Holistic Review in Doctor of Physical Therapy Admissions Can Lead to Enhanced Diversity in Admitted Students

Abstract

Background and Purpose. 

Despite an increase in the number of physical therapist education programs and applicants, there is limited diversity represented in the physical therapy profession. This case report describes the development and implementation of a holistic review rubric with the goal of increasing diversity in 1 entry-level physical therapist education program.

Case Description. 

The University of Colorado Physical Therapy Program developed a holistic review rubric, based on literature review and conversations with other programs, with a focus on the specific mission/values/goals of the program. Admissions decisions for the 2018–19 admissions cycle were based on holistic rubric scores in addition to the traditionally used cognitive measures and interview recommendations.

Outcomes. 

The Program received 919 verified applications, 713 met the eligibility requirements and were reviewed using the holistic rubric, 193 were invited to interview, and 71 matriculated. Overall, the Program admitted a greater proportion of diverse students as compared with the total Program applicant pool in the following categories: 1) race/ethnicity, 2) socioeconomic status, and 3) other unique characteristics (first-generation college student, military experience, and rural). Second, compared with the Physical Therapy Centralized Application Service data, the Program admitted an increased proportion of diverse students. Third, the 193 applicants who were interviewed by the Program based on the holistic review compared with the top 193 applicants based on cumulative grade point average had an increased proportion of diverse students.

Discussion and Conclusion. 

Although this case report reflects only 1 admission cycle at 1 institution, the initial data suggest that the use of a holistic review may increase diversity in entry-level Doctor of Physical Therapy programs, as compared with using more traditional admissions methods with the goal of leading to increased diversity within the physical therapist profession.

BACKGROUND AND PURPOSE

The number of applicants seeking admission to Doctor of Physical Therapy (DPT) programs has continued to grow during the past decade with 17,834 applicants applying during the 2018–19 Physical Therapist Centralized Application Service (PTCAS) cycle.¹ Simultaneously, the number of programs offering or seeking to offer the DPT degree has also grown to 253 accredited and 45 developing programs in 2019.² Despite the increase in DPT education programs and applicants, there is limited racial and ethnic diversity represented in the physical therapy profession when compared with other health care professions.³ Improvements have been noted over the past several years because DPT graduates in 2019 were 76.7% White compared with 83.6% who identified as White in 2009.⁴ Nevertheless, nearly 78% of physical therapists identify as White, whereas 67% of physicians and 73.5% registered nurses report that their respective provider workforces are White.³ In addition, greater disparity is evident in physical therapy when compared with the US population where 60% of the population is White.⁵

Patients who share the same race as their health care providers have been shown to have improved health outcomes, intention to adhere to plans of care, and satisfaction.^6–8 In addition, providers from underrepresented ethnic groups are more likely to treat patients from their own ethnic group or provide care in settings where patients may be underserved.⁹ Increased ethnic diversity within health professional student cohorts, faculty, professional associations, and research has the potential to improve quality of education, create policy change, and enhance societal engagement.¹⁰ Admission of a more diverse student cohort in health professional programs creates the opportunity for instructing students who are better positioned to draw from the unique experiences, attributes, and stories aligned with multicultural awareness.¹¹ The call to increase diversity within physical therapy has been made clear,^12,13 and DPT admissions are the point of entry into the profession when physical therapist education programs have the opportunity to influence and increase the diversity of individuals who will join the profession.^14,15 The University of Colorado (CU) Physical Therapy Program (heretofore known as the Program) Recruitment and Admissions Committee (RAC) began to reevaluate its admissions processes in 2016 to attempt to increase diversity in the Program’s student body and future physical therapy workforce. Although the Program has a long history of success in graduation, licensure, and employment statistics, it was not meeting the needs of the growing racial and ethnic diversity within the state of Colorado or nationally.⁵ In addition to race and ethnicity, the Program wanted to address other areas of diversity as defined within the School of Medicine (SOM). This SOM definition of diversity includes sexual orientation, gender identity, disability, religion, political beliefs and socioeconomic status, life experiences, record of military service and employment, and other talents and personal attributes that can enhance the scholarly, clinical care, and learning environment.¹⁶ Many of these diversity characteristics were already represented within the Program, but others were underrepresented when compared with the general population⁵ and in need of improvement.

