Developing a Tool for Selection for Medical School : A search for academic and non-academic parameters to predict future medical school performance

Abstract

Worldwide places in medical school are scarce and medical education and training are expensive for providers and learners. Therefore, medical schools aim to offer the places available only to those applicants with the highest probability of successful medical training and subsequent career. To reach this goal, medical schools have developed several selection procedures, including interviews, admission tests and other measures of personal competencies. Uniquely in the Netherlands, selection was organised nationally based on a lottery that is weighted for academic attainment. However, both the lottery and the unproven selection procedures have been described as unfair to medical school applicants, as neither includes any truly objective criteria for predicting future performance. The Dutch situation in which access to medical school was granted by lottery and the possibility to select up to 50% of the students by a selection procedure provided a unique opportunity to form a control group of randomly admitted students to compare with those selected. We developed an evidence-based selection procedure addressing non-academic (i.e. motivation) as well as academic skills. The former evaluated motivation through the determination of the candidate’s active involvement in extracurricular activities, the latter by tests concerning the study skills of candidates in a medical school context. The main outcome was that the relative risk for dropping out of medical school was significantly lower in selected students than in controls admitted by lottery. Those selected obtained a higher mean grade than the lottery admitted students on their clerkships. Thereby selected students participated more often in extracurricular activities, which was also associated with higher clerkship grades