The benefits of aptitude testing for selecting medical students

The A level is the most common tool for assessing school leavers applying for higher education, including medicine. If medical school outcome is accurately predicted by A level grades, as described by McManus et al,1 what place, if any, do aptitude tests have in the selection of medical students?

Applications for medical school from appropriately highly qualified candidates have increased year on year2 until it has become increasingly difficult to discriminate between candidates with similar A level performance. Most medical schools wish to select future doctors using non-cognitive attributes alongside A levels, but procedures, such as interviewing, are time consuming and labour intensive. An urgent need is to reduce the number of candidates by initial screening that is appropriate, fair, and transparent but also gives added value to the process.

A further important reason for considering such testing initiatives is the concern that some groups are underrepresented in medicine because A level grades reflect educational background and social class.3 Additional tests that can show intellectual ability or aptitude rather than achievement may be a valuable means to widen participation. These tests—some without undue reliance on a heavy science background—may be a useful adjunct to A levels where candidates offer a variety of subjects from different examining boards or offer non-traditional qualifications.

Attributes such as general mental ability, critical thinking, problem solving, communication skills, empathy, psychological robustness, and integrity are some of the commonly cited required qualities of medical students. Aptitude tests such as the biomedical admissions test (BMAT), the medical school admissions test (MSAT), and the graduate medical school admissions test (GAMSAT) define intellectual ability in terms of critical reasoning and problem solving; examining a candidate's understanding of interpersonal issues and written communication. The personal qualities assessment test (PQA) assesses verbal, numerical, and spatial reasoning by its mental agility test, contains a personality inventory, and has an ethical reasoning paper. These tests aim to assess more than intellectual ability and have added value alongside A levels assessing some of the desirable non-cognitive characteristics in potential medical students.

To be defensible a selection method must be reliable within and across successive cohorts of applicants. It must select on the basis that it claims to test (that is, have construct validity) and it should predict the eventual performance of the potential doctor who is selected.

The personal qualities assessment test has been shown to distinguish candidates on the basis of cognitive function and personality independent of social class and schooling. The reliability and validity of the test has been documented, but the long term predictive value of performance as a doctor is under investigation.4 The biomedical admissions test and medical school admissions test have high face validity and allow differentiation between candidates without further inflation of A level grades. Although experience in the United Kingdom, Australia, and New Zealand is positive further validated data are needed to confirm that these tests successfully predict long term outcomes.

No one is advocating the abandonment of A levels in the selection of medical students. It is timely, however, to develop and evaluate selection methods that may be useful adjuncts in a holistic selection process that is fair, transparent, and accountable both to applicants and to their future patients.5