To facilitate an increase in diversity of matriculated students during the admissions process, a holistic review rubric was developed to address noncognitive applicant attributes.¹⁷ The development of the holistic review rubric was based on guidelines from the Association of American Medical Colleges^18–20 and other health care professions which had created holistic application review tools to supplement the use of traditional cognitive measures, such as grade point average (GPA) and Graduate Record Exam (GRE), in admissions.^21–24 The de-emphasis of traditional cognitive measures reflects a recent trend because some graduate programs have stopped using GRE scores²⁵ and many undergraduate programs have discarded standardized tests as admission criteria.^26–29 These changes have opened the door to the consideration and use of other noncognitive measures in admissions.

This case report describes the development and implementation of an innovative admissions approach using a holistic review rubric with the goal of increasing diversity while maintaining high academic standards in 1 entry-level DPT program. The Program’s objective was to increase diversity in the admitted cohort by focusing on the following specific characteristics reported through PTCAS by applicants who choose to disclose these personal descriptors: 1) race/ethnicity, 2) socioeconomic status (SES), and 3) other unique characteristics (first-generation college student, military experience, and rural). The objective of this case report was to provide a transparent view of 1 program's holistic physical therapy education admissions process to allow other physical therapy programs to compare and contrast their own admissions efforts and to advance the use of holistic admissions practice in physical therapy education.

CASE DESCRIPTION

The holistic review rubric was developed following a review of the literature related to admissions processes and use of alternative noncognitive measures, direct communication with 1 DPT program that was using a holistic review tool as part of their admission process, and discussion with admissions committee members of other programs on the Anschutz Medical Campus, such as nursing and medicine, who were using their own holistic review processes. Most of the published literature on the use of holistic review suggested rubric items focused on service, leadership, personal attributes, and life experience.^17–24 In the rubric created and used by this Program, an explicit connection was drawn between the rubric items and expected student outcomes valued by the Program. This was a philosophical strategy to underscore the importance of the Program's specific mission, values, and goals. For example, if the ability to demonstrate core values of a physical therapist was important in our graduates, we wanted to ensure that top applicants already demonstrated initiation of activities or personal attributes representative of these core values. This focus on the Program's mission, values, and goals, coupled with the definition of diversity supported within the institution, led to a creation of a new rubric, informed by existing and publicly shared rubrics.

Ultimately, the committee determined that the most important attributes to look for in an applicant to the Program in the 2018–19 application cycle were as follows: 1) scholarly aptitude and intellectual curiosity, 2) commitment to the physical therapy profession and interdisciplinary approach to health care, 3) community engagement and leadership, 4) positive personal qualities, and 5) personal experience with diversity and/or health disparity. The rubric evaluated each of the 5 categories and assigned a point value of 0–4 based on the representative criteria of that attribute for a total of 20 possible points. Scoring instructions allowed for 0.5 scores (Figure 1).

Figure 1.: Holistic Review Categories

Review of the applicant essays was assessed through the rubric by evaluating writing proficiency, clarity, and quality, and by evaluating the applicant's ability to respond to the essay prompts using organized and meaningful thought that reflects previous life experience. In addition, letters of recommendation were considered as a measure of the applicant's positive personal qualities based on the direct comments and the ratings associated with characteristics listed on the PTCAS “Reference Request Form.”

The entire RAC of 6 faculty (approximately 25% of all core program faculty) and 1 program staff member was trained together in using the holistic review rubric for the application review process. The goal of the training was to establish consistency across application reviewers and included applying the holistic review to applications from a previous cycle. During the training, all reviewers scored 2 applications individually and the scores were compared and discussed by the group to identify any discrepancies or inconsistencies. Once all reviewers had agreed on scoring and had resolved unwarranted variation, a third application was read, scored, and discussed by all reviewers collectively. The intent of this activity was to achieve a comfortable level of consistency required to meet the training goal, defined as achieving overall scores within 1–1.5 points by all raters grading the same application.

