Qualitative variables in medical school admission

Personal qualities, character traits, life experience, and adaptive capacities are all associated with effective professional life and work. Despite widespread acknowledgement that qualitative factors are crucial for success as a medical student and physician, the variables are rarely measured or considered when medical schools reach decisions about student admission. This essay examines the qualitative variables that medical school admission committees might consider when filling their classes, and it offers recommendations about using qualitative data for admission decisions. It concludes with an agenda for research on medical school admission.     

Demographic variables in medical school admission

Admission committees report that demographic variables, although accurate, reliable, and easily obtained from applicants to medical schools, are only moderately important in their decision making. This may be because the committees are concerned about the validity and legality of using such data as admissions criteria. This essay discusses the research on the validity of demographic variables and the recommendations for their legal use in selecting students for medical school. The relationships of age, gender, size of hometown, parental education, parental occupation, parental income, and marital status to medical school outcomes of preclinical performances, clinical performance, attrition, specialty choice, and practice location are summarized. [Race or ethnic group is discussed in a separate essay in this issue.] Although the authors focus on the predictive value of demographic variables, these variables play a more important role as the moderator variables for other predictors of medical school outcomes. The full value of using demographic variables derives from data obtained in local validity studies. To comply with the equal-protection and due-process requirements, admission officers must assure that the use of demographic information in the admission process is explicit in bulletins given to applicants and is uniformly applied in the evaluation of all applicants.     

Moral dilemmas in medical school admission

The wide range of complex moral and ethical issues of medical school admission committees are seldom publicly acknowledged, reflected upon, analyzed, or discussed, although they are faced regularly. Three cases are presented that illustrate some of the common and unusual moral dilemmas in the admission process. These issues and several practical strategies for ethical decision making are discussed, along with their limitations and weaknesses. These practical strategies are applied to the three cases to see what solutions might be offered.     

Can medical school admission committee members predict which applicants will choose primary care careers?

PURPOSE: To determine the accuracy of admission committee members' predictions regarding which applicants are likely to become generalists, and to determine which applicant characteristics are used and should be used in making these predictions. METHOD: Thirteen characteristics of each applicant who entered medical school in 1990-1993 and graduated in 1994-1997 were obtained from their applications. Committee members reviewed these characteristics and assigned a probability of each applicant's choosing a generalist career. Just before their graduation, the students were surveyed to ascertain their career plans. The relationships between the characteristics and career predictions were analyzed using regression models. A secondary analysis examined the relationship between the students' stated career preferences at matriculation and career plans at graduation. RESULTS: The accuracy of the committee members' predictions was low. Predictions of generalist careers were significantly related to seven applicant characteristics: rural legal residence, gender (women), lower science grades, lower MCAT science scores, lower levels of parents' education, no reported research activity, and higher levels of community service. In contrast, the students' actual generalist career plans at graduation were significantly related only to gender (women) and higher levels of community service. In the secondary analysis, applicants' stated career preferences at matriculation were the strongest predictor of their having generalist career plans at graduation. CONCLUSIONS: Admission committee members often made inaccurate predictions about applicants' career plans. This may be because they based their judgments on applicants' characteristics that were not significantly related to the students' career plans at graduation.     

The ability of a medical school admission process to predict clinical performance and patients' satisfaction.

PURPOSE: The authors evaluated the ability of a two-step admission process to predict clinical performance and patients' satisfaction on a third-year objective structured clinical examination (OSCE). METHOD: Subjects were three matriculating classes (1993, 1994, 1995) at one medical school. Data for the classes were analyzed separately. Independent variables were the Academic Profile (AP), an initial ranking of applicants based on grade-point ratio and MCAT scores, and the Selection Profile (SeP), an average of three interview scores. Interviews were offered based on AP rank, and admission was offered based on SeP rank. Dependent variables were total score on the faculty-graded portion of the OSCE and patients' satisfaction scores completed by the OSCE standardized patients. The authors evaluated the correlations between AP and OSCE performance and between SeP and OSCE performance. The authors also compared the OSCE performances of students whose ranks changed after interviews (SeP rank < AP rank or SeP rank > AP rank). The level of significance was adjusted for the number of comparisons (Bonferroni method). RESULTS: Complete data were available for 91% of eligible students (n = 222). No class showed a significant correlation between either AP or SeP rankings and OSCE performance (p > .01). Likewise, there was no difference in OSCE performance for students whose ranks changed after the interview. CONCLUSIONS: The admission ranking and interview process at this medical school did not predict clinical performance or patients' satisfaction on this OSCE.     

A structured interview for medical school admission, Phase 1: initial procedures and results.

