In-course and career outcomes predicted by medical school selection procedures based on personal qualities.

This paper reports a 40-year follow-up of 57 graduates from the initial intake to an Australian medical school who were selected on the basis of either academic criteria alone or desirable personal qualities as assessed by non-cognitive tests and an interview (with a third small group satisfying both criteria). Both students and teaching staff have remained blind to the basis for selection until the present day. Analysis of their under- and post-graduate careers indicates that 'academic' entrants were more likely to complete an intercalated BMedSci degree and to become specialists, while 'personal qualities' entrants were more likely to graduate with honours, become GPs, and win higher degrees after graduation. However, gender more significantly predicted these outcomes, with female results similar to 'personal qualities' entrants and males' similar to 'academic.' The results are interpreted with reference to the aims and structure of the Newcastle medicine curriculum.

Why is it so hard to consider personal qualities when selecting medical students?

Having 'good' doctors is important to everybody. How to select medical students better has been discussed repeatedly for more than seventy years, implying that prevailing methods could be improved. A significant body of research exists about selection methods and their application in medicine. Yet most medical schools world-wide continue to use prior academic performance and cognitive ability as their major criteria for selection, with minor or no consideration of personal qualities and interpersonal skills (possibly assuming they will develop naturally during training and practice). We describe the main methods available for assessing personal qualities of applicants to medical school and have attempted to identify some reasons and systemic disincentives working against their adoption.

Reliability of personality and values tests: The effects of "high stakes" selection conditions, and of four years in medical school.

This study investigated if scores on tests of personal qualities are affected by whether they will determine selection decisions ("high stakes") or not; and whether they are stable for individuals and groups across a four-year medical course. Two tests, one assessing values and one assessing components of personality, were administered either at the same time as a medical university entrance exam (first cohort; N = 216), or after entry was confirmed (second cohort; N = 142). Both cohorts took the tests again after four years of medical school. Analysis of variance was used to compare group mean scores and interactions, and correlation coefficients to measure temporal reliability. The high stakes cohort initially presented themselves in a significantly more positive light on the personality test. After four years of medical school scores on both tests changed significantly, towards more communitarian values and less empathic attitudes. Thus, personality scores were affected by both the conditions under which the initial tests were conducted and by the passage of time, but values only by the passage of time. Before and after scores were significantly correlated.

Have we got the selection process right? The validity of selection tools for predicting academic performance in the first year of undergraduate medicine.

This article was migrated. The article was marked as recommended. Content: There remains much debate over the 'best' method for selecting students in to medicine. This study aimed to assess the predictive validity of four different selection tools with academic performance outcomes in first-year undergraduate medical students. Methods: Regression analyses were conducted between admission scores on previous academic performance - the Australian Tertiary Admission Rank (ATAR), the Undergraduate Medicine and Health Sciences Admission Test (UMAT), Multiple-Mini Interview (MMI) and the Personal Qualities Assessment (PQA) with student performance in first-year assessments of Multiple Choice Questions, Short Answer Questions, Objective Structured Clinical Examinations (OSCE) and Problem-Based Learning (PBL) Tutor ratings in four cohorts of students (N = 604, 90%). Results: All four selection tools were found to have significant predictive associations with one or more measures of student performance in Year One of undergraduate medicine. UMAT, ATAR and MMI scores consistently predicted first year performance on a number of outcomes. ATAR was the only selection tool to predict the likelihood of making satisfactory progress overall. Conclusions: All four selection tools play a contributing role in predicting academic performance in first year medical students. Further research is required to assess the validity of selection tools in predicting performance in the later years of medicine.

Predictors of professional behaviour and academic outcomes in a UK medical school: A longitudinal cohort study.

BACKGROUND: Over the past 70 years, there has been a recurring debate in the literature and in the popular press about how best to select medical students. This implies that we are still not getting it right: either some students are unsuited to medicine or the graduating doctors are considered unsatisfactory, or both. AIM: To determine whether particular variables at the point of selection might distinguish those more likely to become satisfactory professional doctors, by following a complete intake cohort of students throughout medical school and analysing all the data used for the students' selection, their performance on a range of other potential selection tests, academic and clinical assessments throughout their studies, and records of professional behaviour covering the entire five years of the course. METHODS: A longitudinal database captured the following anonymised information for every student (n = 146) admitted in 2007 to the Hull York Medical School (HYMS) in the UK: demographic data (age, sex, citizenship); performance in each component of the selection procedure; performance in some other possible selection instruments (cognitive and non-cognitive psychometric tests); professional behaviour in tutorials and in other clinical settings; academic performance, clinical and communication skills at summative assessments throughout; professional behaviour lapses monitored routinely as part of the fitness-to-practise procedures. Correlations were sought between predictor variables and criterion variables chosen to demonstrate the full range of course outcomes from failure to complete the course to graduation with honours, and to reveal clinical and professional strengths and weaknesses. RESULTS: Student demography was found to be an important predictor of outcomes, with females, younger students and British citizens performing better overall. The selection variable "HYMS academic score", based on prior academic performance, was a significant predictor of components of Year 4 written and Year 5 clinical examinations. Some cognitive subtest scores from the UK Clinical Aptitude Test (UKCAT) and the UKCAT total score were also significant predictors of the same components, and a unique predictor of the Year 5 written examination. A number of the non-cognitive tests were significant independent predictors of Years 4 and 5 clinical performance, and of lapses in professional behaviour. First- and second-year tutor ratings were significant predictors of all outcomes, both desirable and undesirable. Performance in Years 1 and 2 written exams did not predict performance in Year 4 but did generally predict Year 5 written and clinical performance. CONCLUSIONS: Measures of a range of relevant selection attributes and personal qualities can predict intermediate and end of course achievements in academic, clinical and professional behaviour domains. In this study HYMS academic score, some UKCAT subtest scores and the total UKCAT score, and some non-cognitive tests completed at the outset of studies, together predicted outcomes most comprehensively. Tutor evaluation of students early in the course also identified the more and less successful students in the three domains of academic, clinical and professional performance. These results may be helpful in informing the future development of selection tools.

