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Science as superstition: Selecting medical students

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... [5][6][7][8] The debate still continues about the time and content of the selection process, and the impact of gender on success. 5,9 Some believe that an entry selection process before admission, based on the basic sciences, is the best solution. Others are in favour of a selection process that takes place after a year, or more of study and that is based on the subjects taught to students. ...
... 5 Also, women are reported to be more efficient regarding non-cognitive skills (empathy and communication), which can be predictive of success at medical school. 9 The selection process could further emphasise the adaptive advantage that female students have. 5 This theory, however, remains controversial, as many studies have shown no significant differences in the adaptation to university between male and female students. ...
... The subsequent, frequently recurring, and continuing debate indicates that little progress has been made in establishing an optimal method for medical student selection. The literature continually fosters the impression that medical schools are still selecting some unsuitable students (Campbell et al. 1974;Lockhart 1981;Lancet [Editorial] 1984;Best 1989;Barr 2010). ...
... Contemporary commentators have continued to ask the question: Is this the right way? (Hughes 2002;Powis 2003Powis , 2008James et al. 2010;Mercer & Puddey 2011;Wilson et al. 2012;Eskander et al. 2013;Leinster 2013). Barr (2010), writing in The Lancet, ''found no scientific evidence that supported the power of performance in undergraduate science courses as a way to predict clinical or professional quality as a physician'' and ''found . . . consistent evidence that performance in the premedical sciences is inversely associated with many of the personal, non-cognitive qualities so central to the art of medicine''. ...
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Abstract Despite the abundant supply of academically outstanding applicants to medical schools in most countries the regularly recurring debate in the academic literature, and indeed sometimes in the popular media, implies that admissions committees are still getting it wrong in a significant number of instances. How can this be so when our procedures are directed unashamedly at selecting the most highly academically and intellectually qualified students in the expectation that they will make the best doctors? Perhaps it is time for a radical change in emphasis. Instead of endeavouring to differentiate among the top ranks of a pool of outstandingly qualified applicants, the selection effort might be better focused on identifying those potentially unsuitable in terms of their non-academic personal qualities to ensure they do not gain entry. The account that follows is an analysis of the problems of medical student selection and offers a potential solution - a solution that was first suggested in the medical literature 70 years ago, but not adopted. It is the present author's contention that the cycle of debate will continue to recur unless such an approach is pursued.
... In particular, conceptions of academic performance now include how well students navigate interpersonal encounters (Oswald, Schmitt, Kim, Ramsay, & Gillespie, 2004; Schmitt et al., 2009). Even medical schools, which teach content that is very technical, are increasingly acknowledging that interpersonal skills and personal characteristics (also known as soft skills or 21st century skills) represent core dimensions of academic performance (Barr, 2010; Kaplan et al., 2012; Lievens, 2013; Lievens & Sackett, 2012; Powis, 2010). This shift in the conceptualization of academic performance has been shown in past research. ...
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Accumulating evidence suggests that effective communication and interpersonal sensitivity during interactions between doctors and patients impact therapeutic outcomes. There is an important need to identify predictors of these behaviors, because traditional tests used in medical admissions offer limited predictions of "bedside manners" in medical practice. This study examined whether emotional intelligence would predict the performance of 367 medical students in medical school courses on communication and interpersonal sensitivity. One of the dimensions of emotional intelligence, the ability to regulate emotions, predicted performance in courses on communication and interpersonal sensitivity over the next 3 years of medical school, over and above cognitive ability and conscientiousness. Emotional intelligence did not predict performance on courses on medical subject domains. The results suggest that medical schools may better predict who will communicate effectively and show interpersonal sensitivity if they include measures of emotional intelligence in their admission systems. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
... Medical professionals, including doctors, are expected to understand how patients and their families feel, to show sympathy, to communicate in an appropriate matter, to establish rapport, and to gain trust, as well as using professional knowledge and skills. 1 It is said to be essential not only to evaluate the applicants' intellectual knowledge in terms of an examination but also to assess personal qualities on which a good doctor-patient relationship will be established, at the time of the selection of students. 2 A number of medical schools have used applicants' essays and individual or group interviews as a measure to assess personal qualities. ...
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Background: The Personal Qualities Assessment (PQA), developed by the University of Newcastle, Australia to assess the aptitude of future medical professionals, has been used in Western countries. Purposes: The objective was to investigate whether the PQA is appropriate for Japanese medical school applicants. Methods: Two of the PQA tests, Libertarian-Dual-Communitarian moral orientations (Mojac) and Narcissism, Aloofness, Confidence, and Empathy (NACE), were translated into Japanese, and administered at the Tokyo Women's Medical University entrance examinations from 2007 to 2009. Results: The distributions of the applicants' Mojac and NACE scores were close to the normal distribution, and the mean scores did not exhibit a large difference from those in Western countries. The only significant difference was that the mean score of the NACE test was slightly lower than the Western norm. Conclusions: The translated PQA tests may be appropriate for use with Japanese applicants, though further research considering cultural differences is required.
... High academic scores are insufficient for being a good physician [12]. Therefore, a more holistic approach to selectiontaking into consideration non-cognitive attributesneeds to be developed and applied [13]. Medical schools are increasingly including non-cognitive attributes (NCA's) in addition to cognitive ability in the admission process [11,[14][15][16]. ...
