Improving the selection of medical students

A significant number of outstanding doctors I have met during my
medical career would not these days gain entry into any UK medical school.
They would include an oft decorated world class cardiologist, an ENT
surgeon with virtually zero complication rates and the fastest and safest
cardiac anaesthetist I have ever come across. They would find it difficult
to comprehend that their entry would depend on comparing pictures of
squares and circles or solving some inane arithmetical problems. They
would be surprised that the answer to the question “Is the Sun the main
source of energy to the Earth?” is not yes but “not sure” because this was
not mentioned in a jumbled up article on which the answers should have
been based. These “failed medical school entrants” also happened to be the
most rounded, well read people with many varied interests outside
medicine.

Nowadays the “ideal” selection criteria must be both equitable and
defensible. Thus we have this test and other test and cognitive test and
psychometric tests, 360 degrees assessment and plenty of other “industry”
test which correlate well with some other tests etc .etc.

It is clear that a majority (but not an overwhelming one) of the
selected students will be the right people for the task. It is also clear
that a considerable number of students are not as suited for medicine as
some of the failed candidates. These suboptimal candidates made it by
having spent an eternity going through countless preparatory tests or
because their parents (in addition to spending money on superior
schooling) guided them step by step including inordinate amount of private
tutoring. The very same parents would arrange for their 15 year old
son/daughter to have “hospital experience”. As he/she was too young to be
allowed in contact with patients, this youngster would spend a fortnight
sitting with a radiologist in a reporting room and thus already
demonstrating his “love” for medicine at this early stage.

This person has never heard of Pasteur or Harvey or Lister and
probably will never do so for rest of his/her life. He /she does not
properly understand the theory of greenhouse gases and can not place the
assassination of John Kennedy even within a decade. He/she will practice
medicine by numbers, will select a specialty with optimal progress and
remuneration prospects and will be good at the clinical awards game.

In the meantime a potential Ehrlich will become perhaps another civil
servant because aged fifteen he enjoyed reading Dickens, tried to write
some poems or spent too much time exploring things with his microscope. He
admired Landsteiner‘s epoch making discoveries and realised that these
could not be achieved without incredible work ethics and diligence. But he
was too young to be that single-minded to try to achieve starred As even
in the less relevant subjects, and his parents were not prepared to
control every minute of his time outside school.

Not a month passes that some academician does not complain about the
inequality of selection and that that group or other group is under/over
represented. We never hear about talented students who got lost in the
system because the people who devised this very system wanted it to be
“fair” and “defensible”.

When Francis Coppola cast the virtually unknown Al Pacino in the
film The Godfather he was unable to defend his decision by using any
“hard” evidence. There were no Objective Structured Actors Examinations or
psychometric tests which asked what amout of sorrow a tested actor would
have imagined on a scale one to ten. But even if they had existed Coppola
would not use them, because conviction and talent cannot be measured on
any scale.
Many years back I sat as a student’s representative on the admission panel
at my medical school. I always wandered at the uncanny ability of my
professors to select the right people. They, of course, took into
consideration the secondary school marks, references and the results of
essays but in the end they always asked themselves “Is he/she going to be
a good doctor?” During these interviews they were compassionate, helpful
and understanding, but still could see through rehearsed platitudes, lack
of original thought; bluff or bluster They never accepted someone where
lack of knowledge was fundamental and it did not matter whether the
deficiency was at the scientific or general level. Sometimes they
recognised there was a mix of weaknesses and potentials. In such cases
(when the panel felt these faults could be rectified) these students were
offered a place at so called year zero and the next time round they had to
pass very rigorous tests and be observed the whole year so as to gain
acceptance . But they did not lose the chance and medicine did not lose
some really excellent doctors.

These top teachers spent an inordinate amount of their busy time not
giving “offers”, but giving many more students an opportunity to face
them. They knew that the time spent would be repaid many times over. They
knew that the human touch started at the selection and carried on
throughout the training and it was not bolted on as another subject in
“online” based training.

Competing interests:
None declared

Medical school is an intense, demanding process of education and preparation,
in which young people are transformed into physicians. Since this process
coincides with physical and emotional maturation into adulthood, medical
school
is a time of great change. The task for the medical student is to incorporate all
these changes into a unified, cohesive identity. The best way to accomplish this
is for the medical student to focus on being humble, by identifying with the
poor, sick, and disadvantaged. This will help to neutralize the inevitable hubris
that comes with being a physician.

Competing interests:
None declared