Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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Rural applicants also lose out.
- John A J Macleod (23 October 1998)
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Do medical schools want conformity in their graduates?
- Peter Littlejohn (26 October 1998)
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Mature student intake should be increased
- Naseer Ahmad (28 October 1998)
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Choosing with facts, or fictions ?
- B Miller (29 October 1998)
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Academic qualifications should not be decisive in selecting students
- M Vally (2 November 1998)
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Choosing with fact, or with fiction?
- B M Miller (2 November 1998)
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Secondary school standards remain the key
- Andrew D McLean (2 November 1998)
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How to build evidence in the selection process?
- Mayer Brezis (9 November 1998)
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Comprehensive selection tests : Reliability,Validity and Predictive outcome
- Sheena Singh (30 July 2007)
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John A J Macleod, Rural General Practice Lochmaddy, HS6 5AE
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Pupils who have attended Secondary Schools in a Rural Area are also at a disadvantage in applying for Medical Schools. This is on two counts a) they tend to have lower grades than pupils from city schools b) Admission interviews are arranged and carried out by people who are city dwellers. Ref 1. All civilian and service applicants for flying training have to go through specific aptitude testing so surely the long term benefits of using such a method of improving selection for medicine would well out weigh the initial costs. Policy For Rural Training, 1995 W.O.N.C.A. |
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Peter Littlejohn, Rural general practice Cape Breton, Nova Scotia, Canada
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Graduates from medical schools invariably end up in very wide-ranging situations. Is it not important for admissions procedures to seek out those who will become skilled researchers, visionaries, and even administrators, as well as skilled clinicians? If so, how is the mix determined and what would the be the best combination of skills and abilities for each "type"? If medical schools were to admit only those who fell within the second standard deviation for all parameters, what would we stand to lose? The debate has to go further. Peter Littlejohn |
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Naseer Ahmad, 2nd Year Medical Student, Liverpool University Liverpool University
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As a mature male student, from the ethnic minorities, it is somewhat of a minor miracle that I got into medical school! I do feel that being a mature student brings tremendous advantages especially so in the new 'problem based learning' (PBL) method of teaching. Under this method, small groups of around 8 student are given a scenerio and based upon this set their own learning objectives along the broad categories of; structure and function (anatomy and physiology), individual groups and society (sociology), population perspectives (public health and epidemiology) and ethics. For such group work to succeed, discussion needs to take place in order for the successful setting of objectives. It is in these discussions that the mature student's role is, I feel, vital. The mature student, by the virtue of being older, more experienced and generally more aware of the real world can bring colour to discussions. My experience has found that students straight from secondary school, often (but not always) have little idea of how to discuss matters fully i.e. they do not support their ideas well nor can they identify flaws in counter arguments. This can mean that important issues are glossed over e.g. 'ethics of allowing contraceptives to be available freely' The mature student in these situations can prompt, question and encourage group members to make their arguments more 'water tight'. Although, there is a danger that mature students can take control of discussions and impose their view on younger group members, intervention from the 'PBL tutor' (whose normal role is to remain silent during discussions) should prevent this. I feel, that having at least one mature student per PBL group, can bring tremendous advantages to this new method of teaching in addition to the general advantages of having mature medical students (e.g. decreased likelihood of dropping out) and as such, mature student intake should be increased. |
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B Miller, Specialist registrar in Anaesthesia Manchester
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Editor - Powis concludes in his article on "How to do it - Select medical students", that the "fundamental principle" for selection is a profile "considered by the administrative committee to be important".1 But who makes up this committee ? And how does it assess the data for each individual ? It must be remembered that we are trying to foresee the development of a number of skills, differing in significance depending on the candidates final field of work. Basic skills must include the ability to assess information, to act appropriately, and to communicate. But, the technical skills of Surgery, are very different from the verbal skills needed in Psychiatry, or the statistical and political ones in Public Health Medicine. In the UK the majority of applicants for medical school are 17 or 18 years old. Few know enough about the details of the various branches of medicine to have a clear idea of their future. Furthermore, this is still a young age, and for many, their first time away from home. Can we know how their personal and interpersonal skills will develop ? The current system is very crude, using mainly the achievement of academic qualifications. However when semi-subjective are applied the problems of racism, sexism, ageism etc. occur. Although there can be no some doubt that the technique may exclude fine potential candidates, it is at least likely to ensure that the candidate is able to cope with the academic detail. As with all aspects of medicine, the time has come for rigorous evidence-based trials. We must review candidates assessed by these techniques for medical school selection, after qualification, and in established medical practice. Otherwise we merely to pretend to a science that we do not possess, and pretend to ourselves a security that we have not earned. Let us not rush in to new forms of assessment, which, although they may appear to illuminate the facts, may only be obscuring them. |
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M Vally, Student Johannesburg
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Academic qualities in a prospective student should not be a major decisive factor when choosing a medical student. External influences should also be considered e.g. if a prospective student has to hold down a part-time job, if there where any events during one's schooling career that led to a decline in marks. Many people with great potential to succeed as health practitioners have been forced to find alternative careers because of circumstances that have led to a decline in marks. So how do we choose a medical student? There are no right answers and no wrong answers. However, a suggestion would be to make provision for such students who feel that they should be considered as a special case. Their applications should be considered as a whole and not filtered out by the computers to select the cream of the crop with "A" aggregates. |
