Selecting students for medical school Jon Cohen

Admission to medical school What are we trying to achieve? How do we achieve it?

Medical school admissions: key requirements To select the best candidates who will become outstanding doctors

The Ultimate Good Docto r Able to apply knowledge Technical competence Team worker Organised, conscientious Reliable Empathetic Communication skills Ethical, High integrity, professional Calm under pressure Good at decision making Life long learner Problem solver Conceptual thinker Adapted & simplified from Powis, Bore & Munro

We generally agree about what we are looking for although 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 :1005 Admissions processes for five year medical courses at English schools: review

Difficult question #1: How do we capture the diversity we need for medicine, 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” are referring 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 related to 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 UCAS Probably all of them suffer from risk of unintended bias Keen 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 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 the course for reasons of: reputation finance humankindness! That being the case, academic criteria are bound to be the best “predictors” of success, since success is usually measured as completing the course

Alternative approaches to in-course selection Y1 Current model: selection through the course based on academic failure and rarely, FtP Alternative model: expanded Y1 entry with major selection on academic & non-academic criteria at end Y1, thereafter mainly by FtP or 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”