Selecting medical students: An unresolved challenge.

Despite the abundant supply of academically outstanding applicants to medical schools in most countries the regularly recurring debate in the academic literature, and indeed sometimes in the popular media, implies that admissions committees are still getting it wrong in a significant number of instances. How can this be so when our procedures are directed unashamedly at selecting the most highly academically and intellectually qualified students in the expectation that they will make the best doctors? Perhaps it is time for a radical change in emphasis. Instead of endeavouring to differentiate among the top ranks of a pool of outstandingly qualified applicants, the selection effort might be better focused on identifying those potentially unsuitable in terms of their non-academic personal qualities to ensure they do not gain entry. The account that follows is an analysis of the problems of medical student selection and offers a potential solution - a solution that was first suggested in the medical literature 70 years ago, but not adopted. It is the present author's contention that the cycle of debate will continue to recur unless such an approach is pursued.

The influence of critical thinking skills on performance and progression in a pre-registration nursing program.

BACKGROUND: The importance of developing critical thinking skills in preregistration nursing students is recognized worldwide. Yet, there has been limited exploration of how students' critical thinking skill scores on entry to pre-registration nursing education influence their academic and clinical performance and progression. AIM: The aim of this study was to: i) describe entry and exit critical thinking scores of nursing students enrolled in a three year bachelor of nursing program in Australia in comparison to norm scores; ii) explore entry critical thinking scores in relation to demographic characteristics, students' performance and progression. METHOD: This longitudinal correlational study used the Health Sciences Reasoning Test (HSRT) to measure critical thinking skills in a sample (n=134) of students, at entry and exit (three years later). A one sample t-test was used to determine if differences existed between matched student critical thinking scores between entry and exit points. Academic performance, clinical performance and progression data were collected and correlations with entry critical thinking scores were examined. RESULTS: There was a significant relationship between critical thinking scores, academic performance and students' risk of failing, especially in the first semester of study. Critical thinking scores were predictive of program completion within three years. The increase in critical thinking scores from entry to exit was significant for the 28 students measured. In comparison to norm scores, entry level critical thinking scores were significantly lower, but exit scores were comparable. Critical thinking scores had no significant relationship to clinical performance. CONCLUSION: Entry critical thinking scores significantly correlate to academic performance and predict students risk of course failure and ability to complete a nursing degree in three years. Students' critical thinking scores are an important determinant of their success and as such can inform curriculum development and selection strategies.

Trial use of the Personal Qualities Assessment (PQA) in the entrance examination of a Japanese medical university: similarities to the results in western countries.

BACKGROUND: The Personal Qualities Assessment (PQA), developed by the University of Newcastle, Australia to assess the aptitude of future medical professionals, has been used in Western countries. PURPOSES: The objective was to investigate whether the PQA is appropriate for Japanese medical school applicants. METHODS: Two of the PQA tests, Libertarian-Dual-Communitarian moral orientations (Mojac) and Narcissism, Aloofness, Confidence, and Empathy (NACE), were translated into Japanese, and administered at the Tokyo Women's Medical University entrance examinations from 2007 to 2009. RESULTS: The distributions of the applicants' Mojac and NACE scores were close to the normal distribution, and the mean scores did not exhibit a large difference from those in Western countries. The only significant difference was that the mean score of the NACE test was slightly lower than the Western norm. CONCLUSIONS: The translated PQA tests may be appropriate for use with Japanese applicants, though further research considering cultural differences is required.

Nursing students' personal qualities: a descriptive study.