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B M Miller
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Editor - Powis concludes in his article on "How to do it - Select medical students", that the "fundamental principle" for selection is a profile "considered by the administrative committee to be important".1 But who makes up this committee? And how does it assess the data for each individual? It must be remembered that we are trying to foresee the development of a number of skills, differing in significance depending on the candidates final field of work. Basic skills must include the ability to assess information, to act appropriately, and to communicate. But, the technical skills of Surgery, are very different from the verbal skills needed in Psychiatry, or the statistical and political ones in Public Health Medicine. In the UK the majority of applicants for medical school are 17 or 18 years old. Few know enough about the details of the various branches of medicine to have a clear idea of their future. Furthermore, this is still a young age, and for many, their first time away from home. Can we know how their personal and interpersonal skills will develop? The current system is very crude, using only the achievement of academic qualifications. Although there can be no doubt that the limitations of this technique exclude many fine potential candidates, it is likely to ensure that at least the candidate is able to cope with the academic detail. As with all aspects of medicine, the time has come for rigorous evidence-based trials. We must review candidates assessed by these techniques for medical school selection, after qualification, and in established medical practice. Otherwise we merely to pretend to a science that we do not possess, and pretend to ourselves a security that we have not earned. Let us not rush in to new forms of assessment, which, although they may appear to illuminate the facts, may only be obscuring them. Dr. B. M. Miller Specialist Registrar in Anaesthesia Manchester (NorthWest) Regional Rotation 1 Powis D. Select medical students. BMJ 1998;317:1149-50. |
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Andrew D McLean, research fellow University of pennsylvania
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Given that the UK selects the majority of medical students directly from school it seems strange that very little analysis of the nature of school curriculae and exams has been made during this debate. British schools have always tested a variety of skills in their exams and to generalise that exam results reflect only an isolated "academic" skill base does not stand up to analysis. Mathematical, linguistic (verbal and written), deductive, analytical and experimental skills are all tested in a very fair way in British schools. Also exam results reflect other less defined but critically important attributes such as concentration, hard work, time and pressure management and so on. Despite all the recent changes in undergraduate and post-graduate medical exam curriculae, the early part of ones medical career remains a series of exams. Selection of people for specific fields with specific aptitude requirements is practically impossible. This is because the only real way to assess such aptitude is 'on the job'. Given all this, why not select medical students solely on the basis of school examinations which are marked independently of race, sex, religion and class (the latter, in my experience, the main, and least acknowledged, source of bias in the British medical establishment). Aptitude related selection can start after people are in the door and have some idea what different specialities involve. I would hate to think that people who have shown a high degree of objectively assesed ability are turned down on the basis of an interview or other definitively non-objective selection procedure. Personally, I don't think that I would have got into medical school on the basis of interviews carried out when I was 17 or 18 years old. So why not just demand certain school exam results, set the threshold, and be done with it. At least the overwhelming priority would be met, namely fairness. |
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Mayer Brezis, Professor of Medicine Hadassah University Hospital Mount Scopus Jerusalem, Israel
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We definitely need more scientific evidence to construct an efficient selection process for medical students or to realize that the selection process may have no value or may even be detrimental. I suggest we develop a registry and analyse the results of currently used selection processes at the entrance of medical schools, looking at: 1. What did happen to those rejected? How many have successfully completed a medical school elswhere? 2. What was the degree of correlation between the score on the selection process and the results on the final exams or feedbacks during rotating internship? Building such a registry will need several years, but it will eventually give us the need evidence on what type of selection, if any, has predictive power for the formation of better physicians. |
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Sheena Singh, Professor & Head, Department of Physiology Chrisitan Medical College, Ludhiana, Punjab, India, 141008
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Most Medical Colleges in India rely only on a scholastic aptitude selection test that measures simple recall of facts. A study done by the author as a 'CMCL-FAIMER Institute' fellowship project in 2006, on ‘Motivation of Medical students for selecting Medicine a career’, revealed that most students (62%) had applied for medicine because it was their parents’ desire that they become a doctor and some had selected Medicine even though they did not want to do it (10%) in a study group of 50 students selected in July 2006 in Christian Medical College, Ludhiana,India.(The 'CMCL-FAIMER Institute' is the Christian Medical College & The Foundation for the Advancement of International Medical Education and Research Institute that offers fellowships in Medical Education.) A variety of methods used to select students for medical studies should be developed. Holding an interview with the candidates will provide qualitative data on factors like motivation and communication skills. Assessment of psychomotor skills would be helpful. However, it is very difficult to predict whether students selected in this way will turn out to be the best doctors in the future unless evidence proves so. There will always be some bias due to preferences of the observers. Students of 17 or 18 are still developing and may develop positive coping skills during the medical course. Also students coming from different sociocultural and language backgrounds cannot be assessed with the same yardstick. Government policies in India make it mandatory to admit some students from socially and economically compromised areas. It might be a good idea to make students who have already been selected by the academic testing alone to undergo the comprehensive testing and data collected to be tested for reliability and validity and correlated with their subsequent scores and success in their careers. This is a challenging and exciting area to research. dr_sheena_singh@hotmail.com Competing interests: None declared |
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