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Selection for medical schools
Chris McManusUniversity College London
‘Selection in Medicine’, ASME, London, 28th April 2010
Selection for medical schools
Selection for medical schools
• Academic
– A-levels
– Aptitude tests (BMAT, UKCAT, GAMSAT, etc)
• Non-academic
– Personality
– Motivation
• Widening access
– Complex issue
Selection for medical schools
• A-levels:– Valid predictor of outcome in medical school and
postgraduate assessments
• Westminster clinical entry cohort (1975-82)
• 1991 cohort study
• UCL entrants 2004
– Valid across all universities for all subjects(HESA)
The 1991 Cohort Study
EntrantsOct 1991
EntrantsOct 1992
N ~ 3300N ~ 590092%
ApplicantsOct-Dec 1990
Questionnaire
Leverhulme/DoH
N ~ 270060%
Final Year1996
Questionnaire
Final Year1997
Questionnaire
DoH
N ~ 270055%
PRHOsAug 1996-Jul 1997
Questionnaire
PRHOsAug 1997-Jul 1998
Questionnaire
NTPMDE
N ~ 240060%
SHO/SpRGPs
Dec 2002
Questionnaire
LondonDeanery
MRCP~1997-99
N = 92531%
March2009
N ~ 270061%
LondonDeanery
Questionnaire
Part 1mark at first attempt
80.075.0
70.065.0
60.055.0
50.045.0
40.035.0
30.025.0
20.015.0
10.0
100
80
60
40
20
0
Std. Dev = 11.34
Mean = 47.7
N = 925.00
MRCPmark
MRCP(UK) markat first attempt
5.55.04.54.03.53.02.52.01.51.0
Pa
rt1
ma
rka
tfirs
ta
tte
mp
t
75
70
65
60
55
50
45
40
35
30
25
20
MRCP(UK) markat first attempt
EEE DDD CCC BBB AAA
A-level grade
A-levels
BasicMed Sci
BSc Class
MRCPmark
BSc Taken
GCSE
AH5
MRCP(UK) markat first attempt
A-levels
BasicMed Sci
BSc Class
MRCPmark
BSc Taken
GCSE
AH5
MRCP(UK) markat first attempt
AH5 =High-level intelligencetest for university levelstudents
Selection for medical schools
• A-levels:– Of course no longer usable in medicine …
UCAS 2003-5
All UCASapplicants
MedicalSchoolapplicants
MedicalSchoolentrants
• High A-level grades require:
• Intellectual ability
• Motivation / drive / study habits / learningstyles / personality (conscientiousness)
• Content knowledge (e.g. biology /chemistry)
• Which are the key components for predictingmedical school outcome?
• Probably not intellectual ability
– Necessary but not sufficient
A-levels as predictors
Selection for medical schools
• “Aptitude” tests– BMAT
– UKCAT
– GAMSAT
– MSAT
– MCAT
Selection for medical schools
• What is meant by ‘aptitude’?
• Tests are of two fundamental types:
– Achievement: Knowledge/content– A-levels
– BMAT: Section 2: Scientific knowledge and applications;
– MCAT biological sciences / physical sciences subtests
– GAMSAT: III: Reasoning in Biological and Physical Science
– Ability/Aptitude: Essentially IQ tests, although that term islittle used:
– UKCAT: Verbal reasoning/ Quantitative reasoning / Abstract reasoning/ Decision analysis
– BMAT: Section 1: Aptitudes and skills
– MCAT: Verbal reasoning subtest
– GAMSAT: I - Reasoning in the Humanities and Social Sciences
Selection for medical schools
• Do ability/aptitude tests predict?
(1973)
Commissioned byCommittee of Vice-Chancellorsand Principals
The ISPIUA project: Investigationinto Supplementary PredictiveInformation for University Admission
Test of Academic Aptitude (TAA):Mathematics (M) and Verbal (V)
October 1967: 27,315 students inthe 4th term of the Sixth Form
If ISPIUA’s Test ofAcademic Aptitudedidn’t predict, doUKCAT and BMAT?
• BMAT– 2003 onwards, previously MVAT
– ~ 12,000 entrants to medical school
• UKCAT– 2006 onwards
– ~ 24,000 entrants to medical school
• BMAT – Medical Education 2009, n=1002
• UKCAT – Lynch et al Med Ed 2010 n=341
• Why are there no proper validity/outcomestudies?
Do UKCAT and BMAT predict?
Achievement tests
• MCAT
• BMAT
Academic Medicine, 2007
• High A-level grades require:• Intellectual ability• Motivation / drive / study habits / learning
styles / personality (conscientiousness)• Content knowledge (e.g. biology /
chemistry)• Which are the key components for predicting
medical school outcome?• Not clear
– Content – intuitively reasonable– Personality & Motivation – may also matter
• Why A-level chemistry?
A-levels as predictors
Widening access
• Discussion of the issues is not popular
• People do differ, and some of that variationmay well affect the brain
• Socio-economic group (SEG) is complex
– Income
– Education
– Cultural inheritance
– Status
• “Poor” or “working class” make goodheadlines but bad science and bad policy
The Guardian, 26th April 2010
Dr Harry Isenberg (1916-2010)
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