Audit of admission to medical school: I--Acceptances and rejects

A prospective study of the process of application, selection, and admission to medical school was performed. St Mary's Hospital Medical School received 1478 UCCA applications for admission in October 1981: 94 (6.4%) applicants entered St Mary's in October 1981, 436 (29.5%) entered other medical schools, 176 (11.9%) read a subject other than medicine, and 772 (52.2%) did not enter university. The study included 12.6% of all applicants and 12.9% of all entrants to British medical schools in October 1981. Educational qualifications, demographic variables, type of schooling, family background, and the manner of application were examined in relation to overall selection. A level achievement was the major determinant of acceptance. O level achievement, early application, and medical parents had significant but smaller independent effects on the chance of acceptance. Social class, age, sex, and school type did not predict acceptance when corrected for academic and other factors. Few differences in personality, career preference, cultural interests or attitudes were found between those accepted and those rejected.     

Predicting academic performance at a predominantly black medical school

A study was conducted by the authors that examined the validity of the Medical College Admission Test (MCAT), undergraduate grade-point average (GPA), and "competitiveness" of undergraduate college in predicting the performance of students at a predominantly black college of medicine. The performance measures used in the analysis consisted of course grades in all four years of medical school and scores on both Part I and Part II of the National Board of Medical Examiners (NBME) examinations. The predictive validities of the MCAT scores and undergraduate GPAs were found to be similar to those revealed in earlier studies conducted at predominantly white schools. Two exceptions to these similarities were found. First, the MCAT scores at the black school had a somewhat lower validity in predicting NBME examination scores than was the case at the other schools. Second, of the six MCAT subtest scores, Skills Analysis: Reading had the highest correlation with first-year grades, in contrast to results at the other schools. No differences between men and women were found in the validity of MCAT scores and the GPA. The competitiveness of the undergraduate college attended was found to contribute significantly to the prediction of all measures of medical school performance.     

Use of a medical reasoning aptitude test to help predict performance in medical school

A medical reasoning aptitude test (MRAT) was designed to assess aptitude for clinical problem-solving in medical school applicants. The purpose of the study reported here was to determine whether the information provided by this test, when used in conjunction with college grade-point averages (GPAs) and scores on the Medical College Admission Test (MCAT), would improve the prediction of medical school performance. Specifically, the authors investigated the incremental predictive value of the MRAT relative to students' overall performance in medical school and, more specifically, to their knowledge and clinical reasoning during preclinical years and clinical performance during the clerkship year. Overall, it was found that, with the exception of the first year, the addition of MRAT scores to the GPAs and MCAT scores increased precision in identifying students who performed poorly or exceptionally well in the second year and the clinical clerkship year. This last finding is especially useful, since few other tests have provided that information. On the basis of the preliminary findings, the authors propose further use and validation of the MRAT.     

Undergraduate medical education

The number of applicants to US medical schools, which declined steadily between 1985 and 1988, increased slightly for the class entering in 1989. The profile of entering students showed a small decline from last year in the percentage of students with grade point averages categorized as "A" (3.5 or above on a 4-point scale) and slight declines in four of the six MCAT subtest scores. The percentage of both women and minority students in the entering class increased from the previous year. An interesting observation is the large percentage increase this year in students transferring to LCME medical schools from graduate and professional degree programs and from osteopathic medical schools. While the number of full-time faculty members in medical schools continues to increase, significant vacancy rates exist in some departments. More than 5% of full-time faculty positions are vacant in genetics, pathology, dermatology, family medicine, neurology, obstetrics-gynecology, orthopedics, otolaryngology, pediatrics, and surgery departments. Along with faculty vacancies, there has been a considerable turnover of medical school deans. The curriculum in most medical schools includes some innovative instructional formats, such as problem-based learning and computer-assisted instruction. However, current data do not allow a generalization about the extent to which these are being utilized. It seems that, at least in some institutions, multiple methods are being used to assess the clinical competence of medical students (observation by faculty members and residents, written and oral examinations, and multiple station examinations), including the use of standardized patients. About half of the medical schools require students to pass the NBME Part I examination and about one third require passage of Part II. The subject examinations provided by the NBME seem to be used widely, at least in the clinical disciplines. Within the past year, about 14% of medical schools have reported the presence of students or residents who have been diagnosed with human immunodeficiency virus infection, and 12% have had students or residents diagnosed with hepatitis B virus infection. It is critical that medical schools teach students how to prevent occupational exposure to these infections, as well as ensuring that adequate health insurance coverage be provided for these conditions.     

