Selecting students for medical school

Jon Cohen

Medical school admissions: key requirements

• To select the best candidates who will become outstanding doctors

The UltimateGood Doctor

Able to applyknowledge

Technicalcompetence

Teamworker

Organised, conscientiousReliable

EmpatheticCommunication

skills

Ethical,High integrity,professional

Calm under pressure

Good at decision making

Life longlearner

Problem solverConceptual thinker

Adapted & simplified from Powis, Bore & Munro

We generally agree about what we are looking foralthough we don’t agree how to get there

“The stated criteria for admission to medical school show commonality. Universities differ greatly, however, in how they apply these criteria…”

Parry et al, BMJ 2006 332:1005

Admissions processes for five year medical courses at English schools: review

Difficult question #1:

How do we capture the diversity we need formedicine, both in terms of skill sets:

• paediatric neurology vs forensic pathology• primary care vs tertiary care• individualised care vs public health vs global health

and in terms of social & societal experience

Difficult question #2:

At what point do you measure the outcome?

What is success?

How will we know when we have got it right?

Note: most papers that talk about “predicting outcome” arereferring to successful completion of the degree course

• the number of failing doctors?• the number of complaints to the GMC?• junior doctors’ sense of preparedness?• patients’ input?

And when?• At graduation?• At the end of Foundation?• After 5 years in practice?

What should we measure?

F1 doctors failing = 159 (2.2%) F2 doctors failing = 228 (3.2%)

UKFPO Annual Report, 2010

The number of doctors in difficulty was 266 (4.6%). Half of these were relatedto the doctors’ health, the remainder (very small numbers) to other reasons.

UKFPO Annual Report, 2010

Of the 266 doctors in difficulty, > 80% were expected to be successfully signed off.

UKFPO Annual Report, 2010

Medical school admissions: key requirements

• To select the best candidates who will become outstanding doctors

• A system that is robust, fair, transparent and which actively supports the WP agenda

Widening participation – specific schemes

Widening participation in “general” applicants:The real challenge

Increasing concerns with all “non-academic”elements of UCASProbably all of them suffer from risk of unintended biasKeen interest in exploring alternatives, e.g. :

• all graduate entry• Admissions centres• MMIs

Medical school admissions: key requirements

• To select the best candidates who will become outstanding doctors• A system that is robust, fair, transparent and which actively supports the WP agenda

• Evidence-based, defensible process, not open to challenge under Equalities legislation

• Not overly expensive/cumbersome to operate

UCAS Application(Academic

only)

Interview Decision

UCAS Application (Academic

only)

UKCAT Score

Interview Decision

UCAS Application

Interview Decision

1 School

2 Schools

2 Schools

1 School

UCAS application (Academic

only)

BMAT

UCAS Application

BMAT Score

Interview Decision

Different schools use different approaches

Data provided courtesy of GMC, 2011

A final thought: in-course selection

The current model favours retention on thecourse for reasons of:

• reputation• finance• humankindness!

That being the case, academic criteria are boundto be the best “predictors” of success, since successis usually measured as completing the course

Alternative approaches to in-course selection

Y1 Y1

Current model: selectionthrough the course based onacademic failure and rarely,FtP

Alternative model: expanded Y1entry with major selection onacademic & non-academic criteriaat end Y1, thereafter mainly by FtPor severe academic failure.

Summary

• Admissions is a tough area: we welcome constructive discussion & debate, and we are actively exploring alternative models

• We are particularly keen to expand, develop & improve our WP work

• In the absence of better data, the current variety of approaches is a strength that encourages diversity; there is almost certainly no single “right answer”