1. Selecting students for medical school – a continuing challenge
Jon Cohen

2. Where do we start from?
“In reviewing entry criteria for medical schools
nationally & internationally, it became clear that
none has found a way of predicting which applicants
will do well in their subsequent career.”
“While there are many opinions & anecdotes, there
is a dearth of predictive evidence for the various
tools used in selection.”
Goulston & Oates. Admission policy review, University of Sydney Medical School, 2009

3. Nevertheless, there are “views”….
We are working with the Medical Schools Council and others to identify examples of good practice in selection of medical students, based on the best available evidence. If necessary we will commission further research. One area would be to consider predictors of performance and whether these might be used to inform student selection processes used by medical schools.
The state of medical education & practice in the UK. GMC, 2011
While we accept the need for intellectual ability, there is also a need to ensure
that the individuals selected also demonstrate an aptitude for the caring professions
and have values that underpin their choice of career.
LETBs should only commission from institutions that select students and trainees in
partnership with employers, ensuring wider participation through use of processes
such as value based recruitment based on the NHS constitution.
Education & Training (2): A report from the NHS Future Forum, 2011

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

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

6. What is it?
How is it defined?
Is there any SINGLE definition?
What end point should we use?
How much should we be driven by current fads
Should we be training GPs? Brain surgeons?
Is the NHS changing? Importance of team work. Will doctors be different in 10 yrs time?

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

8. We generally agree about what we are looking for
although we don’t agree how to get there
Admissions processes for five year medical courses at English schools: review
“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

9. 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

10. 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

11. What should we measure? 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?

12. F1 doctors failing = 159 (2.2%) F2 doctors failing = 228 (3.2%)
UKFPO Annual Report, 2010

13. The number of doctors in difficulty was 266 (4. 6%)
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

14. Of the 266 doctors in difficulty, > 80% were expected to be successfully signed off.
UKFPO Annual Report, 2010

15. 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

16. Widening participation – specific schemes

17. 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

19. 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

20. Different schools use different approaches
UCAS Application
(Academic only)
Interview
Decision
UCAS Application (Academic only)
UKCAT Score
1 School
2 Schools
UCAS application (Academic only)
BMAT
BMAT Score
Data provided courtesy of GMC, 2011

21. Are contextual data the answer?
What else could we do?
Are contextual data the answer?

22. Which contextual data will be provided?
EDUCATIONAL INFORMATION RELATED TO THE APPLICANT’S SCHOOL
the school’s performance at GCSE level
[percent obtaining five or more A* - C grades]
the school’s performance at A level
[ average “points” per A level entry and per A level student]
SOCIOECONOMIC DATA
percent of students receiving free school meals
percent receiving EMA
postcode [low progression to HE area]

23. What do we want from contextual data?
Research based, justifiable, adds value
Relevant to the purpose for which it is being used
Valid & reliable [Caution: re self-declared data]
Should improve inclusivity
Transparent to applicants, schools and family/advisors.

24. What can contextual data be used for?
For widening participation
by encouraging applications
identifying students who may need help with the
application process
to inform selection for interview
to inform selection after interview
To identify students who need may additional educational
support on-course
To identify students who may need additional financial
support

25. How might contextual data be used?
University of Oxford, 2011 entry
“When an applicant is predicted to achieve three A grades at
A level, and performs to an appropriate standard in any
required pre-interview admissions test, a candidate will be
strongly recommended for interview if the contextual
information for both prior education and socio-economic
circumstance is flagged”

26. 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

27. Alternative approaches to in-course selectionY1 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.

28. 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”