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Recent data have called into question the reliability and predictive validity of standard admission procedures to medical schools. Eliciting non-cognitive attributes of medical school applicants using qualitative tools and methods has thus become a major challenge. 299 applicants aged 18–25 formed the research group. A set of six research tools was developed in addition to the two existing ones. These included: a portfolio task, an intuitive task, a cognitive task, a personal task, an open self-efficacy questionnaire and field-notes. The criteria-based methodology design used constant comparative analysis and grounded theory techniques to produce a personal attributes profile per participant, scored on a 5-point scale holistic rubric. Qualitative validity of data gathering was checked by comparing the profiles elicited from the existing interview against the profiles elicited from the other tools, and by comparing two profiles of each of the applicants who handed in two portfolio tasks. Qualitative validity of data analysis was checked by comparing researcher results with those of an external rater (n =10). Differences between aggregated profile groups were checked by the Npar Wilcoxon Signed Ranks Test and by Spearman Rank Order Correlation Test. All subjects gave written informed consent to their participation. Privacy was protected by using code numbers. A concept map of 12 personal attributes emerged, the core constructs of which were motivation, sociability and cognition. A personal profile was elicited. Inter-rater agreement was 83.3%. Differences between groups by aggregated profiles were found significant (p < .05, p < .01, p < .001). A random sample of sixth year students (n = 12) underwent the same admission procedure as the research group. Rank order was different; and arrogance was a new construct elicited in the sixth year group. This study suggests a broadening of the methodology for selecting medical school applicants. This methodology differentiates between both individuals and groups, providing a personal attribute profile of applicants, useful for admission procedures. The qualitative procedures are cost-effective, can easily be taught and used by faculty members. The predictive validity of the presented model requires a longitudinal trial.
... two independent tests or sets of tests -the one for ability, the other for character'' (Smyth 1946). Though most medical students do graduate and become professional and capable doctors, the subsequent and continuing debate creates the impression that medical schools are still selecting unsuitable students (Campbell 1974;Lockhart 1981;Lancet editorial 1984;Best 1989;Barr 2010), ''who, though able to pass examinations, have not the necessary aptitude, character or staying power for a medical career'' (Goodenough Committee 1944). ...
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Background: Over the past 70 years, there has been a recurring debate in the literature and in the popular press about how best to select medical students. This implies that we are still not getting it right: either some students are unsuited to medicine or the graduating doctors are considered unsatisfactory, or both. Aim: To determine whether particular variables at the point of selection might distinguish those more likely to become satisfactory professional doctors, by following a complete intake cohort of students throughout medical school and analysing all the data used for the students' selection, their performance on a range of other potential selection tests, academic and clinical assessments throughout their studies, and records of professional behaviour covering the entire five years of the course. Methods: A longitudinal database captured the following anonymised information for every student (n = 146) admitted in 2007 to the Hull York Medical School (HYMS) in the UK: demographic data (age, sex, citizenship); performance in each component of the selection procedure; performance in some other possible selection instruments (cognitive and non-cognitive psychometric tests); professional behaviour in tutorials and in other clinical settings; academic performance, clinical and communication skills at summative assessments throughout; professional behaviour lapses monitored routinely as part of the fitness-to-practise procedures. Correlations were sought between predictor variables and criterion variables chosen to demonstrate the full range of course outcomes from failure to complete the course to graduation with honours, and to reveal clinical and professional strengths and weaknesses. Results: Student demography was found to be an important predictor of outcomes, with females, younger students and British citizens performing better overall. The selection variable "HYMS academic score", based on prior academic performance, was a significant predictor of components of Year 4 written and Year 5 clinical examinations. Some cognitive subtest scores from the UK Clinical Aptitude Test (UKCAT) and the UKCAT total score were also significant predictors of the same components, and a unique predictor of the Year 5 written examination. A number of the non-cognitive tests were significant independent predictors of Years 4 and 5 clinical performance, and of lapses in professional behaviour. First- and second-year tutor ratings were significant predictors of all outcomes, both desirable and undesirable. Performance in Years 1 and 2 written exams did not predict performance in Year 4 but did generally predict Year 5 written and clinical performance. Conclusions: Measures of a range of relevant selection attributes and personal qualities can predict intermediate and end of course achievements in academic, clinical and professional behaviour domains. In this study HYMS academic score, some UKCAT subtest scores and the total UKCAT score, and some non-cognitive tests completed at the outset of studies, together predicted outcomes most comprehensively. Tutor evaluation of students early in the course also identified the more and less successful students in the three domains of academic, clinical and professional performance. These results may be helpful in informing the future development of selection tools.
... Die Kritik bedeutet nicht, dass kognitive Kriterien aus der Studierendenauswahl zu verbannen sind, vielmehr sollten neben diesen Kriterien einbezogen werden, die eine größere sozioökonomische Vielfalt unter den Ausgewählten und eine Vorhersage für die klinischen Abschnitte des Studiums zulassen (Bore, Munro & Powis, 2009;Humphreys, 1960;Lievens et al., 2009a). Die kognitiven Fähigkeiten stellen eine Schwelle zum Medizinstudium dar, die genommen werden muss, aber die nicht alles sind, was einen guten Arzt ausmacht (Barr, 2010). Um eine hinreichende Passung zwischen dem Bewerber und dem Studiengangprofil zu gewährleisten, sollte demnach die Studierendenauswahl adaptiert werden (Wenzel, 2008;Wissenschaftsrat, 2004 ...
