One more to go
Students applying to study medicine in the
United Kingdom in 2007 have an extra hurdle to clear. The UK
clinical aptitude test assesses characteristics of suitability for
a medical career, as John
Bonner explains
How
do you choose between two equally good candidates for medical
school, both with the requisite A level grades? Even more tricky,
how do you pick out one in 10 applications from a pile of up to
2500 high achieving students?
The increasing numbers of A level students
achieving the highest grade has been one of the main factors behind
the steady growth in numbers of applications to UK medical schools.
This was the challenge that brought together admissions heads from
across the country to a conference in Exeter two years ago.
From that meeting, a consortium of UK medical
and dental schools proposed to develop the UK clinical aptitude
test, a computer based test of the cognitive abilities of
prospective students. Professor Ian Johnson of Nottingham
University is chairman of the consortium. “We were looking
for a better way of coping with the sheer volume of applications.
At Nottingham, for example, we will typically get about 2500
applicants for the 250 places on the medicine course. We can
usually rule out about 500 on academic grounds but from the rest we
have to select about 800 for interview.”
Unfair selection process
Most applicants have more than satisfactory
teacher testimonials and personal statements, and so schools have
increasingly fallen back on academic performance as the only
objective method of differentiating between candidates. Professor
Johnson believes, however, that using this single criterion as the
basis of the selection process could be seen as a cop out.
“There are many other factors (besides
academic ability) that make a good doctor. But there isn't
much point in us banging on about motivation, a caring attitude,
and so on if we tell a candidate that we are choosing someone else
because they got 2% more in chemistry.”
The new test will help the schools fulfil
their obligations to the individual candidates and to society as a
whole, explains Dr Sandra Nicholson, associate dean for admissions
at Queen Mary's School of Medicine and Dentistry, London.
“There has been growing disquiet about the lack of
transparency in the admissions process and to be fair to all
candidates we need to be able to show why we select one rather than
another equally good candidate. There is also the question of
widening access to medical school. The public wants its doctors to
possess certain personal qualities and a strong academic
performance doesn't necessarily guarantee that they have
them.”
Developing the test
There were no suitable test materials to pluck
off the shelf and so the consortium spent many months developing
the new exam in collaboration with the US company Pearson VUE,
which specialises in computer based cognitive testing. The test is
in a multichoice format in four parts lasting under two hours. The
four components are similar in many ways to standard IQ tests, and
assess verbal, quantitative, and abstract reasoning, with a final
decision analysis test.
How and where the exam would be introduced
were issues that caused lengthy debate in the consortium. Some
people felt that a pilot study should be carried out, and once the
data had been collected and assessed, the test could then be
launched nationally. But others noted that this process would take
many years, and in all likelihood, the goalposts would have moved
by the time that the test was fully validated. Ultimately, the
decision was taken to grasp the nettle and go ahead with the
project without direct evidence of a link between success in the
test and subsequent performance as a medical student, and later as
a doctor.
Pearson VUE have some experience of running a
very similar academic selection procedure, the national admissions
test for law, used by the law faculties at 11 British universities.
The new test will be carried out between July and September 2006 at
one of 150 test centres nationwide, and with centres in 40
countries for overseas candidates. The test this year will cost
£60, with a £5 discount for early applicants—a
bursary to pay the full cost will also be available for those in
financial need.
One more hurdle
Despite attempts to lighten the financial
burden of the new test, many prospective medical students are still
suspicious about the emotional impact of the test and query whether
it is even necessary. Kate St Louis is an 18 year old from north
London hoping to be part of the September 2006 intake. “It
looks to me as if it is just creating another exam that we have to
get through to get into medical school—we already have enough
as it is.”
Professor Johnson insists that the new test
fulfils an entirely different function to standard academic exams.
“There is no intention of retesting academic ability, that is
already adequately covered by General Certificates of Secondary
Education and A levels. The new test is not curriculum based and
there is no revision required, because we are trying to test innate
ability, the ability to think straight.”
Nonetheless, having looked at the practice
questions on the test's website, Ms St Louis notes
similarities with the sort of verbal and mathematical reasoning
tests used by selective secondary schools. “With those sort
of tests you can get better and more confident with practice. There
will be those students who are given extra support and tuition and
so they will be the ones that are more likely to get in, so there
is likely to be a two tier system.” Certainly, commercial
companies offering that sort of service have already emerged, and
the consortium warns in its brochure that it does not endorse any
such preparation course, insisting that such training is neither
necessary nor desirable.
Does success in the test equal success in the
course?
