Admissions processes for five year medical courses at English schools: reviewBMJ 2006; 332 doi: https://doi.org/10.1136/bmj.38768.590174.55 (Published 27 April 2006) Cite this as: BMJ 2006;332:1005
All rapid responses
The article (Admissions processes for five year medical courses at
English schools: review: BMJ Volume 332) consisely demonstrated the fact
that differences exist amongst our medical schools and such differences
may resist a push towards a harmonised admissions process thus existing ad
But the suggestion that such differences may impede uniformity across
the school should not be a concern if such a difference does not hinder a
suitable candidate gaining a place at a medical school of their choosing.
A centralised admissions process is nothing more than a grand idea
which is not based upon thorough evidence to extract the most suitable
candidate from the hording masses. This is especially so when one
considers the differences in the execution of the undergraduate curricular
amongst the medicsl schools and therefore it is just logical sense that
the admissions processes would be different.
To unify the admissions processes across the board would be a poor
reflection on the differing locals through which each medical school arose
and continues to support (e.g. the medical atmosphere in London is very
different from that in perhaps Cardiff due to the differing environmental
forces that govern how medicine is taught and what sort of doctors are
expected to emerge from each school to serve that particular locale).
Despite suggestions for implementing modern guidelines that consider
non-academic as well as academic capabilities when chosing a medical
student as executed though cognitive tests the situation would remain that
no system would completely weed out unsuitable candidates as the nature of
medicine is such that you can only understand and appreciate it when you
are a member of the club.
Further would cognitive assessment significantly separate the
excellent from the good especially when one considers the differing high
school backgrounds of the applicants and thus the differing levels of
coaching that each would receive to engage in such a test? Bias would
Perhpas the best way to filter the excellent is simply to anaylse not
the grade but the marks of each candidate. This would remove the need for
cognitive tests because as we know performance at A-level is perhaps the
best predictor for success throughout the undergraduate years.
Thus the final solution may be fundamentally based on a more thorough
assessment of academic performance that encompasses not just GCSEs and A-
Levels but other academic domains (e.g. music performance and theory) to
assess the candidates suitability to juggle numerous academic
responsibilities and therefore their ability to juggle the numerous
demands throughout the course which are intended to produce a more rounded
Competing interests: No competing interests
I agree with the concerns voiced by Koralage and Kmietowicz
(18/03/06), regarding the rising trend of candidate selecting by number
rather than face-to-face interview and true ‘holistic’ appraisal of their
potential. These changes, however, are not limited to those exiting their
basic medical training into the new Modernising Medical Careers (MMC)
process, and are also a worry for those prospective candidates wishing to
enter medical training.
With the ‘BioMedical Admissions Test’ (BMAT) already used by four UK
medical schools, and the new ‘UK Clinical Aptitude Test’ (UKCAT) due to be
enforced next year by the remainder, selectors should take care to ensure
that the tried-and-tested interview system is not hastily abandoned
altogether in favour of 'universalising' entry procedures. As this article
concurs, with the increasing numbers of ‘grade-A’ applicants for medical
places, it is agreed that there is a genuine need for methods to
differentiate the many ‘good’ from the few ‘excellent’. Certainly the
return of including A-level marks or A+ and A++ grades has been
considered, however despite being a relatively simple extra solution,
these ideas have yet to materialise. Whilst aptitude testing may be a step
in the right direction, a single extra form or an exam will never be the
solution by itself; with tomorrow’s doctor required not only to be a
scientist, but also a lawyer, a politician, a manager, a presenter, a
teacher, an author, as well as a moral and ethical carer, over-reliance on
a single test to eliminate students may lead to promising candidates being
lost from the system. Despite the BMAT’s youth, it appears that
overwhelming demand for places has already made some selectors ‘cave-in’
to the safety-net that it offers. I have met several frustrated candidates
with strong applications who were rejected without interview after failing
to secure top-marks in the BMAT, whilst ‘weaker’ candidates with higher
scores were invited to interview. The same 'rejected' candidates
subsequently gained places at 'non-BMAT' universities, whilst a number of
the high-scorers are without any offers. Hopefully the UKCAT (solely an
aptitude test rather than an aptitude and science test) will help, however
this should be utilised as an adjunct - not the a single candidate ranking
solution. As the previous letter states, in the USA and Australia the 'pay
hundreds of dollars and we guarantee good scores on the entry test'
business is booming - a great barrier to the fairness of entrance tests,
which should test potential ability and not prior cramming and knowledge.
Throughout our training we are taught to ‘treat the patient, not the
number’. Yet surprisingly, when it comes to selecting prospective and
current doctors, the systems are growing increasingly reliant upon
numbers. UK school A-level examination results have proven to correlate
with success at degree level, but has the relatively medically unexplored
territory of aptitude testing actually proven an association with success
at doctor level? Like MMC, the theory may be good, but this time the
substance and implementation should not be hurried, and should first be
approved of by both selectors and candidates alike. Applicant numbers may
rise, but with a profession’s future at stake, key changes to selection
processes should not cut corners just to simplify, universalise and
modernise the task – particularly when good candidates are lost as part of
the ‘guinea-pig’ phase. Each university still needs to have a degree of
freedom to select candidates that the tutors feel will be suited to the
unique learning environment that it offers. Appropriate assessments of the
more generic abilities required in doctors may help, but potential
students and doctors should be selected upon the strength of their whole
application, and not solely eliminated based upon the outcome of a single
score. Interviews may be scary, but they do actually work. Let’s not rush
to rid ourselves of them just yet.