Article
Der Wunsch nicht-kognitive Faktoren in Selektionsprozessen für Studierende zu berücksichtigen, besteht bei den medizinischen Fakultäten und der Öffentlichkeit bereits seit den 1970er Jahren. Auch heute liegt die Herausforderung noch immer darin, reliable und valide Verfahren zur Erhebung nicht-kognitiver Kriterien zu entwickeln und zu erforschen. Für eine adäquate Patientenversorgung und -sicherheit nehmen in der Medizin insbesondere soziale Kompetenzen einen hohen Stellenwert ein. Ziel dieser Arbeit ist es daher, einen reliablen und validen videobasierten SJT zur Erfassung von sozialen Kompetenzen für die medizinische Studierendenauswahl zu entwickeln. Während der erste Teil der Arbeit die Testentwicklung erläutert, beschreibt der zweite Teil die Validierung anhand zweier Bewerber- und einer Studierendenstichprobe (N=769, N=163, N=90). In diesen wurden unter anderem die Akzeptanz der Teilnehmer und der Zusammenhang mit kognitiven Kriterien (fluide Intelligenz, Abiturnotendurchschnitt, Test für Medizinische Studiengänge), sozialen Kriterien, Persönlichkeitsfaktoren und Studienleistungen untersucht. Der SJT wurde von den Teilnehmern akzeptiert und als nützlich erlebt. Er zeigte keine Zusammenhänge mit kognitiven Verfahren. Es konnten vereinzelte Zusammenhänge mit Skalen und Kriterien sozialer Kompetenzen (Offensivität, soziale Orientierung, Kontaktfähigkeit, soziale Eingebundenheit, erlebte soziale Unterstützung) und Persönlichkeitsskalen (Extraversion) nachgewiesen werden. Auch lagen tendenziell höhere Zusammenhänge mit klinischen Studienleistungen vor, deren Schwerpunkt auf sozial kompetentem Verhalten lag, als mit vorklinischen Leistungen. Die Abgrenzung des SJTs zu kognitiven Kriterien gelang insgesamt konsistenter als der Nachweis der konvergenten Validität. Weitere Studien zur Untersuchung der konvergenten und prädiktiven Validität sind geplant. Derzeit steht der SJT allen Studienplatzbewerber und -interessenten als freiwilliges Online-Self-Assessment auf der Homepage der Medizinischen Fakultät Heidelberg unter dem Namen „Selbsteinschätzungstest für soziale Kompetenzen“ zur Verfügung.
... High academic achievement has often excused poor social skills. While central to medical admissions and recruitment processes, it captures knowledge acquisition but is an unreliable indicator of social communication skills [30,31]. In training, with attitudes more difficult to assess, programs have often relied on quantitative assessment tools focusing on knowledge and memory. ...
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Some highly challenging, seemingly “unsolvable” situations that arise in medical education could be the result of autistic traits (AT) in learners. AT exist in physicians and learners, ranging from profiles compatible with DSM-5’s criteria for autism spectrum disorder (ASD) to more subtle manifestations of ASD’s “broader phenotype.” Often associated with strengths and talents, AT may nonetheless pose significant challenges for learning, teaching, and practising medicine. Since AT remain widely under-recognized and misunderstood by educators, clinicians, and affected individuals alike, they represent a blind spot in medical education. The use of a “neurodiversity lens” to examine challenging situations may help educators consider different pedagogical approaches to address those potentially stemming from AT. This paper aims to raise awareness and understanding of AT-related difficulties in struggling medical learners. To overcome the blind spot challenge and help develop this “neurodiversity lens,” we explore different angles. Beyond any diagnostic consideration, we offer a series of contextual examples, paralleled with explanatory concepts from the field of ASD. We also underline the role of context on functional impact and describe the often ill-defined pattern of challenges encountered, as well as the fertile grounds for interpersonal misunderstandings and disrespect. We propose historical, cultural, and clinical reasons likely contributing to the blind spot. Mindful of the potential risks of prejudice associated with identifying AT-related difficulties, we underline the necessity and feasibility of conciliating diversity and dignity with accountability standards for medical competence.
... To be a good doctor requires certain personal qualities in addition to academic ability. That is why it has now been widely accepted that admission to medical schools should not be based on academic standards alone (Reede 1999;Barr 2010). In many prestigious universities, a student's scientific capabilities and meta-cognitive characteristics are evaluated side by side (Marley & Carman 1999;Lumsden et al. 2005;Roding 2005;Parry et al. 2006). ...
