Rather than interviews and psychological tests, medical schools should select their entrants based on cognitive ability tests, according to an editorial released on April 11, 2008 in BMJ.

Written by Celia Brown and Richard Lilford, of the University of Birmingham, this editorial emphasizes the importance of the methods medical schools use to select future doctors, because it raises questions about predicting the characteristics of a good doctor. In the United Kingdom, approximately £200,000 (about $400,000 USD) per medical student -- but outside of monetary costs, the ramifications of choosing people who will not be good doctors are much greater.

Doctors should have three broad attributes, according to the writers: cognitive ability, humanity, and diligence. While it would, of course, be optimal to screen for all three of these attributes, it is apparent that the only one of these that can be evaluated with any reasonable accuracy in a system of mass selection is cognitive ability.

Academic performance is often predicted by school examination results. However, some argue that the British A-Levels are not actually helpful in selecting medical students because most candidates applying for medical school do achieve the top grades, and these grades simply favor students from more privileged backgrounds. These criticisms could be corrected by a system that selected based on actual marks awarded, rather than on course grades or by adjusting entry requirements according to the applicant's background.

Some European countries use a lottery, weighted by exit examination results from schools. Such a random process, while not preferred by the authors, at least avoids the illusion of scientific analysis, they say.

Despite these potential options, some medical schools have introduced aptitude tests, which do not actually appear to predict clinical performance. This casts considerable doubt on the quality of these tests when predicting performance beyond medical school. Additionally, they are costly for the candidates as well as the universities, and there is no actual evidence of improved prediction in comparison to considering school examination marks alone.

Psychological tests and tests to measure 'empathy' are not adequate for selection, because people simply do not know the mixture of psychological traits that are favorable for good service and personal progression. Unlike IQ or examination results, they can be manipulated easily to provide desirable answers.

A low predictive accuracy is attributed to interviews as well. They regularly allow in the people they are meant to eliminate, and they appear to be biased towards aesthetically pleasing people.

The authors suggest, therefore, that cognitive ability tests are advantageous in the selection of medical students, because the processes they test are similar to those used in clinical practice. Namely, they test the application of knowledge to a problem.

Selecting medical students: Tests of cognitive ability are probably the best method at present
Celia a Brown, Richard J Lilford
BMJ 2008; 336: 786
doi: 10.1136/bmj.39517.679977.80
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Written by Anna Sophia McKenney