PURPOSE: Despite their widespread use, medical school admission interviews often are unstructured and lack reliability. This report describes the development of a structured admission interview designed to eliminate bias and provide valid information for selecting medical students, with preliminary information about the interview's reliability and validity. METHOD: After screening applications, 490 applicants to a public medical school residency program were interviewed by two faculty members using a structured interview format. Interview scores were compiled and correlated with undergraduate grade-point averages (GPAs); Medical College Admission Test (MCAT) scores; Iowa Evaluation Form (IEF) scores, an in-house evaluation of applicants' noncognitive abilities; and eventual admissions status. RESULTS: Interrater agreement was good; the percentages of rater pairs whose scores differed by one point or less ranged from 87% to 98%. Scores on the structured interview revealed low to moderate correlations with other admission criteria: 10 (p < 0.05) for cumulative GPA, 0.18 (p < 0.01) for MCAT Biological Science, 0.08 (p > 0.05) MCAT Physical Science, and 0.10 (p < 0.05) MCAT Verbal Reasoning. None of the correlations between the overall interview scores and the IEF scores reached statistical significance (p = 0.05). Higher overall scores on the structured interview did predict a greater likelihood of being accepted into the medical school and the interview score accounted for 20% of the incremental variance in admission status beyond GPA, MCAT, and IEF scores. CONCLUSIONS: The moderate-to-low correlations with other admission criteria suggest that the interview provided information about candidate credentials not obtained from other sources and accounted for a substantial proportion of the variance in admission status. This finding supports the considerable time and resources required to develop a structured interview for medical student admissions. Final judgment on the validity and utility of this interview should be made after follow-up performance data have been obtained and analyzed.     

Dimensionality and predictive validity of the HAM-Nat, a test of natural sciences for medical school admission

Background

Burnout has been traditionally defined in relation to the dimensions of "exhaustion", "cynicism", and "inefficiency". More recently, the Burnout Clinical Subtype Questionnaire (BCSQ-12) further established three different subtypes of burnout: the "frenetic" subtype (related to "overload"), the "under-challenged" subtype (related to "lack of development"), and the "worn-out" subtype (related to "neglect"). However, to date, these definitions have not been applied to students. The aims of this research were (1) to adapt a Spanish version of the BCSQ-12 for use with students, (2) to test its factorial validity, internal consistency, convergent and discriminant validity, and (3) to assess potential socio-demographic and occupational risk factors associated with the development of the subtypes.

Method

We used a cross-sectional design on a sample of dental students (n = 314) from Santiago and Huesca universities (Spain). Participants completed the Burnout Clinical Subtype Questionnaire Student Survey (BCSQ-12-SS), the Maslach Burnout Inventory Student Survey (MBI-SS), and a series of socio-demographic and occupational questions formulated for the specific purpose of this study. Data were subjected to exploratory factor analysis (EFA) using the principal component method with varimax orthogonal rotation. To assess the relations with the criterion, we calculated the Pearson correlation coefficient (r), multiple correlation coefficient (R_y.123), and the coefficient of determination (R² _y.123). To assess the association between the subtypes and the socio-demographic variables, we examined the adjusted odds ratio (OR) obtained from multivariate logistic regression models.

Results

Factorial analyses supported the theoretical proposition of the BCSQ-12-SS, with α-values exceeding 0.80 for all dimensions. The "overload-exhaustion" relation was r = 0.59 (p < 0.001), "lack of development"-"cynicism", r = 0.49 (p < 0.001), "neglect"-"inefficiency", r = 0.47 (p < 0.001). The "overload"-"lack of development" relation was r = 0.21 (p < 0.001), "overload"-"neglect", r = 0.20 (p < 0.001), and "lack of development"-"neglect", r = 0.38 (p < 0.001). The BCSQ-12-SS explained 38.44% of the variability in "exhaustion", (R_y.123 = 0.62), 30.25% in "cynicism" (R_y.123 = 0.55), and 26.01% in "inefficiency" (R_y.123 = 0.51). "Hours spent on studying" was found to be associated with "overload" (p = 0.001), "campus" with "lack of development" (p = 0.013), and ""failed subjects" with "neglect" (p = 0.011).

Conclusions

The results support the definition of burnout as established by the BCSQ-12-SS. As such, the BCSQ-12-SS can be used for the recognition of clinical profiles and for the suggestion of potential intervention strategies specific to the characteristics of each particular case.     

Relationship between primary care practices in medical school admission and the matriculation of underrepresented-minority and female applicants.