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Background: Tehran University of Medical Sciences has two streams of medical student admission: an established high school entry (HSE) route and an experimental graduate entry (GE) route. Aim: To compare the cognitive skills, personality traits and moral characteristics of HSE and GE students admitted to this university. Methods: The personal qualities assessment tool (PQA; www.pqa.net.au ) was translated from English to Persian and then back-translated. Afterwards 35 individuals from the GE and 109 individuals from the 2007 to 2008 HSE completed the test. The results were compared by t-test and Chi-square. Results: The HSE students showed significantly higher ability in the cognitive skills tests (p < 0.001). They were also more libertarian (p = 0.022), but had lower ability to confront stress and unpleasant events (p < 0.001), and had lower self-awareness and self-control (p < 0.001). Conclusion: On the basis of their personal qualities, the GE students had more self-control and strength when coping with stress than the HSE students, but the latter had superior cognitive abilities. Hence it may be useful to include cognitive tests in GE students' entry exam and include tests of personal qualities to exclude those with unsuitable characteristics.
... It has been argued, and generally agreed that becoming a good doctor requires more than knowledge-based academic achievement alone (Barr, 2010) and identifying the desirable personal qualities of future doctors has become an important concern for medical student selection (Powis, 2010). Nevertheless, these desirable qualities of the 'ideal' doctor have been difficult to define and the existing literature lacks a general consensus on these (Albanese et al., 2003). ...
Article
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Background: There is a lack of consensus regarding the qualities possessed by the ideal doctor, and very limited research regarding the views of medical students on these qualities. Aims: To investigate the views of commencing medical students regarding the desirable qualities of doctors. Methods: A survey containing a set of proposed desirable qualities of doctors identified from the existing literature was completed by 158 first-year medical students. Results: The survey had a 75% response rate. Students rated the individual qualities of empathy, motivation to be a doctor, good verbal communication, ethically sound, integrity and honesty as the most important. A factor analysis identified six categories of qualities: methodical processing, cognitive capacity, people skills, generic work ethic, role certainty and warmth. Significant differences in factor scores were found across subgroups of students (international and domestic students, with and without prior tertiary studies) on the following factors: methodical processing, which was scored highest by domestic students with prior tertiary studies, cognitive capacity, which was scored highest by domestic students without prior tertiary studies and generic work ethic, which was scored highest by international students. Conclusions: Medical students identified a range of desirable personal qualities of a doctor which varied according to student characteristics, including their prior educational experience. Future research aiming to define such desirable qualities should include a broader range of stakeholders, including students at different training levels and institutions.
... [1][2][3][4][5][6] Therefore, a 'more holistic and sophisticated approach to selection -based on predictors of care that are both valid and patient-relevant -needs to be developed and applied'. 7 Over the years, a variety of approaches for measuring soft skills (e.g. interviews) have been proposed and examined. ...
Article
Context: Today's formal medical school admission systems often include only cognitively oriented tests, although most medical school curricula emphasise both cognitive and non-cognitive factors. Situational judgement tests (SJTs) may represent an innovative approach to the formal measurement of interpersonal skills in large groups of candidates in medical school admission processes. This study examined the validity of interpersonal video-based SJTs in relation to a variety of outcome measures. Methods: This study used a longitudinal and multiple-cohort design to examine anonymised medical school admissions and medical education data. It focused on data for the Flemish medical school admission examination between 1999 and 2002. Participants were 5444 candidates taking the medical school admission examination. Outcome measures were first-year grade point average (GPA), GPA in interpersonal communication courses, GPA in non-interpersonal courses, Bachelor's degree GPA, Master's degree GPA and final-year GPA (after 7 years). For students pursuing careers in general practice, additional outcome measures (9 years after sitting examinations) included supervisor ratings and the results of an interpersonal objective structured clinical examination (OSCE), a general practice knowledge test and a case-based interview. Results: Interpersonal skills assessment carried out using SJTs had significant added value over cognitive tests for predicting interpersonal GPA throughout the curriculum, doctor performance, and performance on an OSCE and in a case-based interview. For the other outcomes, cognitive tests emerged as the better predictors. Females significantly outperformed males on the SJT (d = -0.26). The interpersonal SJT was perceived as significantly more job-related than the cognitive tests (d = 0.55). Conclusions: Video-based SJTs as measures of procedural knowledge about interpersonal behaviour show promise as complements to cognitive examination components. The interpersonal skills training received during medical education does not negate the selection of students on the basis of interpersonal skills. Future research is needed to examine the use of SJTs in other cultures and student populations.
... In particular, conceptions of academic performance now include how well students navigate interpersonal encounters (Oswald, Schmitt, Kim, Ramsay, & Gillespie, 2004; Schmitt et al., 2009). Even medical schools, which teach content that is very technical, are increasingly acknowledging that interpersonal skills and personal characteristics (also known as soft skills or 21 st century skills) represent core dimensions of academic performance (Barr, 2010; Kaplan et al., 2012; Lievens, 2013; Lievens & Sackett, 2012; Powis, 2010). This shift in the conceptualization of academic performance has been shown in past research. ...
... In the absence of consensus, and reluctant to challenge the status quo, admissions committees take the conservative and traditional approach, basing their high-stakes decisions primarily on an applicant's cognitive abilities, identified by a combination of undergraduate grade point average (GPA), science GPA, and Medical College Admissions Test (MCAT) score, and perhaps to some extent on their own intuition or gut feeling of the applicant's potential. 1 This approach has been proven to no longer be effective. Every year, students with traditionally attractive admissions ''numbers'' leave medical education programs across the United States for a variety of reasons, including, but not limited to, academic underperformance, illness, family problems, or simply making a wrong career choice. 2 A recent meta-analysis found the average attrition rate from medical school to be 11.1% (range, 2.4%-26.2%). ...
