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PRIOR academic achievement may be the most accurate predictor of timely medical school completion, according to new research, but experts argue that a broader approach to medical student selection is essential in shaping a medical workforce that meets Australia’s diverse health care needs.
Professor Richard Murray, President of Medical Deans Australia and New Zealand (MDANZ), said that the selection of medical students was an important public policy issue, as it was the first step in determining the people who would serve our priority health needs in the future.
“Medical schools have a monopoly on the production of doctors in Australia, and with that comes a social responsibility to produce the doctors that the community needs,” said Professor Murray, who is also Dean of the College of Medicine and Dentistry at James Cook University. “There is a set of characteristics that society might think are important for the doctors it wants in the future – things like diversity, background, humanistic qualities, openness to challenge, empathy – and they don’t get a guernsey in these [academic] tests.”
His comments came as researchers reported in the MJA that cut-scores for prior academic achievement (GPA or ATAR) had the greatest predictive value for both timely graduation and passing the final clinical skills assessment, with medium to large effect sizes (0.44–1.22) for all five undergraduate medical schools in Australia and New Zealand. Undergraduate Medicine and Health Sciences Admission Test (UMAT) scores and selection interviews had smaller effect sizes (0.00–0.60), the researchers reported.
The researchers evaluated data from 3378 students enrolled in the medical schools between 2007 and 2010. Outcome measures were timely graduation (no later than a year beyond minimum time) and results of final clinical skills assessment (pass or fail).
In an accompanying editorial, Associate Professor Paul Garrud, Assistant Director of Medical Education at the University of Nottingham in the UK, wrote that it was necessary to assess more than academic excellence when selecting medical students. Professor Garrud observed that, for instance, an applicant might be unsuitable for medical school if they lacked personal insight and reflection.
“Assessing both academic ability and personal qualities are accordingly essential,” he wrote.
Professor Murray said that the MJA findings were of interest in further illuminating the challenges involved in the selection of medical students, but “shouldn’t be used as a recipe” for medical student selection.
“We might be prepared to admit more students who take a little longer to complete their studies, or require some assistance to succeed if, in return, we produce graduates who are more attuned to the needs of society,” said Professor Murray, who noted that two-thirds of James Cook University’s 1400 medical graduates now worked in communities outside of capital cities.
He said that the research findings might help with early identification of students who may require more targeted pastoral care, cultural support or tutorial assistance.
Professor Murray pointed to the MDANZ policy on medical student selection, which stated that while scholastic performance was highly important, recruiting students to represent ethnic, socio-economic and geographical diversity was also crucial.
Agnes Dodds, Associate Professor in Medical Education at the University of Melbourne, said that the MJA research was a sophisticated analysis of pass-fail outcomes. She said that such tools may become more important as the shift towards ungraded assessment continued, but medical school failure rates remained extremely low.
“There is fairly good evidence now that people don’t fail because of academic shortcomings but more because of personal circumstances and health issues,” she said.
Professor Dodds said that a certain level of academic ability, and understanding of science, was essential to completing medical studies, but the existing ATAR/GPA requirements were often much higher than were needed to successfully complete the course.
“These are high-prestige courses and there is a pressure on places,” Professor Dodds said. “Schools are faced with a dilemma in selecting the students who have not only academic ability but also the personal attributes required in medicine. That’s why schools have moved to interviews, and particularly to multi-mini interviews, to look at attributes like communication skills and empathy.”
Professor Dodds agreed that it was also important that the medical student cohort reflected the gender, ethnicity and socio-economic balance of the community.
“Academic ability is probably the baseline, and then you can start looking at other aspects. You can’t choose people who you think are not going to be able to complete the course; although you can choose people whose test results or ATARs – which are not 100% related to ability anyway – are lower, if you have in place support mechanisms for these students.”
Australian Medical Students’ Association (AMSA) President Alex Farrell welcomed new research in the area, saying that the selection criteria used in medical schools should be evidence-based.
“In AMSA’s view, universities should use a broad range of evidence-based criteria so that it is possible to select a medical workforce that is reflective of Australia’s diverse population with its varied health needs,” Ms Farrell told MJA InSight.
She said that the focus on timely completion of medical school may not be relevant at a time when medical students were increasingly taking time out from their studies.
“More and more medical students aren’t graduating on time and there are whole range of reasons why. They may take time off to travel, work and earn money in between studying, or to do research. They may take a year off to look after their health or pursue hobbies, passions or leadership opportunities,” said Ms Farrell, who is herself taking a year off university to focus on her role as AMSA President.
“There are a range of reasons why students may not graduate on time, most of which don’t correlate with the quality of the doctor they will become at the end of their degree.”
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There seems to be a whole industry supported by hopeful medical students – GAMSAT, UMAT and the groups that offer preparatory courses. Interviews probably produce a more disingenuous student as students learn to game the system. Is this what we want to be fostering? Students arrive at medical school already burnt out given the hoops that they have had to jump through. IS it ethical what we are doing to our prospective students? The problem is that there are many more applicants than positions and it is competitive. Selection should be via a transparent and defensible process and academic attainment is the most defensible. It will not be long before we see a class action against universities for the unfair university entrance processes. Any process that is not black and white and has the possibility of nepotism or pushing someone’s agenda is potentially unfair and open to legal scrutiny.