The adoption of a holistic review process did require an increase in time, and a commitment from all members of the committee, to review each application compared with the process used in previous admissions cycles. The average time to review each application essentially doubled from 15–20 to 30 minutes per application with the implementation of the holistic review. The number of people involved in the review process also increased from 2 faculty and 1 staff to participation of all 7 committee members. This increased effort was supported by the Program Director through the Program's strategic plan.

The holistic review rubric was initially used in 2016–17. The rubric was adjusted in 2017–18 and again before the 2018–19 admissions cycles (Table 1). Each revision reflected changes in the PTCAS general essay and Program specific supplemental questions, consultation and conversation with other DPT programs using holistic review methods and measures, the SOM Office of Inclusion, and internal committee discussion after each admission cycle.

Table 1. - Changes Made Between the Initial and Updated Holistic Review Rubric

Initial 2016–2017 Rubric

Changes to Rubric in 2018–2019 Cycle

Categories:  • Scholarly aptitude and intellectual curiosity  • Commitment to the physical therapy profession and interdisciplinary approach to health care  • Community engagement and leadership  • Personal understanding of diversity and/or health disparity Scoring:  • 0–3 for each category (total of 12 points) Reviewer remark categories:  (1) Recommend with reservations  (2) Satisfactory  (3) Exceptional Shortcomings:  • Found the rubric to be too exposure or experience driven rewarding those who were able to do certain things and putting at disadvantage those who did not have the same opportunity  • Scores were less variable than desired

Categories expanded:  • Added as a fifth category: positive personal qualities Scoring adjusted:  • 0–4 for each category (total 20 points)  • Allowed incremental scoring of 0.5 Reviewer remark categories modified:  (1) Do not recommend  (2) Recommend with reservations  (3) Satisfactory  (4) Above average  (5) Exceptional Reason for changes:  • Sought to rely more on self-reflection and context throughout the application rather than experience  • Sought clearer differentiation of rubric scores  • Modified program-specific essay prompts

In each admissions cycle, the application undergoes a primary review to address the academic metrics. When the applicant has met the academic requirements (Table 2), the application moves into the holistic review process for scoring by one of the application reviewers.

Table 2. - Primary Review Academic Requirements

Requirement	Details
Bachelor's degree	Completed or planned to complete in the current academic year or before matriculation
Met all prerequisite Course requirements	Completed or planned to complete in the current academic year or before matriculation, and adherence to Program requirements:  • Grades of C- or below are not accepted  • Cannot have >1 science prerequisite in progress in the spring before matriculation If an applicant did not meet one/several of these requirements, an email was sent stating the deficits and the applicant had the opportunity to explain any unique circumstance (eg, a course was in progress/planned but not reflected on their transcript)
Met GPA requirements  • Cumulative GPA of at least a 3.0  • Math/Science GPA of at least a 3.0	If an applicant fell below the 3.0 minimum GPA but had met the criteria to be a “unique candidate,” their application underwent further review. Unique candidates included those of an underrepresented minority (racial/ethnicity or socioeconomic), first generation, veterans, rural AND demonstration of a positive grade trend
Official GRE scores	Official scores had to be sent to our school code, but no minimum score was required

Abbreviations: GPA = grade point average; GRE = Graduate Record Examinations.

This application review process occurred from the beginning of the admissions cycle up until approximately 2 months after the application deadline. Once all applications were evaluated by both the primary and secondary review processes, the entire cohort was ranked based on the GPA, GRE, and holistic review rubric scores. A spreadsheet was created using the holistic review rubric score as the primary ranking metric organized in descending order (scores of 20, then 19.5, 19, 18.5, 18, etc). A decision meeting was held by the RAC to consider whom to invite to interview considering rubric scores and traditional cognitive criteria. After interviews, the RAC members gathered again to review postinterview ratings. Factors that contributed to the decision to offer admission to a student included total scores (ie, holistic review and cognitive factors) and interview recommendations.

