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SUMMER is not only the time for going to the beach; it is also the time thousands of Australians try to slot into a university course.
For school leavers, university entry depends on the Australian Tertiary Admissions Rank (ATAR). As with other exams throughout school (eg, the National Assessment Program – Literacy and Numeracy, or NAPLAN), some hold the view that the ATAR has become too much of the focus for students, schools and families; instead of seeking a well rounded education, they seek a big ATAR. One journalist has referred to it as “worshipping at the altar of ATAR”.
Thousands of ATAR worshippers have a very concrete goal in mind: medical school.
Nowadays, a high ATAR no longer suffices to qualify for medical school. Undergraduate courses require an Undergraduate Medicine and Health Sciences Admission Test (UMAT) and the post-graduate courses set the Graduate Australian Medical Schools Admission Test (GAMSAT) as one of their prerequisites. Every year, over 10 000 Australians sit one or both of these exams, competing for about 3000 university places.
The merits of undergraduate versus post-graduate courses may be a topic for a future article, but effectively, the process for entry into either course mode is made up of the same three components:
- an academic qualification – ATAR for undergraduates, a degree for post-graduates;
- an entry exam – UMAT for undergraduates, GAMSAT for post-graduates; and
- an interview.
There are a few special entry programs, but the numbers are small (eg, the University of Sydney’s combined program).
Having had four boys pass through high school in the past decade and having hosted scores of medical students in Coonabarabran, the topic of medical school entry comes up all the time.
Let me illustrate …
Part 1 of a typical conversation with an ATAR worshipper:
Aniello: Have you thought about what you want to do after Year 12?
ATAR worshipper: Yes. I would like to do medicine.
Aniello: At which university?
ATAR worshipper: If I get a high ATAR, I hope to go to the University of New South Wales (UNSW). I have done the UMAT and hope they give me an interview.
Aniello: And if not?
ATAR worshipper: I will do medical science and sit the GAMSAT a few times until I get a good mark in that and keep applying for medicine until I get in.
That is the path hundreds, and perhaps thousands, undertake and many remain frustrated for years before entering a medical school or finally giving up and choosing another career.
Part 2 of Aniello’s conversation with an ATAR worshipper:
Aniello: Have you thought about going to Newcastle or Armidale instead of UNSW? The entry criteria are not as onerous.
ATAR worshipper: No. I want to go to the University of Sydney or UNSW.
Aniello: What’s wrong with the other programs?
ATAR worshipper: Not as prestigious.
Aniello: And why medical science? Say you don’t get into medicine, what work will medical science let you do?
ATAR worshipper: I will wait until I get into medicine. I will do a Master or PhD while I wait.
Aniello: Why don’t you do something related to medicine first, such as nursing or pharmacy or another allied health discipline. It will give you some practical knowledge that will serve you well in medicine.
At this point the ATAR worshipper has a drop in blood pressure, turns pale and thinks Aniello is an alien life form.
ATAR worshipper: Others have told me to do medical science. That’s what everyone else does.
End of conversation …
The large enrolment of medicine hopefuls in medical science degrees is because of the obvious benefits; they confer basic knowledge in various pre-clinical disciplines, expose students to academics in the medical disciplines and make the subsequent study of medicine easier.
Not studying science before entering medical school does make the medical degree tougher. The students I have known in this situation all admit that they have to work harder and longer to get to the same endpoint.
However, the medical science degrees do not necessarily teach other skills that come in handy during medical school (eg, time management, interpersonal skills, written and verbal expression). This is when those who have had lives in other industries often shine.
Therefore, medicine hopefuls should keep an open mind. Other clinical disciplines (eg, pharmacy, nursing, physiotherapy, veterinary studies) allow both a practical and an academic grounding that other paths to medical school may not. In my mind, it is an under-rated and underutilised path to medical school. It’s my tip for the worshippers.
Dr Aniello Iannuzzi, FACRRM, FRACGP, FARGP, FAICD, is a GP practising in Coonabarabran, NSW, and a clinical associate professor at the University of Sydney.
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Perhaps if salaries of doctors are inline with other professions such as lawyers, accountants and engineers there will be less demand for medical places. Smart candidates attend umat, gamsat and medical interview tuition classes. I remember years ago candidates had to sit for the gmat exams before being allowef to do an MBA. But when demand for MBA fell the gmat was abolished. Umat and gamsat nonsense were created by the Americans as the medical profession in the USA is highly paid. I totally agree that I would rather be treated by a competent rude doctor than an incompetent compassionate doctor.
I believe there is a lot of unfairness surrounding medical school entry. One aspect that concerns me is the advantage offered to students with ‘rural’ background. It seems unfair that students with rural background can achieve at significantly lower levels for UMAT and ATAR with very little evidence to show that these students return to rural practice. Students of rural background have privileged entry to most universities yet a city born and bred student (the decision of the parent not the candidate to be living in a major city) who has worked hard and achieved at higher levels and is genuinely interested in rural practice is not even shortlisted at James Cook University. The ‘rural background’ is also being rorted by people with rural property but who do not actually live rural. Also, students living in large regional centres are given rural advantage yet students don’t experience any educational disadvantage in these cities. Higher achieving city students seem to be now diverted into other health professional courses and then sit the GAMSAT along with the other 15,000 or so for relatively few domestic places.