1. Nadeeja Koralage. BMJ 2006 332: 675
2. Zosia Kmietowicz. BMJ 2006 332: 625
3. Jayne Parry et al. BMJ 2006; 0: bmj.38768.590174.55v1
Competing interests: No competing interests
Entrance To Medical School.
May I have the temerity to suggest that each individual applying to
enter Medical School really does wish to achieve that particular goal?
That being the case may I suggest the following?
1. As the UK GCE is now a totally pointless and inaccurate
measurement of a pupil`s academic ability (witness the absurd scores and
grades compared with the50`s and 60`s,when perhaps one or two pupils out
of a year of120 pupils at Grammar school,may have obtained 8 ordinary
level subjects and of those progressing to the 6th form,a handful(5 or 6)
may have achieved 3 advanced level subjects)this should now be discarded.
2.A standard multiple choice paper(s) in 3 subjects considered ideal for
medical school entrance should be substituted.Thus all bias can be
eliminated. Questions can be set at a central office ,from those sent in
by any number of sources,to be approved by a central body and confirmed as
acceptable by each medical school.
3.If desired,an IQ test may also be added,but not the politically correct
nonsense of the additional papers set inthe UMAT examination in Australia
and being trialed elsewhere,by sociologists and psychologists.
The brightest people are required. Pupils for subjects requiring large
amounts of empathy might be better suited to these fields of study?
4.By choosing academically bright students,the medical profession may have
a chance of reversing its
destruction and reducing the huge waste brought about by civil servants
and other bureaucrats to the NHS.
5.Each medical school would have the opportunity of offering places to the
best minds applying for places. Obviously there would have to be some form
of limit to the number of schools each student could apply for.
6.I realize the old humbug that the student may not for whatever reason
do well in one or more of the academic tests on the day,when they were
expected to excel, but further attempts may be considered.
7.The so called UMAT test in Australia is being circumvented by clever
`cramming course' to help those who can afford them to pass this test.This
will surely happen in other countries adopting similar tests.Likewise
courses on interview techniques and questions,such that students are
likely to have every answer spoonfed to them,together with methods of
conducting themselves at the interview.
8.The rise of the various types of `barefoot doctor' must be opposed,the
general population are entitled to the highest standard of care. I
personally would not wish to be seen by poorly trained `assistants' of
9. Finally,the method of payment of the bright new generation of doctors
would need to be considered. The standard of care as received in Australia
under the fee for service arrangement,gives the highest standard for the
general population,and ensures superb standards of care through efficiency
and competition.Only in the `free' public clinics does it fall in
standards,but no where to the level of those found in the British NHS.
These thoughts are just intended as the basis for discussion,and to
simplify entrance requirements to medical school which are becoming
Give the places to the brightest students who have professed a desire
to enter the most noble of professions.
Competing interests: No competing interests
It is useful to have a comprehensive summary of the ways in which UK
medical schools admit students to their five-year courses, but it is
disappointing that the authors of the review in their closing paragraphs,
and in the ‘what this study adds’ section, paint such a gloomy picture of
the current state of UK medical student selection. There is, in fact,
much going on. For example, the authors of the review themselves mention,
but only in passing, that one medical school has trialled a ‘personal
qualities assessment’ procedure (PQA) in the context of medical student
selection but they don’t indicate the results of that trial, which would
have been informative. Interestingly the authors have referenced in their
introduction a relevant study by Lumsden and colleagues but they failed to
mention that this study was centred on the experimental use of PQA with
applicants to all of the Scottish medical schools. The aim of that study
was to gather the scores of prospective medical students, not to inform
selection decisions, but to form the predictor variables against which to
compare the later performance in medical school, and ultimately
professional progress. The Lumsden paper in its conclusion mentions this
long term objective, acknowledgement of which should have cast a somewhat
different light on the review authors’ closing remarks.
We declare an interest in this subject as the developers of the
selection procedure in question. PQA is a portfolio of psychometric tests
designed to measure some of the qualities that the literature and many
surveys have indicated we should be looking for in applicants to medical
school. This fresh approach to student selection has been developed
following extensive consultation with stakeholders as to what we should be
seeking in prospective medical students. Since 1997 the test has been
administered to more than 20,000 individuals in a health professional
context. The reliability of the component instruments has been carefully
monitored and documented, and details of their construct validity (does it
measure what it purports to measure?) has been published in the
international peer-reviewed literature (see www.pqa.net.au for
references). Currently we have on-going research collaborations with
medical schools in England, Scotland, Sweden, Australia and Canada to
evaluate the long term predictive validity of the test. Thus, much of
what the authors of the current paper call for is actually being done by
the PQA research team in collaboration with medical schools.
Lumsden MA, Bore M, Millar K, Jack R, Powis D. Assessment of
personal qualities in relation to admission to medical school. Medical
Education 2005, 59, 258-265
We are the developers of the Personal Qualities Assessment known as PQA
Competing interests: No competing interests