A scoping review of the upstream influences of admissions policies on applicant behaviour: Don’t hate the player, hate the game

INTRODUCTION: Anecdotes from university faculty and educational leaders suggest that medical school admissions policies are driving aspirant behavior in unintended ways. This paper reviews the existing literature for evidence of admission policies' upstream impact on applicant behavior. METHODS: We used a scoping review to summarize research published between 1980-2025, written in English, with empirical evidence of medical school applicants' behaviors being driven by admissions policies. RESULTS: Fifteen papers were included in the review. These revealed three types of policy-mediated admissions practices that influence aspirant behaviour: (1) high weightings of grade point averages and standardized tests, (2) value placed on activities reported on curricula vitae, and (3) the rating of essays and personal statement submissions, interview responses, and letters of recommendation. These policies influenced how aspirants made academic choices, sought supports, and marshalled their time and resources. Notably, aspirants' interpretations of selection policies were partially influenced by information not explicated articulated by the policies. DISCUSSION: Admissions policies that incentivize behaviours misaligned with the values of medical practice may have harmful effects on applicants and the profession. Medical schools should consider the unintended consequences of their selection approach and establish policies that protect aspirant well-being and promote behaviours valued within physicians.