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      Cognition Admission Test as Selection Method for Students’ Entry in a PBL Medical Curriculum [Letter]


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          Dear editor We have read with great interest the paper by Kötter et al1 The authors compared academic performance in the general practice of students in the fifth year of the medical course who were selected to entry the medical school based on pre-university grade point average (pu-GPA) with those who were selected based on pu-GPA and a 30-min panel interview. They observed that the former was considered more suitable for general practice than the latter by the supervising general practitioner. However, because of the small sample size, they correctly stated that the results should be received with caution. Furthermore, because the study was carried in a single center, they conceded that the generalizability of the study to other medical schools was limited. The selection process for students to entry a medical course is still debatable. In other contexts, pu-GPA appears to be associated with outcome prediction2 low rate of students dropout during medical course.3 Pu-GPA has been associated with a successful career following graduation as well.2 Traditional interviews have been considered to have a poor outcome prediction in comparison with pu-GPA in the students’ selection process.2 Therefore, the findings of Kotter et al1 are somewhat surprising. Cognitive admission tests (CAT) are another selection method for students to entry a medical school, which reliably predicts academic performance. At our university, we run a medical course based on a Problem-Based Learning (PBL) teaching approach.4 A preliminary study from our institution clearly shows that marks in the CAT are associated with academic performance at the end of medical course in terms of abilities and attitudes, as assessed by the Objective Structured Clinical Examination (OSCE). Furthermore, marks in the CAT are also associated with academic achievement in terms of cognition, as assessed by the Progress Testing (PT) and end-unit tests of the disciplines of the clerkship (Pediatrics, Internal Medicine, Surgery, Gynecology and Obstetrics, Family Medicine, and Urgency Medicine).5 Kötter et al1 assessed students apparently formed in a Lecture-Based Learning (LBL) medical course using a Likert scale regarding suitability to work as a general practitioner by one general practitioner supervisors. This is simpler than to assess attitude, ability, and cognition by different methods of assessment as the OSCE and the PT, as recommended in the PBL approach. Therefore, we congratulate Kötter et colleagues1 for their challenging work. Nevertheless, for medical courses running a PBL curriculum, we think that CAT is a preferable method for students’ selection to entry a medical course. Nonetheless, we concede that a randomized trial comparing different selection methods is needed in order that we can select students who might ultimately be a good doctor.

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          How effective are selection methods in medical education? A systematic review.

          Selection methods used by medical schools should reliably identify whether candidates are likely to be successful in medical training and ultimately become competent clinicians. However, there is little consensus regarding methods that reliably evaluate non-academic attributes, and longitudinal studies examining predictors of success after qualification are insufficient. This systematic review synthesises the extant research evidence on the relative strengths of various selection methods. We offer a research agenda and identify key considerations to inform policy and practice in the next 50 years.
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            Academic and non-academic selection criteria in predicting medical school performance.

            A two-step selection procedure, consisting of a non-academic and an academic step, was recently shown to select students with a 2.6 times lower risk of early dropout and a higher clerkship Grade Point Average (GPA) than lottery-admitted controls.
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              Contextual considerations in implementing problem-based learning approaches in a Brazilian medical curriculum: the UNAERP experience

              Background Despite being a well-established pedagogical approach in medical education, the implementation of problem-based learning (PBL) approaches hinges not only on educational aspects of the medical curriculum but also on the characteristics and necessities of the health system and the medical labor market within which it is situated. Aim To report our experiences implementing a PBL-based approach in a region of Brazil where: 1) all pre-university education and the vast majority of medical courses are based on traditional, lecture-based instructions; and 2) students’ career interests in primary care, arguably the prototypical PBL trainee, are heavily disfavored because of economics. Results Brazilian guidelines require that clinical training take place during the last 2 years of the medical program and include intensive, supervised, inpatient and outpatient rotations in pediatrics, family medicine, obstetrics and gynecology, internal medicine, and surgery. Throughout the pre-clinical curriculum, then, students learn to deal with progressively more difficult and complex cases – typically through the use of PBL tutors in a primary care context. However, because of curricular time constraints in the clerkships, and students’ general preoccupation with specialty practice, the continuation of PBL-based approaches in the pre-clinical years – and the expansion of PBL into the clerkships – has become exceedingly difficult. Discussion and conclusion Our experience illustrates the importance of context (both cultural and structural) in implementing certain pedagogies within one Brazilian training program. We plan to address these barriers by: 1) integrating units, whenever possible, within a spiral curriculum; 2) introducing real patients earlier in students’ pre-clinical coursework (primarily in a primary care setting); and 3) using subject experts as PBL tutors to better motivate students.

                Author and article information

                Adv Med Educ Pract
                Adv Med Educ Pract
                Advances in Medical Education and Practice
                09 April 2020
                : 11
                : 287-288
                [1 ]Department of Medicine, University of Ribeirão Preto , Ribeirão Preto, Brazil
                Author notes
                Correspondence: Reinaldo B Bestetti Department of Medicine, University of Ribeirão Preto , Avenida Costábile Romano, 2201, Ribeirão Preto14096-900, Brazil Email rbestetti44@gmail.com
                Author information
                © 2020 Bestetti et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                : 02 March 2020
                : 17 March 2020
                Page count
                References: 5, Pages: 2


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