Meanwhile, how confident are the organisers
that the test will achieve its goal of establishing a correlation
between performance in the test and performance in the medical
course? Dr Nicholson says that there are promising indications from
the early results of the national admissions test for law.
“This has been running for a couple of years now and there is
good initial evidence of a link between a student's test
results and how they get on later. There is also some anecdotal
evidence which suggests that students with good test scores who
would not necessarily have got in on academic performance alone are
also doing well.”
Professor Johnson points out that the current
test is not the final finished article and that the system will
develop and become more finely tuned with time. There is also the
possibility of more UK medical and dental schools becoming
involved. Currently, 23 of the 30 UK medical schools have signed
up, the exceptions being Belfast, Birmingham, Bristol, Cambridge,
Liverpool, and two of the London schools—University College
London and Imperial. This will provide a huge dataset of 15 000 to
20 000 candidates whose progress can be monitored in an ongoing
research programme.
Two universities that are not part of the
consortium, Liverpool and Bristol, have agreed to contribute
information on their students' performance to the database.
It is likely that most, if not all, students at those two centres
will have carried out the test if they also applied for a place at
one of the consortium schools.
It should be clear fairly soon if there is a
correlation between performance in the test and achievement at
medical school. Professor Johnson states that it should also be
possible to analyse by, for example, age, gender, and ethnic group,
and to identify whether the admissions process is discriminating
against groups other than on grounds of ability.
Personality test
One direction in which the test system will
definitely change will be through the addition of a further
component in 2007, which will look to assess non-cognitive or
behavioural aspects of the candidate's aptitudes. It involves
an attempt to measure objectively some aspects of the
candidate's personality, such as
empathy, integrity, and mental
robustness that are crucial to success in a medical career.
The exact nature of this examination has not
been agreed. Indeed, those involved seem a little daunted by the
size of the task that they have set themselves. “There are
three important issues that we have to address in this further
test—we have to define exactly which qualities that we want
to assess, then we have to find out whether or not we can reliably
test them, and then we must decide exactly what we do with the
information once we have got it,” Professor Johnson explains.
One likely scenario is that this personality test will identify
outliers, or those candidates with odd personality traits. If these
candidates are excluded, would the schools be barring entry to
their future Nobel prize winners, he wonders?
Should the interview system be abandoned?
Some insight into these more elusive
personality traits can usually be gained during the traditional
interview with the academic staff, used by all UK schools apart
from Edinburgh and Southampton. Many students are concerned that
efforts by the schools to use electronic tests to cut down the time
and effort expended in selection could mean that
more schools abandon the interview system.
“I can understand that from the
university's point of view they need to be able to find a way
to sort out the applications they receive but I'm not sure
this is the way to do it,” said Tessa Dick, a second year
medical student at the University of Manchester. “My
university has put a huge emphasis on the fact that it wants to
produce doctors that have excellent communication skills but how
are you going to assess this without meeting the student in person?
I know that interviews take a lot of manpower and time but I
believe that it is a very necessary part of the application
process.”
Dr Nicholson insists, however, that the new
tests are supposed to supplement the usual methods. “At this
stage there is no indication that it would replace any of the
traditional tools used for selecting candidates. Certainly, there
is no sign from the consortium members that the test will replace
interviews. If anything it should facilitate more useful
interviews—we will probably interview fewer people but for
longer and in more depth.”
Professor Johnson believes that students will
accept the new system more readily when they have learnt more about
how it works. He says students' main concern is with the
fairness of the selection process, and so any method that helps to
eliminate subjective decision making will be regarded as a positive
move.
Speaking from experience
One of the few students with direct experience
of such selection techniques is very enthusiastic about the
concept. Richard Bromilow is another second year medic at
Manchester and sat the graduate Australian medical schools
admissions test used by all Australian medical schools and adopted
in the UK for the graduate accelerated courses. Having already
studied three years of an architecture course, he says the test was
probably the most difficult examination he has ever experienced,
but he recognises its value.
“I'm all for levelling the playing
field for applications into medicine and I think a generic
admissions test may be the way forward. I would say that the
current system seems to be quite elitist in terms of exam results.
If you want to encourage more rounded candidates to think about a
career in medicine and produce medical students with better
communication skills then a standardised non-scientific exam open
to all is a good idea,” he said.
Further information about the UK clinical
aptitude test is at www.ukcat.ac.uk.
John Bonner, freelance
journalist, London, affiliation
Email: johnbonner_1@blueyonder.co.uk
studentBMJ 2006;14:265-308 July ISSN 0966-6494