PURPOSE: To determine whether primary care-oriented (generalist) admission practices at U.S. medical schools address physician workforce diversity issues by resulting in the admission of more members of underrepresented-minority populations or more women. METHOD: The authors performed cross-sectional, secondary analyses of databases from the Association of American Medical Colleges (AAMC). The independent variables were four generalist admission practices: generalist admission committee chair, greater representation of generalists on admission committee, offering preferential admission to likely generalists, and having a premedical recruitment activity targeting likely generalists. The control variable was public/private school ownership. The dependent variables were the mean ages of the matriculating classes and the proportions of students at each school who were African American, (total) underrepresented minorities, women, and married. RESULTS: Ninety-five percent of medical schools completed the AAMC's Survey of Generalist Physician Initiatives in either 1993 and 1994; 94% of matriculants replied to the AAMC's 1994 Matriculating Student Questionnaire. In multivariable analyses, no admission practice was associated with percentages of African Americans, total underrepresented minorities, or women. CONCLUSIONS: Schools with primary care-oriented admission practices did not admit greater percentages of underrepresented-minority students or women. Additional efforts may be required to attract and admit minority and female applicants.     

An admission model for medical schools.

Complex societal issues affect medical education and thus require new approaches from medical school admission officers. One of these issues--the recognition that the attributes of good doctors include character qualities such as compassion, altruism, respect, and integrity--has resulted in the recent focus on the greater use of qualitative variables, such as those just stated, for selected candidates. In addition, more emphasis is now being placed on teaching and licensure testing of the attributes of the profession during the four-year curriculum. The second and more contentious issue concerns the system used to admit white and minority applicants. Emphasizing character qualities of physicians in the admission criteria and selection process involves a paradigm shift that could serve to resolve both issues. To make this or any paradigm shift in admission policy, medical schools must think about all the elements of admission and their interrelationships. A model of medical school admission is proposed that can provide understanding of the admission system and serve as a heuristic guide. This model consists of (1) the applicant pool; (2) criteria for selection; (3) the admission committee; (4) selection processes and policies; and (5) outcomes. Each of these dimensions and the interrelationships among the dimensions are described. Finally, a hypothetical example is provided in which the model is used to help a medical school change its admission process to accommodate a new emphasis in the school's mission.     

Nutritional status of medical patients on emergency admission to hospital

The nutritional status was assessed in 75 consecutive patients acutely admitted to a general medical ward. Weight-for-height, triceps skinfold thickness, arm muscle circumference, plasma albumin and serum transferrin were used as nutritional indicators. By combining abnormalities in two or more of these variables, we found obesity in 9% and undernutrition in 22% of the patients on admission. Energy deficiencies as well as acute and chronic protein undernutrition were observed. Age over 75 years, lack of own teeth and a reason for admission other than circulatory disorders or diabetes were tentatively identified as risk factors for undernutrition-some of them conceivably interdependent. Living conditions and regular medication seemed to be less important determinants in this group of patients. We conclude that undernutrition is prevalent among hospitalized medical patients in Sweden as in other industrialized countries. Patients with "hospital malnutrition" are partly recruited from a population of malnourished elderly people outside the hospital. Adequate nutritional support is an essential objective of hospital care in patients wih medical disorders.     

Rediscovering the medical school.

Medical schools, once devoted primarily to educating medical students, have evolved into complex academic medical centers (AMCs), some of which place a greater emphasis on research and the clinical business than on educating future physicians. This occurred primarily as the result of outside forces, specifically the available revenue streams that have fostered growth. Discipline-based departments have been at the center of the governance structure of medical schools, but many AMCs now have research institutes and centers to enhance research productivity, and faculty group practices to maximize clinical revenue. Although AMCs have been successful in making scientific discoveries, developing new technologies, and providing state-of-the-art clinical care, their successes have not always been favorable to the education mission. Furthermore, the roles of departments and their chairs have not always been carefully considered; a mismatch between organizational and governance structures is occurring. In this article several suggestions are offered to help medical schools rediscover their unique reason for existence and better distinguish core missions from core businesses. Mission-based management and mission-based budgeting provide the framework for maximum success of all the missions. Specific suggestions include (1) organizing a national task force to consider optimal organizational and governance structures of modern AMCs, (2) establishing a core teaching faculty, (3) creating a matrix letter of assignment that aligns salary rates with assigned activities, (4) linking education to the provision of health care to the underinsured, and (5) forming education centers to effectively centralize governance of the education mission.     

职校、卫校、护校类院校解剖学教学存在的问题

正人体解剖学是一门重要的医学基础课程,也是一门医学桥梁课程。其重要性不言而喻。要搞好解剖教学,除了老师善教,学生善学,还存在许多重要问题值得商榷。笔者根据自己多年的教学经验,结合时常的思索、发现,提出下面几个值得商榷的问题,还望同行们不吝提出意见和好的建议,共同促进解剖教学质量的提高。1教材问题的商榷1.1教材统一性的商榷不同的职校、卫校、护校类院校使用的教材很不一致,可以