opportunities to prepare for the selection of HPE programmes. Along with equitable admissions, these recommendations can help to achieve a more representative student population and subsequently a better quality of health education and care.

  • medical education & training
  • education & training (see medical education & training)
  • qualitative research

Data availability statement

No data are available. The data that support the findings of this study are not publicly available due to them containing information that could compromise research participant privacy and consent.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

No data are available. The data that support the findings of this study are not publicly available due to them containing information that could compromise research participant privacy and consent.

View Full Text

Supplementary materials

  • Supplementary Data

    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.


  • Twitter @NoukNouk84, @r_kusurkar

  • Contributors AW, JHR, GC and RAK conceived the idea for the research. LM, AW and RAK designed the research. LM interviewed all participants. LM, AW, SF-W and RAK analysed the data. LM wrote the first draft of the article and all coauthors contributed to the article with important critical revisions in multiple revision rounds. The final manuscript is the result of the combined expertise of all authors and is approved for publication by all authors. RAK is the guarantor.

  • Funding This work was supported by the Nationaal Regieorgaan Onderwijsonderzoek (NRO) (grant number: 40.5.18650.007).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.