OUTCOMES

The Program received 919 verified applications by the application deadline and 713 met the primary academic review requirements (Table 2) which led to review using the holistic rubric. Of the 713 reviewed applications, 193 were invited to interview, 144 were interviewed, and 71 matriculated. Cognitive variables of interest for this case report were cumulative GPA, math/science GPA, and GRE scores. Noncognitive variables of interest for this case report were diversity characteristics of race/ethnicity, SES, and other unique characteristics. Specifically, the variables of interest for race/ethnicity were White (non-Hispanic/Latino), Hispanic/Latino, American Indian/Alaskan Native, Black/African American, Hawaiian Native/Pacific Islander, Asian, or declined to report. The variables of interest for SES were as follows: coming from a family that received public assistance or was economically disadvantaged, an applicant who received a GED or is currently receiving public assistance, or the applicant's family lives in an area designated as a health professional shortage area or medically underserved area. The variables of interest for other unique characteristics were being a first-generation college student, having military experience, and growing up in a rural area. Rural was designated by a positive response to the PTCAS statement: “Yes, I lived in a rural community for more than 50% of my childhood,” and the Program school specific question: “Did you spend your childhood (up to high school graduation) growing up in a community that is considered rural?” Variables were collected both for the 2018–19 Program admissions cycle and for the most recently available PTCAS data. The overall PTCAS data set included all the same variables as the Program data except the rural and military designations.

Two outcomes were assessed to determine whether the holistic review process was achieving the goal of increasing our diversity. First, a gross change in the proportion of diverse students admitted compared with the diverse students in the total applicant pool was assessed for both the Program data and PTCAS data. Second, the proportion of diverse applicants invited to a Program interview after the use of the holistic review rubric (n = 193) was compared with the top 193 Program applicants sorted by GPA only, reflective of a more traditional cognitive-based admissions approach. For GPA, GRE, and overall rubric scores of Program applicants, a mean ± SD was reported, whereas for PTCAS, only means were reported because measures of variance are not included in the PTCAS report. For diversity characteristics, the total number in each category and the percentage were used for both the Program and PTCAS data sets.

Overall, for most of the diversity traits, the proportion of diverse students admitted to the Program in 2018–19 was greater than the proportion of diverse students in the Program applicant pool (Table 3). Specifically, the proportion of racially/ethnically diverse admitted students increased from 0.3% to 6.4% for all of the racial/ethnic categories except those who identified as Asian, which decreased by 1.5% compared with the total Program applicant pool. Second, the proportion of SES diversity in the admitted students increased for families receiving public assistance (3.2%) and those from an area with a shortage of health care professionals (2.5%) but decreased for economically disadvantaged families (−2.8%) as compared with the total applicant pool for the Program. Third, the proportion of unique characteristics in the admitted students increased in all categories (4.0–6.0%). Finally, mean GPA and GRE scores increased for the students admitted to the Program compared with the Program’s total applicant pool.

Table 3. - Characteristics of All Program Applicants Compared With Those Admitted Using the Holistic Review Process and All PTCAS Applicants Compared With Those Accepted in the 2018–2019 Admissions Cycle

