Medical student selection as the ‘first assessment’: international trends

Greater accountability and professional regulation and a more mobile medical workforce means that selecting students with the right attributes to practice medicine is increasingly important. Recruiting and retaining doctors who will stay and practice in the country that trained them, especially with doctor shortages such as rural and remote areas, is a huge social challenge. Selection for medical school is a crucial step in addressing such issues and medical schools have responsibility to ‘get it right’. Whilst cultural and regional differences exist, international trends in medical selection indicate two main shifts: the first towards seeing selection for medical school as ‘the first assessment’, the second is towards using a wider range of selection methods than simply selecting the brightest students as determined by school leaving or university academic qualifications. All selection methods have advantages and disadvantages and, depending on the course of study and (most importantly) the nature of current and future medical practice, schools can tailor selection methods to meet health service needs. Newer methods reflect changes in assessments which are more objective, seeking to formally assess professional attributes and behaviours (non technical skills) as well as cognitive ability. Methods discussed include the application form; personal statement; interview; multiple mini interview (MMI); personality tests, and newer methods such as situational judgement tests (SJTs). Schools need to ensure students are not only fit to study but will be ultimately fit to practice medicine and identify the expertise and resources to carry out what may be labour intensive or expensive activities.