How to prescribe the best doctors

Sydney University has revised its selection criteria for medical students after consulting various groups, write Kerry Goulston and Kim Oates.

Niels Bohr the Nobel laureate in physics said: "Prediction is very difficult, especially if it's about the future."

Predicting those who will do well in medicine is difficult enough, but predicting those who will be good doctors is a far greater challenge.

How do you predict who will become the brilliant researcher, the expert clinician, the gifted teacher, or the doctor who consistently combines expertise with compassion and empathy?

The fact that medical school selection criteria differ across Australia and around the world is evidence that there is no single, proven selection method. Most medical schools look for evidence of excellent academic performance, demonstrated by high school achievement or performance in an undergraduate degree, motivation and commitment for a career in medicine (notoriously hard to measure) and a reasonably balanced personality.

The Faculty of Medicine at the University of Sydney has revised the admission criteria for its graduate entry program. Last year we held extensive consultations with professional and community groups. This was followed by wide debate within faculty. Graduate entry is less likely to have the problem of high achieving school leavers applying just because they "got the marks" but there is still the problem that the decision to study medicine may not be a well-informed one.

The faculty has resolved to do travelling "road shows" to undergraduate degree students and to high schools, particularly disadvantaged schools whose students are not well represented. The aim is to inform potential applicants about the selection criteria and what the course involves but more importantly about a career in medicine, not just the highs, but also the lows such as the stresses, the anxiety and the work pressure.

Selection involves three sequential hurdles: a minimum credit average in an undergraduate degree; scores in the Graduate Australian Medical Schools Admission Test and performance in the Multiple Mini Interview. This interview involves candidates moving through several short interviews where they are asked to comment on brief vignettes to test such qualities as empathy, professionalism, ethical behaviour and integrity. The aggregate of multiple observations gives a more accurate prediction of future performance than any single observation.

It also dilutes the dangers of bias and chance, potential hazards with the traditional interview.

Final ranking will use these three selection criteria, equally weighted.

Also, recognising research priorities at the University of Sydney, applicants with a PhD by research will have a bonus added to the final score. To give a broader perspective there will be significant community representation on the new admissions committee.

We were unable to find evidence for the predictive value of personal statements by applicants, academic references and portfolios all of which are commonly used in medical school selection in North America.

A big change is the proposal to allow a small number of students to apply directly from school for a new six-year combined degree program which would lead to the award of an appropriately tailored science degree as well as the medical degree.

The rationale is that many students see science as a useful first degree before applying for medicine. A tailored degree, with emphasis on the science which matters to medicine, would allow entry to medicine after two years with the additional units required to obtain the science degree being completed during the medical course. For this small group of students the minimum time to obtain a medical degree would be reduced from seven years (three-year undergraduate degree followed by four years of medicine) to six years.

Selection for this new entry route will be based equally on a combination of final year school performance, the Undergraduate Medicine and Health Sciences Admission Test (UMAT) and the Multiple Mini Interview.

The great majority of our medical students will still be selected from graduates. This new proposed entry route would allow a small number who are sure they want a career in medicine to apply after high school, graduate a year sooner than they would otherwise and still finish with two degrees.

How will we know these changes have been successful? The review has recommended establishing an education research group to study outcomes in relation to selection methods so that any changes to selection criteria will be based on evidence. Because of the length of medical training this will require a long-term perspective. Bohr would understand.

WHERE TO STUDY

  • University of Western Sydney: Students lodge application based on UAI and sit UMAT. Applicants may also attend interview.
  • University of Newcastle/University of New England: joint program: Candidates judged by UAI score and must sit UMAT. Interview required.
  • University of NSW: Students sit UMAT and attend interview. This year a UAI of 95 was required.
  • University of Wollongong: Graduate School of Medicine takes 80 students with degrees annually who sit Graduate Medical School Admission test. Interviews favour those with regional ties.

With permission from the Sydney Morning Herald