This month's issue of the Medical Journal of Australia features an article by Associate Professor Michele Groves, from Griffith's School of Medicine, on the effectiveness of medical school selection processes. The study was conducted in collaboration with colleagues from Sydney University and evaluated the relationship between entry characteristics and subsequent performance in medical school of students from the graduate-entry programs at Sydney University and the University of Queensland. Although a small study, it found little evidence that the most commonly used admissions criteria are able to predict clinical or academic performance to any substantial extent.
Admission to medicine is a highly competitive process with demand for places far exceeding supply. The need to select students with both the cognitive ability and the personal attributes to become "good" doctors has led medical schools to develop rigorous admission processes that go beyond the traditional reliance on secondary school exam results. In most cases, entry is based on academic achievement, some kind of written test and an interview. In Australia, the two most commonly used tests are The Graduate Australian Medical Schools Admission Test (GAMSAT) and the Undergraduate Medical Admissions Test (UMAT).
The effectiveness of admissions tests has long been a contentious issue, with several studies suggesting that cognitive measures are not reliable indicators of either academic or clinical performance1-3. Not only are cognitive tests imperfect; interviews may also be poor measures of behavioural and attitudinal aptitude for medical practice4.
This is not to say that current selection processes are resulting in the admission and graduation of students with the wrong characteristics to be come "good" doctors (as suggested in recent news reports). As with most complex and socially critical structures, the health care system, and medicine in particular, offers a wide range of career paths and medical schools' selection criteria need to be able to accommodate a corresponding variety of personalities and values to best meet society's requirements. Consequently, the aim is to recruit a socially diverse body of students who, on graduation, will be able to bring to medical practice not only a high level of biomedical knowledge and clinical skills but also essential humanistic qualities such as empathy, communication and teamwork skill, ethical values and self-awareness.
The selection policy for Griffith's MBBS program is similar to other Australian graduate-entry medical schools in that it is based on a belief that modern medical practice requires doctors who are clinically excellent and socially accountable, who appreciate the multidisciplinary nature of health care provision, and who have a commitment to life long learning. The School therefore needs to enrol students from a wide range of social, cultural and academic backgrounds with diverse experiences and talents. The selection process is intended to reflect this philosophy and places in the program are offered to graduates from all discipline based on their performance in GAMSAT and an interview. GAMSAT is primarily designed to assess problem-solving and critical thinking while the interview aims to evaluate aptitude for medical practice by evaluating applicants' communication skills, pro-social attitude, learning style, motivation, decision-making ability, and capacity for personal management and self evaluation. The interview is structured to ensure maximum standardisation and reliability.
There is no evidence to suggest that medical schools are producing doctors who are inadequately trained or generally unsuited to medical practice. But it is acknowledged that more evidence is required that written tests (such as GAMSAT) and interviews are the most effective way of selecting only those applicants with the intellectual and personal attributes most likely to become competent, safe and ethical practitioners in whatever field of endeavour they choose to involve themselves.
References
- Groves M, Gordon J, Ryan G. Entry tests for graduate medical programs: Is it time to re-think? Medical Journal of Australia 2007;186(3):120-123.
- Kulatunga-Moruzi C, Norman G. Validity of admissions measures in predicting performance outcomes: The contribution of cognitive and non-cognitive dimensions. Teaching and Learning in Medicine 2002;14(1):34-42.
- Salvatori P. Reliability and validity of admissions tools used to select students for the health professions. Advances in Health Sciences Education 2001;6:159-175.
- Eva KW, Rosenfeld J, Reiter HI, Norman GR. An admissions OSCE: the multiple mini-interview. Medical Education 2004;38(3):314-26.