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)