Article
Attrition from medical school remains a serious cause of concern for the medical education community. Thus, there is a need to improve our ability to select only those candidates who will succeed at medical school from many highly qualified and motivated applicants. This can be achieved, in part, by reducing the reliance on cognitive factors and increasing the use of noncognitive character traits in high-stakes admissions decisions. Herein we describe an analytic rubric that combines research-derived predictors of medical school success to generate a composite score for use in admissions decisions. The analytic rubric as described herein represents a significant step toward evidenced-based admissions that will facilitate a more consistent and transparent qualitative evaluation of medical school applicants beyond their grades and Medical College Admissions Test scores and contribute to a redesigned and improved admissions process. © 2017, American Podiatric Medical Association. All rights reserved.
... These non-academic skills can be taught and it may be appropriate to consider identifying preexisting attributes in students applying to medical school. 22,23 If individual clinicians are equipped and enabled to drive the fundamental changes within the healthcare system, they can become agents of social change, practising with confidence in an advocacy role. Addressing health and lifestyle issues (nutrition, activity and sleep) saves many future health dollars, but is difficult without training or experience. ...
Article
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Medical education fails to prepare young doctors for the nature of the work they will encounter. Doctors face a rapidly changing medical landscape, which relies more and more upon interprofessional collaboration to optimise patient outcomes and upon non-clinical skills to provide care efficiently and cost effectively. The current response to change is a reactive and resource-intensive effort, where established doctors are directed towards new ways of working. A better response would be interprofessional clinical and non-clinical training, incorporating a philosophy and style that accommodate innovation, communication and change. This preparative training should be overseen by a single educational enterprise that links undergraduate and postgraduate instruction. Improved training might enable better design of the healthcare system from within.
... Apart from academic achievement, non-academic criteria have also been increasingly recognized as important desirable attributes among the applicants seeking a career in medicine and thus emphasized in selection of medical students. [1][2][3][4][5][6][7][8] Likewise, widening access (WA) measures, that promote equity by addressing the disadvantages faced by applicants from rural and lower socio-economic background to enter medical career, is also being stressed in selection process. [9][10][11] When coupled with the scholarship schemes, such selection process is likely to augment deployment and retention of graduates in rural areas. ...
Article
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p> Background: Patan Academy of Health Sciences (PAHS) aims to produce physicians who would be able and willing to serve in the rural areas. Recognizing the critical importance of student selection strategy, among others, in achieving the program goals, it has adopted an innovative scheme for selecting medical students. This paper describes PAHS medical student selection scheme that favors enrollment of deserving applicants from rural and disadvantaged groups so as to help improve distribution of physicians in rural Nepal. Methods: A student admission committee comprising a group of medical educators finalized a three-step student selection scheme linked with scholarships after reviewing relevant literatures and consultative meetings with experts within and outside Nepal. The committee did local validation of Personal Quality Assessment (PQA) that tested cognitive ability and personality traits, Admission OSPE (Objective Structured Performance Examination) that assessed non-cognitive attributes of applicants. It also provided preferential credits to applicants’ socio-economic characteristics to favor the enrollment of deserving applicants from rural and disadvantaged groups through Social Inclusion Matrix (SIM). Three different categories of scholarship schemes namely Partial, Collaborative and Full were devised with Partial providing 50% and other two categories each providing 100% coverage of tuition fee. Results: PAHS student selection scheme succeeded in enrolling more than half of its students from rural areas of Nepal, including about 10% of the students from that of the most backward region of the country. About one third of students were female and about the same were from public and community school. Sixty percent of students receive different categories of scholarships. Conclusions: Limited findings indicate the success of the selection scheme in enrolling high proportion of applicants from rural and disadvantageous groups and enable them to pursue study by providing scholarships.</p
... Most notably, medical schools in the UK make extensive use of portfolios and referee reports, although these methods have been subject to criticism for the potential for impression management, and their limited ability to predict future performance. 6,9,13 In addition, students from low socioeconomic backgrounds often lack the life experiences required to produce high-quality portfolios. ...
... Apart from academic achievement, non-academic criteria have also been increasingly recognized as important desirable attributes among the applicants seeking a career in medicine and thus emphasized in selection of medical students. [1][2][3][4][5][6][7][8] Likewise, widening access (WA) measures, that promote equity by addressing the disadvantages faced by applicants from rural and lower socio-economic background to enter medical career, is also being stressed in selection process. [9][10][11] When coupled with the scholarship schemes, such selection process is likely to augment deployment and retention of graduates in rural areas. ...