Traditional criteria as predictors of minority student success in medical school.

There have been many reports stating that the traditional criteria of the Medical College Admission Test (MCAT) and undergraduate grade-point average (GPA) have little, if any, value in predicting success in the preclinical years of medical school among students from underrepresented (racial and ethnic) minority groups. In contrast to previous articles this report emphasizes that traditional criteria and the quality of the undergraduate college attended are of some statistical value in predicting success in the preclinical years of medical school among accepted students from under represented minority groups. Of these criteria, the one with the greatest predictive value is the selectivity of the undergraduate college attended.     

Undergraduate medical education

There were 28,123 applicants to US medical schools for the 1987-1988 academic year, a 10% decrease from the 1986-1987 year. Of this number, 17,027 applicants were accepted by at least one school. First-year enrollment equaled 16,686 students, of whom 639 students were repeating the first year. Thus, the number of first-time enrolled students was 16,047. This represents a decrease of 159 new-entry students from the previous year. Over 46% of the students entering medical school in the 1987-1988 academic year had a premedical GPA of 3.50 or higher (on a four-point scale). Eighty-seven percent of US medical schools academically qualified candidates on the basis of noncognitive criteria. In the past five years the number of first-year white male students has decreased by 13.2%, while the number of black male students has decreased by 1% [corrected]. In the same period, the number of white female students increased by less than one tenth of 1%, while the number of black female students has increased by 31.7%. The number of Asians or Pacific Islanders entering US medical schools has more than doubled: the percentage of male students increased by 106.5% and that of female students by 128.4%. The total number of students enrolled in 127 US medical schools in the 1987-1988 year was 65,742; of this number, 22,539 (34.3%) were women. The estimated number of graduates in the 1987-1988 year was 15,947. The total enrollment of students from underrepresented ethnic/racial groups was 6955 (10.6%), of which 4086 (6.2%) were blacks of non-Hispanic origin. The number of new-entry first-year students from underrepresented groups was 1776 (11.1%), of which 1063 (6.6%) were blacks. The number of full-time medical school faculty members was 66,798; another 130,437 were part-time and volunteer faculty members. The average time needed to complete the curriculum requirements leading to the MD degree is 152 weeks. Twenty-two medical schools offered a combined college-medical school program. The length of these combined programs averaged 256 weeks. The number of schools offering a Fifth Pathway program has decreased, and the number of applicants for these programs has also declined. The net attrition rate, which excludes students who withdrew temporarily to pursue advanced study or research, has remained at about 2%. Students dismissed because of poor academic standing represent 16% of the total student attrition.(ABSTRACT TRUNCATED AT 400 WORDS)     

Canadian Applicants to Medical Schools in Canada for 1965-66

An examination of applicants to Canadian medical schools for 1965-66 revealed that 4660 applications were received by the 12 schools for approximately 900 places available; 2852 of these were from Canadians, but because many applicants applied to more than one school, these 2852 applications represented only 1767 individuals. Evaluations made by the schools concerning the acceptability of these applicants showed that only 36 persons rated as “acceptable” by one or more schools failed to gain admission to any Canadian school for 1965-66. Furthermore, 66 “marginal” applicants were accepted, as were 130 multiple applicants who were rated as “acceptable” by one school but “marginal” and/or “unacceptable” by one or more other schools. Of the 464 multiple applicants, only 40% received the same evaluation from all schools to which they applied. If those multiple applicants who were rated as acceptable by all schools to which they applied are added to single applicants rated as acceptable, the pool of these clearly acceptable candidates (40% of all Canadian applicants) is sufficient only to fill 78% of places available. It was thus concluded that it is erroneous to speak of a surplus of well-qualified Canadian applicants at the present time.     