It also seems like it is a lot easier for an international students to gain entry into the medical program in Australia than a domestic student – probably because they bring more money into the university. The international students then obtain their residency whilst studying here and end up applying for intern positions here. Is this the intention?
Also, the UMAT exam has special exam considerations so that some students receive significant amounts of extra time for the exam. In a time-sensitive exam can this be justified if used as a discriminator for medical school entry? There is a whole industry out there organising ‘disability’ considerations for students to afford them extra time in secondary school and UMAT yet there is no transparency of this. Is this actually fair and does it result in accurately ranking students based on academic proficiency?
Fairness and transparency is needed and justification as to why decisions favouring certain students and not others is needed.
I’m not a doctor, but have a child recently accepted to study medicine, having survived the gauntlet of the selection process. With flying colours, and hence a relatively easy path as it turns out. I’ve also had several other relatives of that generation, all on the path, but with different entry processes.
To my eye, most of the comments here relate to worthy candidates who may be missing out because of supply/demand constraints in the system. The reality of the situation is that for each of these candidates that missed out to be offered a place, another student would need to have missed out for their place to be available.
So, until we can absolutely define a set of selection criteria we can all agree on, that will provide a good indicator of success as a doctor in 10 years time, the process must be inherently flawed. There are no predictors in life for something so complex that can be perfect. Indeed, if we did have the “perfect” system, and it was later discovered to be wrong, how damaging would that be?
Going back to the article, seriously answer the question – what about a “second tier” programme? If you are doing it for the prestige of an institute name on the certificate, then your motives, to my eye are all wrong. When I talk to a doctor, I listen to what he is saying, not looking over his should to see where he got that degree. As the article goes on to say, a few months in a clinical environment soon levels all candidates.
In any role in life, there is ultimately a competitive aspect. All of us have to ask the question at some stage, is the reward worth the rigours of the competition? If not, there are other games in town.
We have all benefited from the increased academic rigour afforded by competitive entry to medicine. We have all heard the arguments that “I’m a good doctor, but I wouldn’t get in today.” My uncle said as much, and he may well be right. But until we can all agree on a universal set of valid entry criteria, that improve over time, then the current system is what we have to work with, and each individual must make their own path in that system.
Tough call for a poor 17 year old. You have my sympathy, but ultimately that won’t help. If you are clever enough to be playing in that game, there are many many exciting alternatives.
This is a system in need of immediate and serious overhaul. You now have 3 criteria which you have to fulfill in order to qualify to become a medical student. There is the objective criteria of an ATAR or WAM (depending on whether you are entering an undergraduate or post-graduate program), the somewhat objective criteria of a UMAT or GAMSET score, and then there is the completely subjective interview process whereby others sit in judgement of young people hoping to do medicine. The interview decisions are not justified to anyone, there is no feedback offers to the candidates on their performance, there is no process to appeal the decision, so these interviewers sit in a position where they ultimately decide whether someone can become a doctor or not. A recent experience of note is a candidate with an ATAR of 99.95, a UMAT of 95 who received interviews at several universities and did not receive a single offer. So clearly the objective criteria are worth significantly less than the completely subjective interview process, but no one knows because the universities remain very tight lipped about the process. This process needs to become more open, less subjective, and dare I say it, less open to manipulation, and nepotism. We now have a situation where candidates with lower ATARS / WAMS and lower UMAT and GAMSET are given positions over better performing candidates apparently because their interview was so much better. Really? Is this what we have come to in regards to studying medicine? A situation which is highly dubious at best, and completely unfair in regards to these high performing candidates. I would not mind if I noted the graduates were coming into the profession as far better communicators and far more empathic doctors, but this is not my experience as either a doctor with over 20years in the profession, or as a patient. We must do better than this, and it starts with making the universities openly accountable for the decisions they are making with their interview processes, and better yet, removing the subjective elements of the criteria. After all, how can anyone adequately assess someone’s aptitude for medicine by speaking with them for 8minutes, and how is this more important than performance in more objective assessments, and finally what right do these people have to sit in judgement and decide that this candidate would be a “good” doctor, but another candidate is somehow lacking?
Not sure what process is now but in 2005, daughter was interested in doing Medicine. At one Melbourne Uni (not Uni of Melb), they said they had a flawless selection system based on UMAT,interview & exam scores. UMAT tests empathy, logic, an emotional parameter & spatial orientation. Apparently the selection experts thought too much emphasis on marks & more weight should be afforded qualities to study & practise medicine which they thought they could assess & direct more appropriate people into Medicine. It was emphasised at a parents/teachers meeting how good they were, they could see through anyone with alterior motives at interview & that it was a waste of time studying up for both the interview & UMAT. My daughter got very high marks by which she could walk into any course in the country but apparently not this medical. Although she is the most well spatially orientated human being I know, she must have had a bad day in that UMAT section as she scored in the lower 10th percentile despite scoring in the 90th percentile for all the other parameters. Average came to 50% which disqualified her from an interview which in turn disqualified her from entry. How ridiculous to select an applicant purely on this basis. Much more objective, simpler, cheaper & fairer to go back to the exam score.
