PQA - Measuing the personal qualities and abilities of aspiring health professionals

Selection of medical students: methods and issues

A symposium presented at the

26th International Conference of Applied Psychology

Athens 16 - 21 July 2006

Symposium convenors:

D Munro*, M Bore & DA Powis

University of Newcastle, Newcastle, Australia

In many countries, such as Australia, the United Kingdom, Sweden and the United States of America the number of applicants applying for places in medical school far exceeds the places available. Management of this high selection ratio has lead to the use of screening and selection tests and interviews as well as a heavy reliance on academic grades in the selection of tomorrow's medical doctors. The need to select raises the important question of what skills, abilities and traits should be used to select medical students together with the need to find evidence of the validity of selection measures. The five papers in this symposium call for a more comprehensive approach to selection. In the first, David Powis (Newcastle, Australia) makes the case for considering psychological health and its impact on the careers of doctors. Next, Janet Yates and David James (Nottingham, UK) look at the characteristics of students who struggle in medical courses in UK, and Mary Ann Lumsden (Glasgow, UK) looks at ways of increasing diversity, including the use of personality assessment. Then Chris McManus and colleagues (London, UK) provide a new approach to assessing motivations for doing medicine. Finally, Miles Bore and Don Munro (Newcastle, Australia) describe a novel battery of tests which combine moral orientation and personality to predict unhealthy dispositions.

Presentation 1:

Why do we need to select medical students?

DA Powis*

University of Newcastle, Callaghan, New South Wales, Australia

Traditionally, medical students, like students for most other university courses, have been selected on the basis of prior academic achievement, sometimes tempered by other positive skills and attributes measured by self report, referees' comments, written tests or interviews. That there is room for improvement becomes clear when one considers the outcome statistics relating to doctors, such as the high rate of reported unprofessional behaviours leading to litigation and deregistration. In addition there appears to be an unreasonably high incidence of personal burnout, substance abuse and suicide among medical practitioners. Hitherto there has been an emphasis on selecting for a range of presumed desirable skills and personal qualities in medical students who are prospective doctors, such as intellectual competence, a sound knowledge base or the skills required to acquire one, technical competence and communication skills, but there has been little attention paid to determination of the undesirable qualities that may underpin future poor professional conduct. This paper presents the argument that poor psychological health is a major risk factor for both future unprofessional behaviour in the practice of medicine and premature burnout, and that medical student selection procedures should incorporate valid measures that can screen out such applicants.

Presentation 2:

Risk factors for 'struggling' on the undergraduate medical course

J Yates & DK James*

Medical Education Unit, Medical School, University of Nottingham, England

In a case-control study of medical students over a 5-year period, we examined the relationship between their academic and non-academic characteristics at course entry and their progress on the undergraduate course. We defined a group of students who 'struggled' on the course as those with either major academic failure at any stage, and/or who left voluntarily, whose course was terminated, or who required a temporary suspension for any reason. We found several independent risk factors for 'struggling': having negative comments written in the Head teacher's reference; having lower A-level grades; being a late entrant to the course; being male; and, in UK students for whom ethnic grouping was known, non-White ethnicity was the strongest risk factor. Co-incidentally we found that those who struggled disclosed a high incidence of depressive-type illness to the faculty (24% compared to 1% of non-strugglers), and we are currently investigating this. In a second study we examined the pre-admission characteristics of three entire cohorts of medical students, and recorded their actual progress in examinations throughout the course. The same factors predicted poor levels of performance, although their relative importance varied in the pre-clinical and clinical parts of the course.

Presentation 3:

Increasing diversity in medical students.

MA Lumsden*

Clinical Medicine, Glasgow University, Scotland.

Medical students are predominantly middle class and many universities in the UK and elsewhere are making strenuous efforts to widen access and encourage applications from populations who do not normally think of applying to Medicine. Since school leaving examination results are heavily dependent on school type and background and also form an important part of the admissions process, it may be important to introduce some flexibility into the setting of entrance requirements for those coming from non-traditional backgrounds. Other approaches are to organise awareness-raising activities so that young people from all backgrounds can find out about careers in Medicine. An alternative approach is to incorporate psychometric testing of both cognitive and non-cognitive attributes into the admissions process. This can help in identifying potential, rather than simply testing learned knowledge, by objectively evaluating personality traits that are difficult to assess by other means. In Scotland, we have used such tests on groups of individuals applying to Medicine as well as on school pupils attending schools with low participation rates in higher education. We have investigated the effect of social class on the results as well as identifying some factors that predict success in undertaking the study of medicine.

Presentation 4:

Assessing motivation when selecting medical students.

IC McManus*1, G Livingston1, C Katona2

University College, London; University of Kent, England

Medical school selectors often wish to assess the motivations of students for studying medicine. However there are few instruments available for assessing generic reasons for becoming a doctor. Instruments run the risk of suffering from the twin problems of being too vague, in terms of actual medical practice, and of having obvious social demand characteristics with respondents giving overly positive responses. To put it simply, almost all applicants are likely to tick a box labelled, "I want to help people". We have developed a novel instrument, the Medical Situations Questionnaire, which assesses how attractive specific aspects of medical practice are in nine medical scenarios described in detailed vignettes. Demand characteristics are minimised by making all answers have positive components, and requiring respondents to rank the options. The questionnaire was administered to 2867 school-aged students attending the weekend-long, UK Medlink conference for individuals considering applying for medicine. Factor analysis of the responses found four generic motivational dimensions, which we labelled Indispensability, Helping People, Respect and Science. We also assessed demographic, academic, personality and learning styles, and in this paper we will discuss how motivations for studying medicine are related to factors such as the Big Five personality dimensions.

Presentation 5:

Selecting out on the basis of potential unethical behaviour.

M Bore* & D Munro

University of Newcastle, Newcastle, Australia

Many suggestions have been made in the medical education literature over the years about the desiderata for medical students and practitioners, ranging from such traits/skills as empathy and communication skills to resistance to fatigue and stress. There are many problems with attempting to select students on such criteria, not least being the difficulty of formulating a practicable battery of valid tests. It can also be argued that many of the required qualities should be deliberately taught, or can be passively acquired, during medical education. The approach advocated in this paper is that, rather than focusing on selecting students on the basis of 'good' characteristics (on which most applicants will be at least satisfactory), admissions officers should concentrate on selecting out the minority of applicants who are likely to be poorly adjusted to the demands of a professional medical career. The research work to be presented uses a combination of moral orientation and interpersonal dispositions to arrive at a typology of ethical orientations, with certain combinations indicative of poor mental health and dispositions typically associated with behaviours considered unethical within the context of medical practice. The validity of this approach is supported by a growing body of evidence.