Article
Full-text available
Background: Patan Academy of Health Sciences (PAHS) aims to produce physicians who would be able and willing to serve in the rural areas. Recognizing the critical importance of student selection strategy, among others, in achieving the program goals, it has adopted an innovative scheme for selecting medical students. This paper describes PAHS medical student selection scheme that favors enrollment of deserving applicants from rural and disadvantaged groups so as to help improve distribution of physicians in rural Nepal. Methods: A student admission committee comprising a group of medical educators finalized a three-step student selection scheme linked with scholarships after reviewing relevant literatures and consultative meetings with experts within and outside Nepal. The committee did local validation of Personal Quality Assessment (PQA) that tested cognitive ability and personality traits, Admission OSPE (Objective Structured Performance Examination) that assessed non-cognitive attributes of applicants. It also provided preferential credits to applicants' socio-economic characteristics to favor the enrollment of deserving applicants from rural and disadvantaged groups through Social Inclusion Matrix (SIM). Three different categories of scholarship schemes namely Partial, Collaborative and Full were devised with Partial providing 50% and other two categories each providing 100% coverage of tuition fee. Results: PAHS student selection scheme succeeded in enrolling more than half of its students from rural areas of Nepal, including about 10% of the students from that of the most backward region of the country. About one third of students were female and about the same were from public and community school. Sixty percent of students receive different categories of scholarships. Conclusions: Limited findings indicate the success of the selection scheme in enrolling high proportion of applicants from rural and disadvantageous groups and enable them to pursue study by providing scholarships.
... Dealing irst with the health-care worker, the selection of these individuals to undertake their chosen vocation is invariably done by consideration of various personal atributes, in the case of medicine academic achievement and individual performance in tests [69][70][71][72][73]. This process and subsequent education takes no account of the fact that as soon as these people graduate, they will be working in a team environment. ...
... Accordingly, this study lends evidence for the inclusion of SJTs in formal school testing systems when decision makers have made a strategic choice of emphasizing an interpersonal skills orientation in their programs. Presently, one commonly attempts to assess (inter)personal attributes through mechanisms such as interviews or letters of recommendation or personal statements , whereas the formal system focuses only on academic achievement in science domains and specific cognitive abilities (Barr, 2010). Hereby it should be clear that measures such as SJTs are not designed to replace traditional cognitive predictors. ...
Article
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This study provides conceptual and empirical arguments why an assessment of applicants' procedural knowledge about interpersonal behavior via a video-based situational judgment test might be valid for academic and postacademic success criteria. Four cohorts of medical students (N = 723) were followed from admission to employment. Procedural knowledge about interpersonal behavior at the time of admission was valid for both internship performance (7 years later) and job performance (9 years later) and showed incremental validity over cognitive factors. Mediation analyses supported the conceptual link between procedural knowledge about interpersonal behavior, translating that knowledge into actual interpersonal behavior in internships, and showing that behavior on the job. Implications for theory and practice are discussed.
... Although the objectives of curricula acknowledged the impor tance of interpersonal skills, most formal medical school admis sions tended to primarily assess academic achievement in science domains and cognitive abilities. Therefore, an editorial in the leading medical journal Lancet suggested that, "a more holistic and sophisticated approach to selection -based on predictors of care that are both valid and patient-relevantneeds to be developed and applied" (Barr, 2010). Our project showed that SJTs (in their various formats) implement part of such an approach. ...
Article
This paper discusses how and why the field of personnel selection has made a long-lasting mark in work and organizational psychology. We start by outlining the importance and relevance of the well-established analytical framework (criterion-related validity, incremental validity, utility) for examining the impact of selection at the individual (job performance) level. We also document the substantive criterion-related validities of most common selection procedures on the basis of cumulative meta-analytic research. Next, we review more recent research that investigated the impact of selection at the more macro organizational (firm performance) level. We show that the positive relationship between selection and performance at the individual-level translates to the organizational-level. Finally, we draw upon a longstanding project on situational judgement tests to exemplify the tradition of implementing interventions for improving the way selection is done in specific settings. We reflect on the reasons for this programme’s impact on the selection process and its decision makers. We end with recommendations to researchers in personnel selection and other fields for increasing the impact of their research projects.
Article
Selection processes for medical schools need to be unbiased, valid, and psychometrically reliable, as well as evidence-based and transparent to all stakeholders. A range of academic and non-academic criteria are used for selection, including matriculation scores, aptitude tests and interviews. Research into selection is fraught with methodological difficulties; however, it shows positive benefits for structured selection processes. Pretest coaching and "faking good" are potential limitations of current selection procedures. Developments in medical school selection include the use of personality tests, centralised selection centres and programs to increase participation by socially disadvantaged students.
Chapter
The incidence of adverse patient events in hospitals has not improved over the last two decades despite enormous efforts in the area of Quality and Safety. Notably, the same errors are often repeated, even though previous reviews of these events have resulted in learnings, guidelines and policy. The traditional review of a Hospital Adverse Event (HAE) is most commonly a Root Cause Analysis (RCA) to find factors and conditions that caused or contributed to the HAE. The basis for the RCA is the James Reason Swiss Cheese model of adverse events developed from analysis of large- scale industrial accidents. In this model the HAE occurs when a patient deteriorating clinical trajectory broaches the hospital’s organisational and professional defences. The learnings from the RCA typically result in new or changed policies and procedures, and occasionally professional disciplinary review of the involved health care workers. Clinical Futile Cycles (CFC) is clinical action or intervention (or lack thereof) that has no patient benefit. Analysis of HAE by looking for CFC creates learnings that focus on the human factors of the involved health care workers, and more importantly the socio, politico, and fiscal cultural hospital environment at the time of the HAE. As such, the learnings focus not on limitations of the individual practitioners but rather, the greater environment that has them often ignoring, broaching or being oblivious to professional standards, and the already existent policy procedure and guidelines.