	CU PT			PTCASb
	All Applicants	Admitted	% Changea	All Applicants	Accepted	% Changea
N	713	71 (10.0%)	—	17,834	10,578 (59.3%)	—
Overall score	74.0 ± 8.3	82.4 ± 5.0	+8.4	—	—	—
Rubric score	13.8 ± 2.7	16.9 ± 1.4	+3.1	—	—	—
Cum GPA	3.59 ± 0.25	3.65 ± 0.24	+0.06	3.43	3.57	+0.14
Math/sci GPA	3.51 ± 0.29	3.61 ± 0.28	+0.10	—	—	—
GRE V%	58.46 ± 21.08	67.04 ± 19.69	+8.58	50.79d	61.61d	+10.82
GRE Q%	49.82 ± 18.13	55.59 ± 16.27	+5.77	38.05d	51.74d	+13.69
GRE A%	62.14 ± 20.32	67.08 ± 18.21	+4.94	48.45d	58.65d	+4.21
White (non-Hispanic/Latino)c	559 (78.4%)	48 (67.6%)	−11.9%	11,626 (65.19%)	7,470 (70.62%)	+5.43%
Hispanic/Latinoa	65 (9.1%)	11 (15.5%)	+6.4%	2,057 (11.53%)	1,000 (9.45%)	−2.08%
American Indian/Alaskan Nativec	8 (1.1%)	1 (1.4%)	+0.3%	43 (0.24%)	15 (0.14%)	−0.10%
Black/African Americanc	16 (2.2%)	4 (5.6%)	+3.4%	1,190 (6.67%)	419 (3.96%)	−2.71%
Hawaiian Native/Pacific Islanderc	2 (0.3%)	1 (1.4%)	+1.1%	35 (0.20%)	21 (0.20%)	0.0%
Asianc	71 (10.0%)	6 (8.5%)	−1.5%	1,884 (10.56%)	1,048 (9.91%)	−0.65%
Declinedc	0 (0%)	0 (0%)	0%	373 (2.09%)	225 (2.13%)	+0.04%
First generation	92 (12.9%)	12 (16.9%)	+4.0%	3,070 (17.2%)	1,551 (14.7%)	−2.5%
Rural	150 (21.0%)	18 (25.4%)	+4.4%	—	—	—
Military	18 (2.5%)	6 (8.5%)	+6.0%	—	—	—
Family public assist	27 (3.8%)	5 (7.0%)	+3.2%	903 (5.1%)	465 (4.4%)	−0.7%
Health prof shortage area	32 (4.5%)	5 (7.0%)	+2.5%	690 (3.9%)	417 (3.9%)	0%
GED or receive public assist	0 (0%)	0 (0%)	0%	24 (0.1%)	11 (0.1%)	0%
Economically disadvantaged family	40 (5.6%)	2 (2.8%)	−2.8%	1,938 (10.87%)	985 (9.31%)	−1.56%

Abbreviations: CE = University of Colorado; GPA = grade point average; GRE = Graduate Record Examinations; PTCAS, Physical Therapist Centralized Application Service.

^aA positive number represents an increase in the proportion of a given characteristic, whereas a negative number represents a decrease.

^bBased on the most recent PTCAS data report from 2018 to 2019.

^cSome applicants selected multiple ethnicities or other categories and were counted in each category they selected.

^dPTCAS reported Unofficial GRE scores by sex, these numbers represent the average of male applicants/female applicants/declined to state.

On the other hand, the PTCAS data¹ showed that the proportion of students admitted with these diverse characteristics was less than the proportion of diverse students in the total applicant pool (Table 3). Specifically, the proportion of racially/ethnically diverse admitted students decreased or stayed the same all categories from 0% to −2.71% compared with the total PTCAS applicant pool. Second, the proportion of SES diversity in the admitted PTCAS students decreased or stayed the same for all categories (0% to −1.56%) compared with the total PTCAS applicant pool. Third, the proportion of first-generation students in the admitted PTCAS students decreased in all categories (−2.5%) compared with the total PTCAS applicant pool. Finally, mean GPA and GRE scores increased for the admitted PTCAS students compared with the total PTCAS applicant pool. In summary, although the Program showed an increase in proportion of diverse students admitted, PTCAS data¹ showed a decrease in the 2018–2019 cycle.

Table 4 provides a comparison of admitted students to the Program to the accepted students in PTCAS, as well as to state and national population data based on race/ethnicity.⁵

Table 4. - Comparison of the Percentage of Admitted CU DPT Students and Accepted PTCAS Students in the 2018–2019 Admissions Cycle to US and Colorado Population Based on Race/Ethnicity⁵

	CU DPT	PTCAS	US Population	CO Population
White (non-Hispanic/Latino)a	67.6%	70.6%	60.1%	67.7%
Hispanic/Latinoa	15.5%	9.5%	18.5%	21.8%
American Indian/Alaskan Nativea	1.4%	0.1%	1.3%	1.6%
Black/African Americana	5.6%	4.0%	13.4%	4.6%
Hawaiian Native/Pacific Islandera	1.4%	0.2%	0.2%	0.2%
Asiana	8.5%	9.9%	5.9%	3.5%

Abbreviations: CU, University of Colorado; DPT, Doctor of Physical Therapy; PTCAS, Physical Therapist Centralized Application Service.

^aSome applicants selected multiple ethnicities or other categories through PTCAS and were counted in each category they selected.