She would have made a great doctor but she’s a lawyer now.
As a graduate who entered Medical School directly from HSC, I have also supervised hundreds of junior doctors from various universities, both undergraduate and post-graduate. I worked with the first interns from the (then) new Newcastle school – which had a revoluntionary selective process and an innovative teaching process. Although some were perhaps more articulate as young interns, they soon became indistinguishable from the others.
When rubber hits the ground, the original medical school appears to make little different to a person’s performance. After a few months of internship,
Both medical schools and post-grad Colleges have revised and updated their selection, training and examination processes over the years, but without great changes in the capability of trainees. What appears to make the most difference is the amount of hands-on clinical exposure – doing rather than watching – which also depends on the motivation of the trainee.
Supporting Ian Hargreaves very relevant comments, graduating in Medicine allows you to follow many possible pathways. Not all require the high levels of emotional intelligence, empathic communication or analytical skills which now seem to be the Holy Grail for successful selection. Many more practical skills also are needed. Good communication/empathy is not going go help me if I am bleeding to death or my airway is obstructed–I need someone to urgently fix the problem. Howard Florey, our most famous graduate, was reputedly a poor communicator and probably would not pass the selection interview today.
Given that a medical degree is also the entry into specialties such as anatomical pathology or surgery, the attributes that lead to high abilities in these fields are not tested in the selection process. The histopathologist needs to stare down a microscope and make life or death decisions based on the appearance of one or 2 individual cells per high power field, so visual and spatial processing is far more important than eloquence of communication. Bluntly telling me I have cancer is better than erroneously but empathetically reassuring me that it is benign.
Similarly, the surgeon requires manual dexterity, which is neither taught nor assessed in a course such as medical science. I would much rather have my surgeon gruffly tell me “we got the cancer out – go home tomorrow” than enter into a caring sharing interpersonal relational communication about why the surgeon did not quite get all the tumour, while obtaining my kindly informed consent to go into an elegantly designed groundbreaking scientific prospective RCT of palliative chemotherapy.
Reading Roger Burgess’ comment above I got halfway through and thought how well suited his son sounded for surgery, but alas, practical/commonsense/good with hands are no longer considered desirable attributes.
The other elephant in the room, of course, is that selection of older, more caring, empathetic, communicative souls correlates with a rise in junior doctor suicides. Does this selection process actually preferentially select the vulnerable?
I would agree with Randal Williams comments. I looked at the UMAT with my children and am sure I would fail. Does this make me any less effective as a doctor ? I doubt it. Medicine as a would be preferable as a postgrad. course and probably after a non science degree initially. I would equally concede That at high matriculation result alone should not qualify you for medicine. I doubt at the ripe age of 17-18 I would have carried out a good interview either due to lack of worldly experience. Maybe a degree of “?maturity” after an initial non medical degree would have improved this as well.
The whole entry process into medicine has become over complicated, convoluted , excessively onerous and too dependent on unreliable indicators such as UMAT, GAMSAT and Interview. None of these existed when I was accepted into medicine in 1964 purely on the basis of my matriculation results. I have had a long , satisfying and ( hopefully) useful career as a surgeon but honestly don’t think I would have got in on today’s criteria. Many who potentially could become great doctors are excluded by inability to pass UMAT/GAMSAT which are ridiculously difficult, many of the answers requiring life experience and wisdom . Courses have sprung up to teach how to pass the UMAT/GAMSAT and interview, negating the whole concept and intention. The whole process needs to be reviewed and made fairer. I am in favour of medicine being a postgrad course, as it is in most other countries, with entry based on GPA and (perhaps) an interview.
My son graduated in a Bachelor of Biomedical Science degree on his 20th birthday and has since completed courses in venepuncture and a diploma in Nutrition. He had passed the GAMSAT at his first attempt but his mark in the sixties was not enough to rate an interview. Disillusioned, he decided to become a paramedic and has since earned an order of merit during his Paramedic university course (nothing less than a distinction in all subjects) and this is embedded in his academic record. Unlike me, he is a very practical and commonsense person and is very good with his hands, He has knocked around in various jobs and is fully tuned into the darker side of human existence. He is now immersed in the practical side of his course and is loving all the action and drama. He is no shrinking violet, after all, he was born and grew up on the Gold Coast. I get the impression that he delights in the interaction with junior doctors in A &E and cannot see the point in flogging himself in a medical course.
My brother is also a doctor (orthopod) and we have been mentors since the boy left school. Thus he has never had any illusions about the profession. This is never factored in when a candidate is being assessed for his chance of coping with a medical career. Alas, I think that ship has sailed. We both graduated from Sydney University but they declined to grant my son an interview…most likely scared of nepotism!
There is no doubt that ” prestigious” universities are thought to somehow help young graduates. I suspect this is not nearly as important as it was 40 years ago when I was an undergraduate. There is also the possibility that the other, newer medical courses provide as good, if not better, teaching.