Thesis
Medical and dental education in Europe face enormous challenges. Admission is one of them. The number of candidates in both these educations often exceeds the available places. This dissertation provides a first look at the use of a fairly new selection tool in admission procedures for medical and dental education: a situational judgment test. First, a general introduction and overview of the literature on SJTs is given. Next, the setting of the dissertation is described: the admission exam for medical and dental studies in Flanders. Obviously, the selection of medical and dental students in Flanders is different from the admission in other countries. First, the Flemish Admission Exam is exactly the same for both medical and dental students. However, the first study shows that students with a lower score on the cognitive tests, tend to choose dental education. This finding raises questions about using the same admission exam for two different majors. Second, the Flemish admission exam uses an SJT as non-cognitive predictor. SJTs have proven their value in the context of job selection. Studies in both medical and dental education show that SJTs can be valid predictors of both academic and job performance. Over time (from year 1 through year 5/7) the validities of the SJT for predicting academic performance (GPA) slightly increased and there was evidence of incremental validity of the SJT over cognitive ability. The SJT was a predictor of supervisory-rated job performance nine years later. In the last study, the technique of propensity scoring is used to study the coaching effects of both cognitive and non-cognitive tests. By using this technique, treatment-control comparisons can be made among individuals with approximately equal probabilities of having received the treatment. Results show that people who seek coaching were those with the lowest scores on the pretest. Coaching effects were largest for the SJT (d=.50), followed by the knowledge tests (d=.45) and general mental ability test (d=.34). SJTs can be valuable additions to cognitive tests in an admission procedure for higher education. However, the coaching effects found, raise questions about using the same SJT on a long-term basis.
Article
Objective: Though many medical schools applied various admission criteria in the selection process, the evidence of using those criteria is unclear. This study examined the predictive validity of each admission criterion for student competency. Design, setting, and participants: We conducted a prospective cohort study of all students who matriculated to Seoul National University School of Medicine from 2002 to 2008. Demographic characteristics, admission criteria scores, and clinical competencies based on grade point average (GPA), objective structured clinical examination score, and internship score were obtained for each student to analyze the predictive validity of admission criteria. Results: Graduate GPA at the end of 4 years positively correlated with preadmission GPA (p < 0.0001) and written test score (p = 0.012) but negatively correlated with essay test (p = 0.049). Internship score significantly correlated with preadmission GPA and graduate GPA. Regression analysis revealed that the preadmission GPA of the affiliated college and young age at admission could predict GPA, and preadmission GPA and graduate GPA could predict the internship score, which indicates postgraduate clinical performance. Conclusions: These findings suggest that preadmission GPA is a reliable predictor of academic achievement during medical school and postgraduate clinical performance. For assessing nonacademic competencies, further research is needed.
Chapter
The United States, rich in technology and extensive in health expenditures, has numerous pockets of patients that receive disparate health care. Much of this is a result of the undervaluing of primary care specialties, caused in part by the drift from medical professionalism. Aspects of professionalism including recognition and attention to civic engagement, pursuit of social justice and placing the needs of patients first, continually compete with the economic, prestige, and lifestyle incentives of the subspecialties. One strategy to remedy this conundrum is to holistically evaluate, select, educate, and train the next generation of socially responsible physicians. This requires a well-articulated mission for the medical school and an admission committee vested in that mission. A critical mass of mission-driven students, with pre-professed and demonstrated interest in primary and population-based care, complete with strong mentoring and support, is necessary to help counter the vigorous tug of subspecialty recruitment. Beyond recruitment, a curriculum that provides strong and consistent exposure to primary and population-based care, valuing community projects and commitments during medical school training is essential. This curriculum must also continually reinforce the student/physician’s responsibility to ensure the equitable health of the local community and be responsible for examining the outcomes, rather than process measures. This will necessitate the medical school to provide meaningful, integrated, and consistent exposure to positive role models, workshops, clubs, and opportunities specific to primary care specialties for the encouragement and excitement of these impressionable students.
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Background: Patan Academy of Health Sciences (PAHS) aims to produce physicians who would be able and willing to serve in the rural areas. Recognizing the critical importance of student selection strategy, among others, in achieving the program goals, it has adopted an innovative scheme for selecting medical students. This paper describes PAHS medical student selection scheme that favors enrollment of deserving applicants from rural and disadvantaged groups so as to help improve distribution of physicians in rural Nepal. Methods: A student admission committee comprising a group of medical educators finalized a three-step student selection scheme linked with scholarships after reviewing relevant literatures and consultative meetings with experts within and outside Nepal. The committee did local validation of Personal Quality Assessment (PQA) that tested cognitive ability and personality traits, Admission OSPE (Objective Structured Performance Examination) that assessed non-cognitive attributes of applicants. It also provided preferential credits to applicants’ socio-economic characteristics to favor the enrollment of deserving applicants from rural and disadvantaged groups through Social Inclusion Matrix (SIM). Three different categories of scholarship schemes namely Partial, Collaborative and Full were devised with Partial providing 50% and other two categories each providing 100% coverage of tuition fee. Results: PAHS student selection scheme succeeded in enrolling more than half of its students from rural areas of Nepal, including about 10% of the students from that of the most backward region of the country. About one third of students were female and about the same were from public and community school. Sixty percent of students receive different categories of scholarships. Conclusions: Limited findings indicate the success of the selection scheme in enrolling high proportion of applicants from rural and disadvantageous groups and enable them to pursue study by providing scholarships.