In Table 5, the characteristics of the Program applicants invited to interview (n = 193) using the holistic review process were compared with the characteristics of the top 193 Program applicants sorted by cumulative GPA. The average GPA is lower in the holistic review group (−0.18); however, the average GRE percentile was slightly higher in the holistic review group for verbal scores (+3.23%), quantitative scores (+1.9%), and analytic scores (+2.41%). The diversity characteristics, however, were proportionally higher in the holistic review group compared with the group with the higher GPA. Specifically, the proportion of racial/ethnic diversity in the holistic review group was 1.08–4.6% higher for all categories except Hawaiian Native/Pacific Islander which did not differ. The proportion of SES diversity in the holistic review group increased for all categories (3.1–5.68%) except GED/public assistance, which did not change. Finally, the proportion of unique characteristics in the holistic review group increased in all categories (1.5–5.44%).

Table 5. - Demographic Characteristics of Applicants Invited to Interview (n = 193) at the Program Compared With the Top 193 Applicants by GPA in the 2018–2019 Admissions Cycle

	193 Invited to Interview by Holistic Review	Top 193 by GPA	Difference
	193 (27.1%)	193	—
Overall score	83.1 ± 4.7	79.8 ± 6.6	+3.3
Rubric score	16.8 ± 1.4	14.5 ± 2.6	+2.3
Cum GPA	3.71 ± 0.22	3.89 ± 0.07	−0.18
Math/sci GPA	3.66 ± 0.27	3.85 ± 0.11	−0.19
GRE V%	67.62 ± 19.54	64.39 ± 19.73	+3.23
GRE Q%	57.68 ± 15.97	55.78 ± 17.04	+1.90
GRE A%	68.38 ± 18.37	65.97 ± 18.00	+2.41
White (non-Hispanic/Latino)a	147 (76.2%)	167 (86.5%)	−10.3%
Hispanic/Latinoa	19 (9.8%)	10 (5.2%)	+4.6%
American Indian/Alaskan Nativea	3 (1.6%)	1 (0.52%)	+1.08%
Black/African Americana	6 (3.1%)	2 (1.0%)	+2.1%
Hawaiian Native/Pacific Islandera	1 (0.52%)	1 (0.52%)	0%
Asiana	22 (11.4%)	18 (9.3%)	+2.1%
Declineda	0 (0%)	0 (0%)	0%
First generation	26 (13.5%)	15 (8.06%)	+5.44%
Rural	43 (22.3%)	38 (20.4%)	+1.9%
Military	9 (4.7%)	6 (3.23%)	+1.5%
Family public assist	12 (6.2%)	1 (0.52%)	+5.68%
Health prof shortage area	17 (8.8%)	11 (5.7%)	+3.1%
GED or receive public assist	0 (0%)	0 (0%)	0%
Economically disadvantaged family	10 (5.2%)	3 (1.6%)	+3.6%

Abbreviations: GPA = grade point average; GRE = Graduate Record Examinations.

^aSome applicants selected multiple ethnicities or other categories and were counted in each category they selected.

DISCUSSION AND CONCLUSION

This Program has made efforts to address the charge from our physical therapy education and profession leaders who have called for change and encouraged us to address the lack of diversity within the PT workforce beginning in DPT education programs. Because the DPT admissions process is the pipeline to the future PT workforce, increasing diversity efforts at this stage has a high potential to have a meaningful downstream effect from admission to the profession to societal levels. Although this case report reflects 1 set of data from 1 year, these data provide initial evidence for the use of a holistic review process to increase diversity in entry-level PT education without sacrificing academic performance.

When the cumulative GPA of the 193 applicants invited to interview after the use of the holistic review (3.71) was compared with the group of 193 sorted by the top cumulative GPAs (3.89), the top GPA group had a slightly higher GPA by 0.18%. However, the holistic review group had a cumulative GPA that was still higher than the total Program applicant pool (3.59) and far exceeded the Program's minimum GPA of 3.0. Furthermore, the holistic review group had GRE scores that were on average of 2.5% higher than the top GPA group, which indicates that the Program has the potential to maintain its current academic standards and success by consideration of these important markers of diversity. Although prospective data related to programmatic measures of success (ie, NPTE scores and GPA within the program) over several years will be necessary to identify the outcomes of implementing the holistic review, we know that the attrition rates have remained consistently <3% before and after the use of the holistic review. Thus, the holistic review does not seem to have altered test outcomes, attrition, graduation, or other program measures of student success in the short-term, but more long-term data are needed to make definitive conclusion about its impact.

