Medical School Admissions in Ontario: Criteria, gender trends, and the sex discrepancy

Overview of the Ontario Medical School Landscape

Ontario has seven medical schools operating under the centralized Ontario Medical School Application Service (OMSAS): the University of Toronto, McMaster University, Western University (Schulich), Queen's University, the University of Ottawa, Northern Ontario School of Medicine (NOSM), and Toronto Metropolitan University (TMU) . OMSAS was established in 1975 by the Council of Ontario Faculties of Medicine (COFM) to streamline the application process, as each school previously had its own separate application and requirements. Gyanberry

Admission Criteria: A Multi-Dimensional System

Modern Ontario medical school admissions are no longer simply about grades. They evaluate candidates across several interconnected dimensions:

1. Academic Performance (GPA)

The minimum academic requirement is three years of full-time undergraduate university study in any discipline, with a minimum GPA of 3.0 on the 4.0 scale. In practice, competitive applicants have GPAs well above this floor — typically 3.8–3.9+. Ontario Universities' Application Centre

2. The MCAT

Applicants must have taken the MCAT within five years of the application deadline, with a minimum score of 125 in each section. However, notably, the University of Ottawa does not require the MCAT to apply or be admitted, and NOSM similarly does not require the MCAT or CASPer exams. GyanberryMedSchoolCoach

3. CASPer (Computer-based Assessment for Sampling Personal Characteristics)

CASPer is an online situational judgment test (SJT) used by most Ontario schools to evaluate non-cognitive traits. The CASPer test claims to evaluate applicants' non-academic, non-cognitive traits or "soft" skills, such as communication, ethics, empathy, and motivation — skills considered desirable for future medical professionals. BeMo®

4. The MMI (Multiple Mini-Interview)

In recent years, medical school selection processes have evolved significantly, transitioning from traditional academic selection models to multifaceted processes that evaluate non-cognitive attributes such as communication, empathy, and ethical judgment, considered essential for health professionals. Most Ontario schools use the MMI as their primary interview format. nih

5. Autobiographical Sketch (ABS) and Reference Letters

Applicants must submit an extensive record of extracurricular activities, research, volunteer work, and employment — and provide reference letters (CAFs) from individuals who can speak to their character and abilities.

The Gender Discrepancy: Women Now Dominate Medical School

The Data

The shift in the gender composition of Canadian medical schools has been dramatic and consistent. In a cross-sectional analysis of Canadian medical trainees over 30 years, there were 137,096 male and 169,099 female MD applicants; 126,422 male and 152,967 female MD students; and 29,413 male and 34,173 female MD graduates. Women now substantially outnumber men at every stage of the medical training pipeline — except in surgical practice. BMC Medical Education

The most recent Canadian medical school classes have a range of 43–74% women (mean 58%), compared with a range of 26–57% men (mean 42%). Enrolment of women in Ontario and Atlantic Canada is above the national average, while enrolment in Western and Prairie schools falls below it. CMAJ

This is part of a broader international pattern. In the 2023–2024 academic year in the US, women made up 57% of medical school applicants, 55% of matriculants, and 54% of total enrollment. Medscape

Why the Discrepancy? A Multi-Causal Analysis

Cause 1: The Upstream Pipeline — Women Dominate Canadian Universities

The most foundational reason is that women far outnumber men in the pool from which medical school applicants are drawn. Nationally, undergraduate enrollment in Canada in 2022–23 was 58.3% women and 41.7% men. Among Canadians aged 25 to 34, about 40% of women hold a university degree, compared to about 26% of men — a gap that has grown since 2006, when the difference was nine percentage points. The Globe and Mail

Women are more likely than men to attend post-secondary institutions, perform better academically during their studies, and are often more engaged in extracurricular activities and campus life. Since medical schools select primarily from university graduates, a larger and more academically accomplished female applicant pool naturally flows into a larger female medical school cohort. Heqco

Cause 2: Non-Cognitive Criteria Favour Women

This is perhaps the most structurally significant cause unique to medical admissions specifically.