The current rural advantage discriminates against city born and bred students ( a decision of their parents not the student) with very little if any evidence to support it. Students in the city must achieve at much higher levels than rural students. Regional large cities are counted as rural and it is difficult to see how opportunities are at all different in these centres. Now , due to the large numbers of students graduating it is unlikely that a rural workforce shortage will continue and there is pressure to control the entry of international medical graduates. There is a lot that is already unfair regarding medical entry- and a subjective component opens the floodgates. You only have to read student blogs to see the unrest, confusion and growing anger at the selection processes. Why not keep it simple and invest the money into better teaching.
Dear Anonymous March 13, 2018 at 9:46 am (a person trying to make name for themselves),
“This is usually put about by SJWs keen to ensure the representation of minority identity groups, but implicit in this is both that medicine for these groups is different, and also that it can only be appropriately supplied by members of the group (e.g. indigenous doctors for indigenous patients). This is akin to suggesting that one needs to have been depressed to be an effective psychiatrist. And it is no step at all, by the same logic, to asserting that white patients should see white doctors.
In effect this is but an outing in its Sunday-best for old style racism”
Well said. I too noticed the whiff of identity politics and liberal regressiveness in this article.
I sense the winds of affirmative action.
Why don’t we use validated psychological assessments? They are used by People and Culture divisions of major organisations. I would help us select for values (altruism, persistence, kindness, curiosity, love of learning, justice, fairness etc) and communication styles that are correlated with being a good doctor (and select out the less helpful ones). This may help maintain the kind of medical workforce we need and the results could be explained to applicants by a qualified person, to help them further their own understanding and foster emotional intelligence.
One of the more pernicious assertions in this discussion is that “universities should use a broad range of evidence-based criteria so that it is possible to select a medical workforce that is reflective of Australia’s diverse population with its varied health needs” and “recruiting students to represent ethnic, socio-economic and geographical diversity was also crucial”.
This is usually put about by SJWs keen to ensure the representation of minority identity groups, but implicit in this is both that medicine for these groups is different, and also that it can only be appropriately supplied by members of the group (e.g. indigenous doctors for indigenous patients). This is akin to suggesting that one needs to have been depressed to be an effective psychiatrist. And it is no step at all, by the same logic, to asserting that white patients should see white doctors.
In effect this is but an outing in its Sunday-best for old style racism. Insisting that recruitment mirror demography is, as noted by the second comment here, unfairly targeting doctors of Asian derivation, whose numbers in the medical workforce do not reflect their number in the population in general.
This discussion appears regularly probably related to a recent student suicide or dropout of medical school. I have already stated that I doubt I would have passed the UMAT. I have reservations that my lack maturity , lack of worldly experience apart from domestic abuse , alcoholism and post war psychological problems in the family some of which were unrecognised at the Time, would have enabled me to pass an interview process. My academic performance alone allowed me to pass, finish medicine and I hope lead a successful medical career.
If change in selection criteria is required why not do a trial- evidence based is the way we select – set up a selection process
1. old criteria ACADEMIC PERFORMANCE AT SCHOOL – no bloody UMAT ETC
2.reasonable academic performance with structure interview process
3. academic performance and if you must, gender, racial , social group characteristics
4.prior degree before medical acceptance
and look at the subsequent outcomes. I suspect will not make much difference
Steve sonneveld
Academic excellence is not an indicator of personality or suitability for clinical practice. Some students only blossom after graduation. The present curriculum @ our universities have changed too much & too rapidly. Using the UMAT as an indicator of fitness to become a medical student has lost some outstanding persona. My son,
has a third generation of medical practitioners has a son, who w2ould have been a brilliant addition to medical practice,failed the UMAT was in the top 3% in the VCE, graduated with honours in Science & was picked to do a PHd. @ Penn university. He had all the social attributes for a clinician as well as being academically proficient. He is lost to Australia & a gain for the USA. I can quote many such examples. Student selection must have a spectrum of qualities as no single attribute is good enough in selection
Perhaps there is not much wrong with medical students. Maybe there is much to be desired in their medical socialisation, or both.
“There is a set of characteristics that society might think are important for the doctors it wants in the future – things like diversity, background, humanistic qualities, openness to challenge, empathy – and they don’t get a guernsey in these [academic] tests.”
These personal qualities continue to be undervalued by the medical community during postgraduate training years also.
“ethnic diversity”. Diverse from what exactly?
New graduate doctors from “traditional” European ethnic backgrounds are already proportionately underrepresented compared with the Australian population. This is because selection is largely driven on academic merit which, as has been said, produces the most capable individual doctors. Does the author advocate discriminating against selection of students of, for example, Asian or subcontinent origins? Or does “diversity” only go in one direction?
It’s long overdue that medical schools in Australia should start to open their doors to any young Australian with a passion to be a doctor, as long as he or she has reached an ATAR that would qualify him or her for entry into any of Science, Engineering, Veterinary Science, Architecture or other science-based courses at the same academic institution. There is no way that interviews can accurately predict who will and who won’t make a good doctor, and so they should be abandoned as a monumental waste of time and as a totally unscientific culling process. As a doctor with a 52 year involvement with teaching hospitals, much of which was associated with the teaching of medical students, RMOs and Registrars, one soon learns that the best doctors were not necessarily the “brightest”.