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Non-academic personal qualities should be taken into account
Article
A review of the literature indicates that people with field-dependent or field-independent cognitive styles are different in their interpersonal behavior in ways predicted by the theory of psychological differentiation. Field-dependent people make greater use of external social referents, but only when the situation is ambiguous and these referents provide information that helps to remove the ambiguity; field-independent people function with greater autonomy under such conditions. Field-dependent people are more attentive to social cues than are field-independent people. Field-dependent people have an interpersonal orientation: They show strong interest in others, prefer to be physically close to people, are emotionally open, and gravitate toward social situations. Field-independent people have an impersonal orientation: They are not very interested in others, show both physical and psychological distancing from people, and prefer nonsocial situations. Finally, field-dependent and field-independent people are different in an array of characteristics that make it likely that field-dependent people will get along better with others. Altogether, field-dependent people have a set of social skills that are less evident in field-independent people. On the other hand, field-independent people have greater skill in cognitive analysis and structuring. This pattern suggests that, with regard to level, the field-dependence–independence dimension is bipolar; each of the contrasting cognitive styles has components that are adaptive to particular situations, making the dimension value neutral. (7 p ref)
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Current medical school admissions criteria favor candidates with superior scientific aptitude and strong interests in scientific subjects. Four measures of this cluster were studied: Medical College Admission Test Science subtest scores, premedical grades in scientific subjects, preference for scientific subjects, and an equally weighted composite of these three. In a sample of 1,135 medical school graduates the four predictors were moderately related to academic performance in the first two years of medical school but almost completely unrelated to performance in the fourth year and to faculty ratings of general and clinical competence. The scientifically oriented graduates tended to enter specialties such as anesthesiology, pathology, and surgery, whereas graduates ranking lower on the overall index showed a slight tendency to prefer internal medicine, pediatrics, and psychiatry. Ratings and adjectival descriptions of premedical students with above average scores on the four measures revealed them to be narrower in interests, less adaptable, less articulate, and less comfortable in interpersonal relationships than their lower scoring peers.
Article
To analyze the correlation between scores obtained on the 25 scales and vectors of the California Psychological Inventory (CPI) and academic test results obtained in various subjects by the same students in the first three years of the six-year medical curriculum at Monash University. The study participants were 133 students who commenced their medical education in 1990 or 1991 and completed their third year in 1993. The student took the CPI in their first year. The academic test results were classified according to assessment type and content. Pearson product-moment correlation coefficients were then calculated between the CPI scores and the test results. With respect to assessment type, the results for multiple-choice question test (MCQs), practicals, calculations, and to a lesser extent, essays were negatively correlated with some CPI scores that might be notionally desirable in a caring profession. Essay and oral examination results were positively correlated with scales such as Socialization, Self-control, and Work Orientation. Results of oral examinations, unlike those of other types assessments, were positively correlated with the CPI scales of Intellectual Efficiency and Management Potential. Three of the assessment types--MCQs, practicals, and calculations--were highly significantly negatively associated with the Empathy scale. With respect to assessment content, results for cell and tissue studies were negatively correlated with several CPI scales, including Empathy. By complete contrast, the scores from clinical and communication skills assessments were positively correlated with many notionally desirable CPI scales, including Empathy, Responsibility, and Tolerance. The results indicate that students with high achievement in many components of the curriculum tend to have personality profiles that seem inappropriate to their chosen careers as physicians. Medical schools espousing humanistic qualities in their educational objectives may be offering a contradictory message to their students by rewarding those with inappropriate personal qualities.
Article
Although health sciences programmes continue to value non-cognitive variables such as interpersonal skills and professionalism, it is not clear that current admissions tools like the personal interview are capable of assessing ability in these domains. Hypothesising that many of the problems with the personal interview might be explained, at least in part, by it being yet another measurement tool that is plagued by context specificity, we have attempted to develop a multiple sample approach to the personal interview. A group of 117 applicants to the undergraduate MD programme at McMaster University participated in a multiple mini-interview (MMI), consisting of 10 short objective structured clinical examination (OSCE)-style stations, in which they were presented with scenarios that required them to discuss a health-related issue (e.g. the use of placebos) with an interviewer, interact with a standardised confederate while an examiner observed the interpersonal skills displayed, or answer traditional interview questions. The reliability of the MMI was observed to be 0.65. Furthermore, the hypothesis that context specificity might reduce the validity of traditional interviews was supported by the finding that the variance component attributable to candidate-station interaction was greater than that attributable to candidate. Both applicants and examiners were positive about the experience and the potential for this protocol. The principles used in developing this new admissions instrument, the flexibility inherent in the multiple mini-interview, and its feasibility and cost-effectiveness are discussed.