There is no doubt that this holistic review process requires a substantial time commitment, increased workload, program leadership support, and administrative assistance, but through these efforts, the holistic review process can potentially result in an important increase in students from more diverse racial/ethnic backgrounds, SES, and unique underrepresented minorities. Programs considering a transition to holistic admissions processes should anticipate up to double the time commitment and associated costs in processing admission applications, which may be barriers to implementation.

The use of a holistic review in the Program has improved alignment between admissions and the attributes that are valued in graduating physical therapy students and alumni. Although the basic structure, general concepts and primary categories of the rubric have remained the same; the rubric specific scoring criteria have been updated for the current cycle to reflect the experience of reviewers and to consider the needs of the Program and institution (Table 1). It is anticipated that any holistic review process is fluid and evolves as admissions team shape criteria to meet their needs.

The Program recognizes that the percentages of racial and ethnic minorities in the physical therapist applicant pool and in the final cohort of admitted students are still low when compared with the Colorado census and US workforce data, specifically for Black/African American and Hispanic/Latino populations (Table 4).^3,5 This realization has resulted in increasing efforts of the Program to reach out to underrepresented minorities, rural students, and other diverse prospective students through recruitment efforts. Examples include pipeline programs targeted to high school and college students from underrepresented backgrounds, as well as outreach efforts in local and rural Colorado high schools, colleges, and universities through virtual and in person visits, communications, and events.

Finally, the data showed that a smaller proportion of Asians and individuals from economically disadvantaged families were admitted as compared with those who applied. It is not entirely clear why these 2 categories showed a decrease; however, the Program was able to speculate on some reasons and continues to evaluate outcomes and adjust the rubric to best align with enrollment goals. The decrease in the number of Asians admitted was based on such a small number that no conclusions can be drawn from this in a single admissions cycle. The decrease in the number of applicants from economically disadvantaged families is also small and may be inconsequential, given the inconsistent manner with which it appears that applicants responded to these PTCAS questions in the application. Furthermore, these data represent only 1 admissions cycle, and the Program will continue to evaluate outcomes longitudinally to ensure that the rubric meets the admissions goals consistent with the program mission.

Limitations exist in the Program's available data for analysis. First, statistical comparison was not performed between the Program and PTCAS data because the PTCAS data set¹ does not report variability. Statistical comparisons were not performed within the Program groups because the samples consisted of some of the same applicants in each group. Although a statistical comparison might have strengthened the interpretation of the results, with such large samples, there would have been risk of concluding that a difference existed when in reality it did not (type I error). Furthermore, it is likely more meaningful to evaluate the overall effect of change vs the statistical significance. A second limitation is the single program analysis using a rubric developed as a program-specific tool. Future research plans could include an analysis across multiple admissions cycles to better assess trends rather than single year over year comparisons. This would allow for a more complete understanding of the impact of holistic admissions and use of a rubric in the process. In addition, a future research collaboration may be to gather similar data from several institutions who also have implemented a holistic review admission process. Currently, there are no common admission practices agreed on for all physical therapy education programs, nor is the need to enhance diversity the same across all programs. Because of this variability, the existing literature from within the PT profession and related health care professions for the use of holistic admissions practices is not always comparable. This made comparing and contrasting the methods and findings of this case report to others a final limitation.

Conclusions from this case study include the following: 1) a holistic review contributes to more diversity within a cohort, 2) considering the diversity of the total applicant pool can contribute to equitable decisions for those offered acceptance into the program, and 3) the combination of these factors resulted in a cohort that reflected more diversity than the national PTCAS data.¹ Improved, targeted recruitment efforts at a national and Program level may contribute to increased diversity in applicant pools. Academic factors, such as GRE scores, which may inherently have some level of bias, may decrease in level of importance in admissions decisions. Ultimately, years of data, additional case reports, and admissions research will contribute to an improved understanding of how PT programs may enroll a diverse and successful cohort of students leading to greater diversity in the physical therapy profession and workforce.