Undergraduate medical education

There were 31,323 applicants to US medical schools for the 1986-1987 academic year. Of this number, 17,092 were accepted by at least one school. First-year enrollment equaled 16,779. Because some students were repeating the first year, the number of first-time enrolled students was 16,206. This represents a decrease of 131 from the previous year. The number of students enrolled in 127 US medical schools in 1986-1987 was 66,142; of this number 22,082 (33.4%) were women. The estimated number of graduates in 1986-1987 was 15,872. The total enrollment of students from underrepresented ethnic/racial groups was 6650 (10.1%), of which 3853 (5.8%) were blacks not of Hispanic origin. The number of new entry first-year students from underrepresented groups was 1679 (10.4%), of which 987 (6.1%) were blacks. The number of full-time medical school faculty was 63,991; another 130,379 were part-time and volunteer faculty. Medical school faculties also have teaching responsibility for a variety of other students, in addition to patient care and research responsibility. The average time needed to complete the curriculum requirements leading to the MD degree is 152 weeks. Twenty-two medical schools offered a combined college-medical school program. The length of these combined programs averaged 254 weeks. More than 93% of students entering medical school in 1986-1987 had completed at least four years of college. More than two fifths of students had a premedical grade point average of 3.50 or higher. The number of schools offering a Fifth Pathway Program has decreased and the number of applicants for these programs has also declined. The net attrition rate, which excludes students who withdraw temporarily to pursue advanced study or research, has remained at about 2%. Only half of 1% of students were dismissed because of poor academic standing.     

Applicants to Canadian Medical Schools for 1966-67

An examination of applicants to Canadian medical schools for 1966-67 revealed that 4534 applications were received for the approximately 974 available places. The number of Canadian applications was 2866 and these were made by 1815 individual applicants, an increase of 48 over 1965-66. United States applicants declined from 1143 to 1013.

Evaluations made by the schools concerning the acceptability of the Canadian applicants disclosed that 55 applicants who rated as “acceptable” by one or more schools failed to gain admission to any medical school in 1966-67 (as compared to 36 in 1965-66). However, of those applicants who did find a place 76 were evaluated as “marginal” or “unacceptable”, while another 126 were rated as “acceptable” by one school but “marginal” and/or “acceptable” by one or more other schools.

These results were interpreted to imply that the Canadian medical schools were still experiencing difficulty in attracting well-qualified applicants for study in medicine.

     

Educational programs in US medical schools, 1998-1999.

To describe the current status of medical education programs in the United States and to trace trends in medical education over this century, we used data from the 1998-1999 Liaison Committee on Medical Education Annual Medical School Questionnaire, which had a 100% response rate, and data from other sources. In 1998-1999, total full-time faculty members numbered 98202, a 1.5% increase from 1997-1998. The number of applicants to medical school declined for the second consecutive year, from 43020 in 1997 to 41004 in 1998, but the academic qualifications of entering students remained steady. The number of applicants from underrepresented minority groups decreased 1.3% from 1997 to 1998, compared with an 11.1% decrease between 1996 and 1997. Women constituted 43.4% of applicants in 1998, slightly more than the 42.5% in 1997. The total number of required hours in the first and second years of the curriculum and the number of scheduled hours per week have declined over the past 15 years, while the average lengths of clinical clerkships remained about the same. The number of schools requiring students to pass Steps 1 and 2 of the United States Medical Licensing Examination continued to increase in 1998-1999, with 50% of schools requiring passing both examinations, compared with 46% in 1997-1998.     

Correlations between SAT scores and MCAT scores of black students in a summer program

The purpose of the study reported here was to determine the relationship between Scholastic Aptitude Test (SAT) scores and Medical College Admission Test (MCAT) scores of black students who had participated in a summer program for minority students interested in health careers held at the Medical College of Georgia. A significant correlation was established between these students' SAT and MCAT scores. These findings suggest that students who are likely to perform well in medical school can be selected for medical school while they are still underclassmen, accepted conditionally, and admitted after completing a prescribed curriculum. Early selection has implications for increasing the number of minority students in medicine and for permitting more liberal arts in the premedical education than the present selection process.     

Applications and Enrolments at the Western Medical Schools: A Study of Medical Matriculants for 1964

All applicants and those who subsequently enrolled for the 1964-65 session in the Western medical schools were studied with the hope that it would encourage a national registration of applicants. Seven hundred and sixty-four applicants completed 865 applications for 288 places in four schools. Although the principal factor in selecting medical students in all Western schools is pre-medical performance, 49 “good-quality” (academically of good standing and under 30 years of age) resident applicants were not accepted in their own provincial school, and 49 places were filled with “poor-quality” students.

The loss of good applicants to the Western medical schools and the 20% overlap of each school's applicant pool with that of other schools suggests that objective standards of quality must be developed, and that a regular annual national assessment of applicants should be conducted by the Association of Canadian Medical Colleges.

