The Universities of Otago and Auckland in New Zealand produce well-trained and sought after health professional graduates, as attested by the ease with which they obtain good jobs overseas. Does the excellent reputation of our graduates overseas mean the two universities admit the right mix of students in order to meet the needs of New Zealand communities? This in turn raises further questions about what traits are desirable in aspirant health professionals for the New Zealand health workforce and, more pressingly, how to identify or measure those traits.
Three papers in this issue of the Journal explore different aspects of admission to health professional programmes.1–3 Poole and colleagues shed light on the recent decision by Auckland to retain an interview for admitting students to their medical programme; Dhar and colleagues report medical student perceptions of the general cognitive test, Undergraduate Medical Admissions Test (UMAT); and Crampton (me) and colleagues provide an overview of the sociodemographic characteristics of students admitted into Otago’s eight health professional programmes. The three papers contribute to an already large literature on admissions processes. Sadly, despite the large amount written on the subject, there are still no gold standards and most admissions tools are contested to a greater or lesser extent.
Medical schools want to select students who are academically high performers. As noted by Poole and colleagues, grade point average (GPA) is the most reliable tool for predicting future academic performance as, not surprisingly, past academic performance predicts future academic performance.
Schools also want to select students who are committed, altruistic, excellent communicators, trustworthy, honest, ethical and so on. Some of these traits are hard to teach and therefore need to be part of the selection criteria: hence the use of UMAT and interviews.
In selecting medical students, Otago and Auckland use similar, but not identical, processes. For example, both universities use GPA and UMAT. One of the main differences between the two is the presence of an interview for all applicants to Auckland but only for those Otago applicants who apply under the ‘Other’ category.
Poole and colleagues report that a working party set up to examine the place of the Auckland interview found that “the Auckland interview in its current format is not particularly valid or reliable in terms of its ability to predict future success at medical school, but at least it is not as resource-intensive as initially thought.” Despite this, the working party recommended retaining the interview because it offers a range of benefits such as community engagement, strong student support, the ability to select in diversity, and the ability to select out those students who don’t actually want to be there. The working party also suggested a number of possible approaches to improve the validity and reliability of the current interview.
General cognitive tests, such as UMAT, are designed to test traits other than straight academic performance. UMAT was developed in Australia and is used widely in Australian medical schools as well as in both New Zealand medical schools. The test has three components: logical reasoning and problem solving, understanding people, and non-verbal reasoning.
Dhar and colleagues report, for the first time, the perceptions of New Zealand medical students of the test. They surveyed all 2043 medical students at Otago and Auckland in 2009, obtaining a 65% response rate. The majority of respondents did not think that UMAT is an important test for selecting medical students because they were not convinced that it judges the non-cognitive attributes required of a doctor and 67% of them thought that it is not a fair test. Students also reported finding the test stressful and about half of all students spent sometimes hundreds of dollars doing preparatory courses and buying UMAT books in an effort to improve their performance.
While students are not necessarily the best judges of the performance of admissions tools, nevertheless these results are alarming as they convey a lack of confidence in UMAT amongst students and also suggest that UMAT places an additional financial burden on applicants to medical school. The two universities will need to think carefully about these findings.
In addition, student diversity is important. Crampton and colleagues state Otago’s view that, in order for health professional programmes to meet the needs of New Zealand society, “ideally the make-up of health professional classes should be equivalent to holding a mirror up to society”. Selecting in diversity—gender, ethnic, rural/urban, socioeconomic—presents challenges.
The reality is that students enrolled in the eight health professional programmes at Otago are not a perfect mirror on society. While noting that nearly 16% of the 2012 medical class are Māori, nevertheless overall both Māori and Pacific students are under-represented in health professional classes, as are students from socioeconomically disadvantaged backgrounds. There are many factors which contribute to this under-representation.
Both Otago and Auckland have affirmative pathways for Māori and Pacific students and students from rural backgrounds, and Crampton and colleagues identify a range of other strategies in use at Otago to select in and support students from a diverse range of backgrounds.
It is essential that the admission policies used in New Zealand’s health professional programmes continue to be researched and debated. These debates should provide the opportunity for input from New Zealand’s diverse communities, health professional groups, policy makers and other stakeholder groups. For these reasons I welcome the publication of these three papers.