Selecting the right medical student

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Abstract

Medical student selection is an important but difficult task. Three recent papers by McManus et al. in BMC Medicine have re-examined the role of tests of attainment of learning (A’ levels, GCSEs, SQA) and of aptitude (AH5, UKCAT), but on a much larger scale than previously attempted. They conclude that A’ levels are still the best predictor of future success at medical school and beyond. However, A’ levels account for only 65% of the variance in performance that is found. Therefore, more work is needed to establish relevant assessment of the other 35%.

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Most cited references 8

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The assessment of clinical skills/competence/performance.

Eric Miller (1990)

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Broadening perspectives on clinical performance assessment: rethinking the nature of in-training assessment.

Marjan Govaerts, L. Schuwirth, Arno M. M. Muijtjens … (2007)

In-training assessment (ITA), defined as multiple assessments of performance in the setting of day-to-day practice, is an invaluable tool in assessment programmes which aim to assess professional competence in a comprehensive and valid way. Research on clinical performance ratings, however, consistently shows weaknesses concerning accuracy, reliability and validity. Attempts to improve the psychometric characteristics of ITA focusing on standardisation and objectivity of measurement thus far result in limited improvement of ITA-practices. The aim of the paper is to demonstrate that the psychometric framework may limit more meaningful educational approaches to performance assessment, because it does not take into account key issues in the mechanics of the assessment process. Based on insights from other disciplines, we propose an approach to ITA that takes a constructivist, social-psychological perspective and integrates elements of theories of cognition, motivation and decision making. A central assumption in the proposed framework is that performance assessment is a judgment and decision making process, in which rating outcomes are influenced by interactions between individuals and the social context in which assessment occurs. The issues raised in the article and the proposed assessment framework bring forward a number of implications for current performance assessment practice. It is argued that focusing on the context of performance assessment may be more effective in improving ITA practices than focusing strictly on raters and rating instruments. Furthermore, the constructivist approach towards assessment has important implications for assessment procedures as well as the evaluation of assessment quality. Finally, it is argued that further research into performance assessment should contribute towards a better understanding of the factors that influence rating outcomes, such as rater motivation, assessment procedures and other contextual variables.

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Predictive validity of the multiple mini-interview for selecting medical trainees.

Jack Rosenfeld, I Reiter, Kevin Eva … (2009)

In this paper we report on further tests of the validity of the multiple mini-interview (MMI) selection process, comparing MMI scores with those achieved on a national high-stakes clinical skills examination. We also continue to explore the stability of candidate performance and the extent to which so-called 'cognitive' and 'non-cognitive' qualities should be deemed independent of one another. To examine predictive validity, MMI data were matched with licensing examination data for both undergraduate (n = 34) and postgraduate (n = 22) samples of participants. To assess the stability of candidate performance, reliability coefficients were generated for eight distinct samples. Finally, correlations were calculated between 'cognitive' and 'non-cognitive' measures of ability collected in the admissions procedure, on graduation from medical school and 18 months into postgraduate training. The median reliability of eight administrations of the MMI in various cohorts was 0.73 when 12 10-minute stations were used with one examiner per station. The correlation between performance on the MMI and number of stations passed on an objective structured clinical examination-based licensing examination was r = 0.43 (P < 0.05) in a postgraduate sample and r = 0.35 (P < 0.05) in an undergraduate sample of subjects who sat the MMI 5 years prior to sitting the licensing examination. The correlation between 'cognitive' and 'non-cognitive' assessment instruments increased with time in training (i.e. as the focus of the assessments became more tailored to the clinical practice of medicine). Further evidence for the validity of the MMI approach to making admissions decisions has been provided. More generally, the reported findings cast further doubt on the extent to which performance can be captured with trait-based models of ability. Finally, although a complementary predictive relationship has consistently been observed between grade point average and MMI results, the extent to which cognitive and non-cognitive qualities are distinct appears to depend on the scope of practice within which the two classes of qualities are assessed.

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Journal

Journal ID (nlm-ta): BMC Med

Journal ID (iso-abbrev): BMC Med

Title: BMC Medicine

Publisher: BioMed Central

ISSN (Electronic): 1741-7015

Publication date Collection: 2013

Publication date (Electronic): 14 November 2013

Volume: 11

Page: 245

Affiliations

[1 ]Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK

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Publisher ID: 1741-7015-11-245

DOI: 10.1186/1741-7015-11-245

PMC ID: 3827327

PubMed ID: 24229397

SO-VID: 39e0a10d-7003-484a-a23e-7168c9142fa3

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This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Selecting the right medical student

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International Journal of Applied Technology in Medical Sciences

Most cited references 8

The assessment of clinical skills/competence/performance.

Broadening perspectives on clinical performance assessment: rethinking the nature of in-training assessment.

Predictive validity of the multiple mini-interview for selecting medical trainees.

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