     

History of not completing courses as predictor of academic difficulty among first-year students

The study reported here was undertaken to determine whether the prediction of academic difficulty in the first year of medical school is enhanced by a consideration of the number of courses withdrawn from, repeated courses, and incomplete courses on a student's undergraduate academic record. All students enrolled from 1981 through 1985 at Southern Illinois University School of Medicine who experienced academic difficulty in the first year were selected for the study. Successful students were matched with these students in terms of minority or majority status and served as a control group. Discriminant and classification analyses were performed in a hierarchical stepwise manner to predict success or difficulty in the first year. The variables that were significant in discriminating between minority students who had academic difficulty and those who did not were the science grade-point average (grades in biology, chemistry, physics, and mathematics), the score on the reading subtest of the Medical College Admission Test (MCAT), and the number of withdrawals from courses. For majority students, the significant discriminating variables were the score on the MCAT biology subtest and the number of incompletes taken for courses. The results of this study have implications for medical school admissions committees, premedical advisers, and premedical students.     

A Pilot Study of Applications to the Four Ontario Medical Schools for Admission to the First Professional Year

In the fall of 1964, newspaper accounts of the medical school applicant situation in Canada reported that hundreds of fully qualified applicants were being turned away because of shortage of places. Such reports precipitated a pilot study of the applications received by the four Ontario medical schools for the first professional year of medicine and it was found, first of all, that the total of 1352 applications represented only 880 individuals. Nearly 32% of these applicants were American and 18% were citizens of Commonwealth or other countries. While a majority of the applicants met the minimal requirements of the schools, very few of the rejected applicants had academic records that justified admission when the informal standards of the schools were applied. It was concluded that it is erroneous to speak of a surplus of well-qualified applicants at the present time and that the need for recruiting programs still remains.     

Modelling the impact of old and new mechanisms of entry and selection to medical school in Ireland: who gets in?

Background

Several changes to entry and selection to medical school in Ireland were introduced in 2009 including the addition of a specialised admission test the Health Professionals Admissions Test (HPAT-Ireland).

Aims

We wished to determine the impact of each aspect of the reforms by modelling outcomes if old and new mechanism had prevailed, the extent to which applicants and entrants repeated the leaving certificate, and leaving certificate and HPAT-Ireland scores of successful candidates.

Methods

The leaving certificate and HPAT scores of all medical school applicants and entrants in 2009 and 2010 were analysed.

Results

Data were available for 2,913 applicants in 2009 and 3,292 applicants in 2010. In 2009, over 33 % of students admitted to medicine would not have been admitted if the decision was based solely on their leaving certificate. The corresponding figure for 2010 was 44 %. In 2009, if entry had been based on the combined HPAT-Ireland and an un-moderated leaving certificate score, this would have affected the outcomes in 5 % of applicants or 25 % of those who secured a medical school place. The corresponding figures for 2010 are 6 and 24 %, respectively. Since 2009 applicants and entrants are far less likely to repeat the leaving certificate examination. HPAT-Ireland entry scores appear relatively stable while leaving certificate scores have varied in an upward direction.

Conclusions

All of the reforms to medical school admission have contributed significantly in determining outcomes. The addition of the HPAT-Ireland adjunct admission test equates with the impact of moderation of leaving certificate points.     

Relationship between past academic performance and results of specialty in-training examinations

In this study, the authors review the records of 63 graduates of Northwestern University Medical School who were residents in its graduate medical education programs of anesthesia and orthopedic surgery. They examine the relationship among college grades, medical school performance, and the results of assessment by annual, nationwide, medical specialty in-training examinations. For the anesthesia group, the best predictors of in-training examination performance were the Medical College Admission Test (MCAT) Verbal Ability score, the college grade-point average for nonscience subjects, and the MCAT Science, General Information, and Quantitative Ability scores. For the orthopedic group, the best predictors were the MCAT Verbal Ability score, the college grade-point average in nonscience subjects, the MCAT Science score, and the National Board of Medical Examiners Part I and Part II examination scores. The previous academic records for the 63 residents contained little to presage results in the in-training examination. The correlation obtained between nonscience college subjects and the in-training examination results was negative.     

Career decisions of unaccepted applicants to Medical School.

