Selecting tomorrow's doctors.

Abstract

Application to medical school is a competitive process. In 2009 there were 27,429 applications for approximately 8000 places in the UK, up 13.7 per cent on the previous year1. The cost of training a medical student is circa £200,000 but the cost of selecting the wrong applicant can be even greater2. Traditionally medical schools have relied on performance in knowledge-based examinations for selection and although these distinguish academically able applicants, it is often the failure to develop non-cognitive competencies such as motivation and/or empathy and ability to communicate that lead to problems for doctors in their professional lives. If we accept that we want our doctors to have the non-cognitive skills to relay information to us as patients and also to have the cognitive skills to consider management/prognosis with us then it follows that we should accept our applicants to medical schools on both their cognitive and non-cognitive abilities. There is now worldwide support for this approach both in the UK from the Medical Schools Council and the GMC and in the US from the Accreditation Council for Graduate Medical Education3. Widening participation so that medical students are representative of the population they serve has assumed importance politically. In 2008 the four lower socioeconomic classes accounted for only 15 per cent of medical students in the UK4. Some schools seek to actively redress this by selecting on aptitude rather than achievement, the latter being related to socioeconomic factors and type of school attended. Given the highly competitive nature of selection which can be secretive and varies between Universities, the Schwartz report into fair admission to Higher Education has recommended the following five principles and two guidelines: 1) the selection process should be both transparent and should be published and available online; 2) selection should consider both achievement and potential; 3) selection methods should be reliable, valid and informed by best practice; 4) the predictive validity of selection methods should be monitored; 5) staff should receive training in selection processes; 6) there should be feedback to unsuccessful candidates; 7) barriers to selection should be minimised e.g. disability considered post selection5. Given that attrition rates in medical school are low it can be argued the selection exercise is of even higher importance. Instruments used for selection include personal statements, academic references, tests of previous academic performance, aptitude tests, personality tests, random selection and interviews. Not surprisingly given the variety of instruments there is considerable controversy surrounding their most effective use.