Selection of medical students
BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7362.495/a (Published 31 August 2002) Cite this as: BMJ 2002;325:495
All rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
Part of the mission of any medical school is to train competent
physicians to care for the community it serves. However, the composition
of these communities have changed drastically largely due to immigration,
and many medical classes still do not reflect these changes. Certain
minority groups continue to be underrepresented (1).
Much literature exists that has proven that perception of health,
treatment and patient satisfaction are culturally mediated (2,3). The
question then is how do we best achieve selecting a medical class that
reflects the diversity of its patient population knowing its importance?
Howes et al. argues that affirmative action is not preferable, as it
“requires medical schools to preferentially take students with lower
academic achievement and communication skills.” He goes on to provide
evidence of Indian colleagues who have succeeded without the benefit of
such a program (4).
Firstly, it is important to note that affirmative action does not
mean the same thing to all people. Some believe that affirmative action
gives preference to underrepresented groups when choosing between equally
qualified candidates. This antiquated idea that ‘affirmative action’
allows substandard students into programs is politically fuelled itself.
Secondly, his example of minority colleagues succeeding to argue his
point is weak at best. All ethnic communities are not the same and face
different challenges and degrees of discrimination. In North America for
example south asian immigration is relatively recent, and as such we have
not faced the same challenges and struggles as the African American
community.
Howes also talks of schools in the UK using “access indicators” such
as postal code and parental social class as admission criteria. Social
class is essential to gage an applicant’s life experience and subsequently
help judge their achievements fairly.
Affirmative action is not about giving anyone a “free lunch”. In
health care, it is about having a physician workforce that is able to
respond to the needs of all patients.
Pavi Singh Kundhal
Medical Student, University of Toronto
1. Dhalla IA, Kwong JC, Streiner DL, Baddour RE, Waddell AE, Johnson
IL. Characteristics of first-year students in Canadian medical schools.
CMAJ 2002;166(8):1029-35.
2. Saha S, Komaromy M, Koepsell TD et al. Patient-physician racial
concordance and the perceived quality and use of health care. Arch Intern
Med. 1999;159(9):997-1004.
3. Chavez LR, Hubbell FA, McMullin JM et al. Understanding knowledge and
attitudes about breast cancer. A cultural analysis. Arch Fam Med. 1995;
4(2):145-52.
4. Howes D. Selection of medical students. BMJ 2002;325:495 ( 31 August
)
Competing interests: No competing interests
Re: How should we select medical students?
Pavi S. Kundhal, in his critique of my letter regarding the selection
of medical students, introduces several points that can interestingly be
developed further.
He states that the composition (primarily ethnic) of the medical
classes should match that of the patient population. This of course is a
fallacious and impractical argument since you can rarely always see a
doctor of the same sex, ethnic and social class as yourself. In the real
world what is important for most patients is to see a doctor who has a
good appreciation of the diseases you may suffer from, and is able to
communicate in an understanding and unpatronising way. Incidentally, in
the UK the proportion of doctors from the Indian subcontinent is much
higher than would be expected from the numbers of non-doctors. Should we
bias against applicants from this ethnic group?
Kundhal believes the idea that affirmative action allows substandard
students (his words) into programs is ‘antiquated’. However one of my main
points was that in the UK, and other countries, students with lower
academic achievement and interactive (i.e. interview) skills are being
given preferential admission and the evidence is doubtful that medical
schools can turn this around. Whatever the opinion of some
behaviouralists, there are differences between individuals and the
personality at 18 years has been fairly well set.
It may well be there is a case for more Asian medical students in
North America, but my argument was that in most of the world so called
“political correctness” is unjustified and Medical schools should be
allowed to select students on the basis of proven ability and aptitudes.
Surely we should abhor discrimination for or against any group. I
believe the phrase “selection for potential” is an excuse for social
manipulation, and diverts attention away from the real problem areas of
poor secondary schooling and underlying social issues. This is where the
real inequalities are manifest.
Competing interests: No competing interests