To investigate the admissions process to medical school and the post-rejection behavior of unaccepted applicants, a national sample of the 16,837 such applicants to the entering medical school class of 1971-1972 was studied in 1973. The majority of the 1,933 respondents had reapplied to medical school following rejection, and 27% had gained entrance to either US or foreign schools by the time of study. Of those still unaccepted, about half were studying or working in health-related fields of study or occupations at least 2 1/2 years following the initial rejection. We conclude that unaccepted applicants demonstrate considerable variance in postrejection behavior, which is associated with both personal and institutional factors.     

Recruitment and progress of minority medical school entrants 1970-1972.

This is a report on a national study of minority group applicants and entrants to the 1970, 1971, and 1972 entering classes of U.S. medical colleges. The aim of the investigation was to further understanding of the factors involved in attempting to increase minority representation in education for the practice of medicine. Data from the Association of American Medical Colleges are used to examine characteristics of successful and unsuccessful minority applicants to medical school. Socieconomic, personal, institutiona, and geographical factors that relate to the recruitment and progress of minority students in medicine are analyzed and evaluated. Differences between Caucasian and minority group students affecting admissions, retention, and promotion are documented. The investigators also compare the projections of a 1970 AAMC task force report with actual occurrences in the national effort to expand educational opportunities in medicine for blacks and other underrepresented minority students (that is, American Indians, Mexican Americans, and mainland Puerto Ricans). This comparison shows substantial progress toward the projected figures but a need for renewed commitment if they are to be reached. Suggestions are offered for improving the recruitment and progress of minority medical school entrants by such means as the AAMC Simulated Minority Admissions Exercises and by ongoing programs at individual medical schools. The study also yielded such pertinent findings as the following: 1. Confirmation that the racial characterizations self-reported by medical school applicants have a high degree of accuracy and an increasing degree of completeness. 2. An encouraging increase in the number of black premedical students who will potentially apply for the medical school classes entering in 1976 and 1977. 3. Growth in the enrollment of low-income medical students, most of it explained by the increase in the numbers of minority group members who have been admitted in recent years. 4. More mobility among blacks than Caucasians with regard to attending medical schools in other than their region of legal residence. 5. A higher proportion of women, of older, and of married students among minority medical school matriculants than among Caucasian matriculants. 6. A slightly higher medical school retention rate for Caucasians than for students from underrepresented minority groups, possibly explained in part by the greater diversity in the socioeconomic and educational backgrounds of the latter. 7. A positive relationship for blacks between the size of undergraduate college attended and successful completion of the first year of medical school.     

Use of MCAT data in selecting students for admission to medical school

In the spring of 1986, medical school admissions personnel were surveyed on their institutions' admissions practices and the use of Medical College Admission Test (MCAT) data in student selection. The admissions officers listed sources of information considered in processing applications. The variables accorded high importance were: overall and science undergraduate grade-point averages, quality of degree-granting institutions, letters of evaluation, interview ratings, MCAT scores, extracurricular activities, work in areas related to health care, breadth and/or difficulty of course work, and state of legal residence. Variables judged of medium importance were: nonscience grade-point average, graduate study, narratives supplied through the American Medical College Application Service or supplemental narratives, demographic factors, and undergraduate research. The respondents divided the 15-point MCAT scale into exemplary, acceptable, and unacceptable ranges of performance. These responses varied widely among institutions. The mean response for the bottom of the acceptable range was a score of seven, and the mean for the beginning of the exemplary range was 11. In considering individual MCAT subtest scores, 34 percent of the admissions officers regarded the six scores individually and equally, 51 percent weighted the areas in ways related to their curricula, and 43 percent summed or averaged scores with equal weights at some point. Thirty-one percent used MCAT scores to adjust grade-point averages across undergraduate institutions.     

Impact of undergraduate courses on medical student performance in basic sciences

Many students planning to apply to medical school take undergraduate courses (for example, biochemistry, embryology, histology, and vertebrate anatomy) covering concepts that are taught within the medical school curriculum. Do these students perform better in similar courses in medical school than students without prior exposure? In the study reported here of 310 medical students, approximately 50 percent had taken biochemistry, 50 percent had taken a course dealing with vertebrate anatomy, 25 percent had taken embryology, and 25 percent had taken histology as undergraduates. In comparisons of the students with prior exposure to these courses and those without prior exposure, no statistical difference was noted in cumulative grade-point averages for the first year in medical school or in the students' scores in three of the four individual medical courses examined. In addition, there was no significant difference in the academic performances in the four courses between the students in the upper and the lower quartiles of the class. Implications regarding undergraduate preparation of medical school applicants are discussed.