MMI performance: Research directly examining the MMI has found consistent gender differences. A study testing measurement invariance confirmed that MMI non-cognitive attributes were demonstrated equivalently by males and females, but significant latent mean differences were identified, with female applicants consistently outperforming male applicants across all three years studied. The authors noted this highlights the need for continued research into how group disparities may impact selection equity. nih

CASPer performance: The primary demographic that would likely benefit from CASPer being weighted in admissions would be women, who have made up the majority of medical school applicants and graduates since 2017. Women tend to score higher on empathy-framed, interpersonally-oriented tasks, which form the backbone of both CASPer and MMI station design. Science-Based Medicine

These tools were designed partly to counteract an over-reliance on GPA and MCAT scores, but in doing so, they appear to have introduced a different kind of demographic skew — one that advantages women.

Cause 3: GPA Patterns

In terms of GPA and MCAT, male matriculants tend to have slightly higher MCAT scores, while women tend to have slightly higher non-science GPAs; men have slightly higher science GPAs. Since most Ontario schools place a heavy weight on cumulative GPA (which includes arts and social science courses), the female advantage in non-science GPA translates directly into admissions competitiveness. Med School Insiders

Cause 4: Extracurriculars, Volunteering, and the ABS

Women are often more engaged in extracurricular activities and campus life. The ABS in OMSAS rewards broad involvement in healthcare volunteering, community work, and leadership. Studies have found that women disproportionately self-select into these experiences — whether through healthcare volunteering, peer mentorship, or community advocacy — which are precisely the activities rewarded by medical school admissions. Heqco

Cause 5: Social and Cultural Shifts in Career Aspirations

Women have always been interested in fields like medicine and science. What changed was access and opportunity — not the underlying interest itself. As institutional barriers were dismantled over the 20th century, women rapidly entered medicine in growing numbers. A compounding effect also plays out: as medicine becomes more female-dominated, it may become culturally more appealing to subsequent cohorts of women, and potentially somewhat less of a default aspiration for men who now have a wider range of career pathways they consider equally viable. Medscape

Cause 6: The MCAT — A Partially Counterbalancing Force

The one major admissions metric where men retain an advantage is the MCAT, particularly in the science sections. Men score higher than women on the MCAT science portion and on standardized licensing exams early in medical school training, though this gap closes or reverses by later clinical exams. Schools that place high weight on the MCAT (like McMaster, which once had over 76% female enrollment before it deliberately broadened admissions criteria) tend to have slightly less extreme gender skews, whereas schools deprioritizing the MCAT (like Ottawa and NOSM) tend to see greater female representation. nih

Institutional Responses and Tensions

McMaster eventually determined the imbalance was not healthy and decided to offer a kind of affirmative action for male applicants — by reducing the emphasis on GPA and broadening the criteria for admission, they were able to offer spots to more male students. This is a telling admission that the structure of criteria, not just the underlying applicant pool, directly shapes gender outcomes.

There is a real and unresolved tension here. On one hand, the shift toward non-cognitive criteria was intended to produce better, more empathetic physicians and to correct the historic male dominance of medicine. On the other hand, studies of CASPer and MMIs have found that these tools "do not appear to offer any significant advantage in promoting diversity or selecting intrinsically motivated applicants," and that they "favour applicants from higher income households" — as wealthier applicants have more resources to prepare for these test formats. BeMo®

The Remaining Paradox: Surgery

Despite women dominating medical school enrollment, a striking reversal occurs in surgical specialties. Increased female representation in medicine is not matched by representation in surgery, with the key factor being the specialty choice process. Among practicing surgeons, there are 7,457 men compared to just 3,457 women. It is paramount not to assume the self-selection of female students out of surgical specialties results from a true incompatibility — it is important to disentangle the origin and validity of information received by medical students that may disproportionately dissuade women from surgical fields. BMC Medical EducationSpringer Data shows that surgery is a demanding job, but due to admission criteria, many men never reach the stage of becoming surgeons. 

Summary

The gender discrepancy in Ontario medical school admissions is not the result of any single policy or bias, but rather the confluence of several reinforcing trends:

• Women significantly outnumber men in the undergraduate pipeline from which applicants are drawn
• Non-cognitive assessment tools (MMI, CASPer) consistently produce higher scores for women
• Women have an edge in cumulative GPA (non-science), while men retain an advantage in MCAT science scores
• Women are more likely to accumulate the volunteering and extracurricular experiences rewarded by the ABS
• Broad cultural shifts have made medicine increasingly aspirational for women, while male career aspirations have diversified

The result is a medical profession in Canada that has fundamentally transformed over a generation, yet one in which new questions about equity, downstream specialty representation, and the validity of non-cognitive selection tools remain genuinely unresolved.

An article blog written with support of Claude Sonet 4.6 May 14, 2026