The effect of a rolling admission policy on a medical school's selection of applicants

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

CONTEXT

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.

METHODS

A formalised literature search was conducted for studies published between 1997 and 2015. A total of 194 articles met the inclusion criteria and were appraised in relation to: (i) selection method used; (ii) research question(s) addressed, and (iii) type of study design.

RESULTS

Eight selection methods were identified: (i) aptitude tests; (ii) academic records; (iii) personal statements; (iv) references; (v) situational judgement tests (SJTs); (vi) personality and emotional intelligence assessments; (vii) interviews and multiple mini-interviews (MMIs), and (viii) selection centres (SCs). The evidence relating to each method was reviewed against four evaluation criteria: effectiveness (reliability and validity); procedural issues; acceptability, and cost-effectiveness.

CONCLUSIONS

Evidence shows clearly that academic records, MMIs, aptitude tests, SJTs and SCs are more effective selection methods and are generally fairer than traditional interviews, references and personal statements. However, achievement in different selection methods may differentially predict performance at the various stages of medical education and clinical practice. Research into selection has been over-reliant on cross-sectional study designs and has tended to focus on reliability estimates rather than validity as an indicator of quality. A comprehensive framework of outcome criteria should be developed to allow researchers to interpret empirical evidence and compare selection methods fairly. This review highlights gaps in evidence for the combination of selection tools that is most effective and the weighting to be given to each tool.

Medical education in the United States of America

This article was written to provide a brief history of the medical educational system in the USA, the current educational structure, and the current topics and challenges facing USA medical educators today. The USA is fortunate to have a robust educational system, with over 150 medical schools, thousands of graduate medical education programs, well-accepted standardized examinations throughout training, and many educational research programs. All levels of medical education, from curriculum reform in medical schools and the integration of competencies in graduate medical education, to the maintenance of certification in continuing medical education, have undergone rapid changes since the turn of the millennium. The intent of the changes has been to involve the patient sooner in the educational process, use better educational strategies, link educational processes more closely with educational outcomes, and focus on other skills besides knowledge. However, with the litany of changes have come increased regulation without (as of yet) clear evidence as to which of the changes will result in better physicians. In addition, the USA governmental debt crisis threatens the current educational structure. The next wave of changes in the USA medical system needs to focus on what particular educational strategies result in the best physicians and how to fund the system over the long term.