Standardising the process versus improving the methods
1 Michael DeGroote Centre for Learning (MDCL), McMaster University, Hamilton, ON, Canada L8N 3Z5
Parry and colleagues surveyed 22 English medical schools to determine their approach to admissions.1 Their major concern is the lack of uniformity across schools, and their solution is the implementation of a centralised admissions process.
This may make good economic sense as there is little point in individual schools trying, for example, to create a standardised cognitive test to supplement or replace A levels. But if the goal of centralisation is simply to create greater uniformity, I think the effort may be misspent. In reviewing their paper, my sense is that there is, in fact, more commonality that difference across schools within England, and, for that matter, in most countries, where a combination of grades and some kind of "non-cognitive" measure is the norm. I am not particularly concerned with the individual variations they identified.
, 百拇医药
I do, however, have concerns about the admissions process, though these are different from those of the authors. I think we all have the cognitive-academic component pretty well in hand. While grade inflation, whether in A levels in the United Kingdom or undergraduate GPA (grade point average) in Canada, is a concern (the average GPA at McMaster last year was 3.74/4) the "fix" is straightforward, through the development of some standardised cognitive tests like the MCAT in the United States.
, 百拇医药
But I do not think that we are doing an acceptable job on the "non-cognitive" side, and I do not think it is simply an issue of training and standardisation of interviews. Measures like the personal interview are not nearly as defensible as the authors claim.2 One interview, like one patient case, is a seriously restricted sample, an insight that led directly to new approaches like the multiple mini-interview.3 Some believe that personality measures are a viable alternative to interviews, but in my view the evidence of reliability and validity to date is pretty inconclusive.4
, 百拇医药
So where do we go from here It seems to me that some diversity of selection is expected and desirable because of the different educational cultures in different schools. I cannot see any compelling reason to insist on further uniformity of selection. After all, the standard assessment of student outcomes will ensure that the products are similar enough. We must do a better job of assessing the non-cognitive domain. I have no illusions that a better admissions process will identify all the potential "bad apples," as some reformers hope. But we can all agree that both cognition and compassion matter and both should be assessed equally and well.
, http://www.100md.com
This article was posted on bmj.com on 16 March 2006: http://bmj.com.cgi/doi/10.1136/bmj.38776.497627.55
Competing interests: None declared.
References
Parry J, Mathers J, Stevens A, Parsons A, Lilford R, Sturgeon P, Thomas H. Admissions processes for five year medical courses at English schools: review. BMJ 2006;332: 1005-8.
Salvatori P Reliability and validity of admissions tools used to select students for the health professions. Adv Health Sci Educ Theory Pract 2001;6: 159-75.
Eva KW, Reiter HI, Rosenfeld J, Norman GR. The ability of the multiple mini-interview to predict preclerkship performance in medical school. Acad Med 2004;79: S40-2.
Lumsden MA, Bore M, Millar K, Jack R, Powis D. Assessment of personal qualities in relation to admission to medical school. Med Educ 2005;39: 258-65., 百拇医药(Geoffrey R Norman, assist)
Parry and colleagues surveyed 22 English medical schools to determine their approach to admissions.1 Their major concern is the lack of uniformity across schools, and their solution is the implementation of a centralised admissions process.
This may make good economic sense as there is little point in individual schools trying, for example, to create a standardised cognitive test to supplement or replace A levels. But if the goal of centralisation is simply to create greater uniformity, I think the effort may be misspent. In reviewing their paper, my sense is that there is, in fact, more commonality that difference across schools within England, and, for that matter, in most countries, where a combination of grades and some kind of "non-cognitive" measure is the norm. I am not particularly concerned with the individual variations they identified.
, 百拇医药
I do, however, have concerns about the admissions process, though these are different from those of the authors. I think we all have the cognitive-academic component pretty well in hand. While grade inflation, whether in A levels in the United Kingdom or undergraduate GPA (grade point average) in Canada, is a concern (the average GPA at McMaster last year was 3.74/4) the "fix" is straightforward, through the development of some standardised cognitive tests like the MCAT in the United States.
, 百拇医药
But I do not think that we are doing an acceptable job on the "non-cognitive" side, and I do not think it is simply an issue of training and standardisation of interviews. Measures like the personal interview are not nearly as defensible as the authors claim.2 One interview, like one patient case, is a seriously restricted sample, an insight that led directly to new approaches like the multiple mini-interview.3 Some believe that personality measures are a viable alternative to interviews, but in my view the evidence of reliability and validity to date is pretty inconclusive.4
, 百拇医药
So where do we go from here It seems to me that some diversity of selection is expected and desirable because of the different educational cultures in different schools. I cannot see any compelling reason to insist on further uniformity of selection. After all, the standard assessment of student outcomes will ensure that the products are similar enough. We must do a better job of assessing the non-cognitive domain. I have no illusions that a better admissions process will identify all the potential "bad apples," as some reformers hope. But we can all agree that both cognition and compassion matter and both should be assessed equally and well.
, http://www.100md.com
This article was posted on bmj.com on 16 March 2006: http://bmj.com.cgi/doi/10.1136/bmj.38776.497627.55
Competing interests: None declared.
References
Parry J, Mathers J, Stevens A, Parsons A, Lilford R, Sturgeon P, Thomas H. Admissions processes for five year medical courses at English schools: review. BMJ 2006;332: 1005-8.
Salvatori P Reliability and validity of admissions tools used to select students for the health professions. Adv Health Sci Educ Theory Pract 2001;6: 159-75.
Eva KW, Reiter HI, Rosenfeld J, Norman GR. The ability of the multiple mini-interview to predict preclerkship performance in medical school. Acad Med 2004;79: S40-2.
Lumsden MA, Bore M, Millar K, Jack R, Powis D. Assessment of personal qualities in relation to admission to medical school. Med Educ 2005;39: 258-65., 百拇医药(Geoffrey R Norman, assist)