Selecting students on their academic record is a better predictor of who finishes medical school than aptitude tests, according to Australian and New Zealand medical school researchers.

In an article published in The Medical Journal of Australia, the researchers say prior academic achievement is a better predictor of a student’s ability to complete their undergraduate medical training than either the admission tests that students sit to gain entry to med school – based on problem solving, reasoning and empathy – or the selection interview.

But an accompanying editorial in the journal says student selection needs to be about more than just academic achievement. The researchers were from New Zealand’s two medical schools – the University of Auckland and University of Otago – as well as the University of New South Wales, Monash University and University of Tasmania.

Dr Paul Garrud, Principal Research Fellow at the University of Nottingham in the UK, was responding to research lead by Associate Professor Boaz Shulruf (of the University of New South Wales and the University of Auckland) and colleagues, which analysed data from four consecutive cohorts of students (3378 students, enrolled 2007– 2010) in five undergraduate medical schools in Australia and New Zealand.

Predictor variables were student scores on selection tools: prior academic achievement, results from the Undergraduate Medicine and Health Sciences Admission Test (UMAT), and selection interview. (The UMAT test is a test used by 15 Australasian universities, including Otago and Auckland, that is designed to assess the general attributes and abilities of applicants to medical and dental schools including their critical thinking and problem solving, understanding people and abstract non-verbal reasoning.)

“The cut-scores for prior academic achievement had the greatest predictive value, with medium to very large effect sizes (0.44–1.22) at all five schools,” Shulruf and colleagues wrote. Aptitude testing and interview didn’t markedly improve discrimination between students who succeeded or failed.

The authors conclude that “there is no gold standard for selecting medical students. Schools must choose fairly the applicants they believe have the aptitude to meet the community’s healthcare needs.”

Dr Garrud suggests that while that method might be “beguiling” when there are many more applicants than available places, “it effectively implies that no criterion is necessary for entry to medical school other than evidence of previous academic excellence, as this predicts competence at graduation, and therefore future patient safety”.

He goes on to argue that this idea “conflates two distinct purposes of selection: establishing that a candidate is suitable, and distinguishing between competing suitable candidates”.

“Firstly, what are the necessary minimum thresholds for anyone wishing to become a doctor? Some candidates will be unsuitable because they lack the cognitive ability to acquire essential competencies (e.g., recognising pulmonary embolism, deciding about appropriate management). Assessing the candidates’ academic records and their cognitive aptitude is therefore required.

“An applicant might also be unsuitable because they lack essential behavioural attributes, perhaps to such a degree that the deficit is regarded as irremediable; for instance, serious or repeated criminal or antisocial behaviour, difficulty in perspective taking, black-and-white thinking, or lack of personal insight and reflection.

“Assessing both academic ability and personal qualities are accordingly essential,” he concludes.


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