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| Testing time for student selection |
29-Jan-2008 |
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EDITORIAL by Australian Doctor Chief Political Correspondent Paul Smith
FEW issues generate as much anguished debate as the way medical students are selected.
The issue has made headlines again because there are rumblings of revolution. The battery of assessments developed in the past 30 years to choose our future doctors seem under threat. The University of Queensland school of medicine is scrapping face-to-face interviews this year, claiming they are useless at identifying likely drop-outs or future stars. And the University of Sydney has launched a review of its own selection process, hinting darkly about adopting the idea of a lucky dip system where candidates’names are plucked from a hat.
The importance of the interviews and the tests — UMAT and GAMSAT — are often sold on two arguments. First, they identify the clever kids who would make good doctors. It’s claimed that without them medical schools would be swamped by academic nerds, each with the social skills of a house brick.
And then there is the equity argument. They mitigate the academic disadvantages of teenagers denied the privileges of a paid-for education.
But there remain serious questions.
The interview and testing process has spawned a parasite industry — the numerous coaching colleges that claim to offer students who can afford their fees an increased chance of selection. This claim is hotly debated. The Australian Council for Educational Research (ACER) — the guardian of UMAT and GAMSAT —insists that you cannot be coached for the exams; that the colleges are ripping off students. The colleges say you can, and judged by their popularity, students agree.
And then there is the ever-present issue about the objectivity of the tests themselves.
UMAT, a psychometric test, is routinely rubbished because it claims to judge not just intellectual aptitude but the more nebulous concept of a caring and sharing personality —applicants’ so-called emotional IQ. Take this sample UMAT question:
Bob
’
s wife, Mary, has been
in hospital recovering from a
heart attack. The doctor
informs Bob that she is now
well enough to return home,
although she will need to
‘
take
things easy for a while
’
.
Bob:
“
I
’
m glad she can
come home now, doctor, but
I
’
m not sure I can look after
Mary by myself. We live on
our own.
”
Doctor:
“
It
’
s natural to feel
a little anxious, but the best
thing for Mary will be to be
back in her own environ
ment.
”
In his response the doctor
has:
A. Not realised that Bob is
concerned.
B Not really dealt with Bob
’
s
concerns.
C. Responded to Bob
’
s con
cerns effectively.
D Made Bob feel bad about
being concerned.
The correct answer is B, but what do the answers to fatuous questions such as this really say about the person a 17-year-old is now and the doctor they will become a decade later?
Three years ago Australian
Doctor asked ACER for the evidence proving the validity of the ‘Understanding Others’section of the test. No was the answer. It feared the test preparation industry could exploit the results. ACER’s reluctance to subject to public scrutiny evidence that the test works seems disturbing for a so-called academic institution with an obvious vested interest.
So why bother with these assessments at all if the interviews don’t work well and the suspicion is that UMAT/GAMSAT couldn’t distinguish between Dr Kildare and Dr Crippen?
Candidates for medical school are extremely bright. The personality traits needed across the medical profession are so broad that you no doubt need the science nerds to become the pathologists and those who can muster a smile at the sight of a heart-sink patient to become GPs.
Does this mean a medical student lottery system is needed? They are used at some Dutch universities, with apparent success. And in terms of social equity, a lottery is fairer than selecting on straight academic scores, where going to an expensive school may provide an unmerited advantage.
Blind chance in other words. Until there is robust, published evidence about the reliability of the selection processes being used, the current system seems justified by blind pretence.
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