BACKGROUND: Reports of a lack of compassionate care from nurses have resulted in calls to integrate the assessment of personal qualities into nursing student selection, with the intent to recruit individuals whose attributes reflect those desired in the practising nurse. Whilst nursing programmes are able to determine students' academic abilities on enrolment limited attention has been given to other qualities. Although there is an understanding of the qualities desired in the practising nurse, to date there has been limited exploration of nursing students' personal qualities as they enter nursing programmes and whether these change over time. AIMS: To describe the personal qualities of newly enrolled Bachelor of Nursing students, and to determine if these qualities are age and gender specific and whether they change over time. METHODS: The Personal Qualities Assessment (PQA; www.pqa.net.au) was completed by 138 nursing students on enrolment and repeated after three years. RESULTS: Twenty four percent of students had PQA scores at the extreme ends (±2 SD) of the continuum of one or more sub-scale distributions. Significant positive correlations were found between age and the PQA measured traits: self-control, resilience, narcissism, empathy and moral orientation. Females were significantly more conscientious, community orientated and involved; males had significantly higher narcissism and aloofness scores and lower empathy. For those students (n=28) who completed the follow-up PQA, their personal qualities scores did not change. CONCLUSION: Most of the study sample possessed mid-range personal quality trait scores, but approximately a quarter of the nursing students recorded extreme scores. Older students were found to have a higher measure of self-control, resilience, empathy and narcissism and more communitarian in attitude. Significant differences were found between males' and females' scores. That personal qualities were unchanged after three years suggests the importance of incorporating the assessment of these qualities into selection and recruitment of nursing students.

Excitotoxic stimulation of brain microslices as an in vitro model of stroke.

Examining molecular mechanisms involved in neuropathological conditions, such as ischemic stroke, can be difficult when using whole animal systems. As such, primary or 'neuronal-like' cell culture systems are commonly utilized. While these systems are relatively easy to work with, and are useful model systems in which various functional outcomes (such as cell death) can be readily quantified, the examined outcomes and pathways in cultured immature neurons (such as excitotoxicity-mediated cell death pathways) are not necessarily the same as those observed in mature brain, or in intact tissue. Therefore, there is the need to develop models in which cellular mechanisms in mature neural tissue can be examined. We have developed an in vitro technique that can be used to investigate a variety of molecular pathways in intact nervous tissue. The technique described herein utilizes rat cortical tissue, but this technique can be adapted to use tissue from a variety of species (such as mouse, rabbit, guinea pig, and chicken) or brain regions (for example, hippocampus, striatum, etc.). Additionally, a variety of stimulations/treatments can be used (for example, excitotoxic, administration of inhibitors, etc.). In conclusion, the brain slice model described herein can be used to examine a variety of molecular mechanisms involved in excitotoxicity-mediated brain injury.

The influence of personal qualities on performance and progression in a pre-registration nursing programme.

BACKGROUND: Research conducted primarily with psychology and medical students has highlighted that personal qualities play an important role in students' academic performance. In nursing there has been limited investigation of the relationship between personal qualities and performance. Yet, reports of student incivility and a lack of compassion have prompted appeals to integrate the assessment of personal qualities into pre-registration nursing student selection. Before this can be done research is needed to explore the influence of students' personal qualities on programme performance and progression. AIM: This study explores the relationships between students' personal qualities and their academic and clinical performance, behaviours and progression through a pre-registration nursing programme in Australia. METHOD: This longitudinal descriptive correlational study was undertaken with a sample of Australian pre-registration nursing students (n=138). Students' personal qualities were assessed using three personal qualities assessment (PQA) instruments. Outcome measures included grades in nursing theory and clinical courses, yearly grade point average, final clinical competency, progression (completion), class attendance and levels of life event stress. RESULTS: Significant correlations were found between academic performance and PQA scores for self-control, resilience and traits of aloofness, confidence and involvement. Final clinical competence was predicted by confidence and self-control scores. Students with higher empathy had higher levels of life event stress in their first year and class attendance had a positive correlation with self-control. Completing the programme in three years was weakly predicted by the measure of resilience. No difference was noted between extreme or non-extreme scorers on the PQA scales with respect to performance or progression. CONCLUSION: This sample of students' personal qualities was found to influence their academic and clinical performance and their ability to complete a pre-registration programme in three years. However, further research is required with larger cohorts to confirm the use of personal qualities assessment during selection.

Comparing the cognitive, personality and moral characteristics of high school and graduate medical entrants to the Tehran University of Medical Sciences in Iran.

BACKGROUND: Tehran University of Medical Sciences has two streams of medical student admission: an established high school entry (HSE) route and an experimental graduate entry (GE) route. AIM: To compare the cognitive skills, personality traits and moral characteristics of HSE and GE students admitted to this university. METHODS: The personal qualities assessment tool (PQA; www.pqa.net.au ) was translated from English to Persian and then back-translated. Afterwards 35 individuals from the GE and 109 individuals from the 2007 to 2008 HSE completed the test. The results were compared by t-test and Chi-square. RESULTS: The HSE students showed significantly higher ability in the cognitive skills tests (p < 0.001). They were also more libertarian (p = 0.022), but had lower ability to confront stress and unpleasant events (p < 0.001), and had lower self-awareness and self-control (p < 0.001). CONCLUSION: On the basis of their personal qualities, the GE students had more self-control and strength when coping with stress than the HSE students, but the latter had superior cognitive abilities. Hence it may be useful to include cognitive tests in GE students' entry exam and include tests of personal qualities to exclude those with unsuitable characteristics.

The desirable qualities of future doctors--a study of medical student perceptions.

BACKGROUND: There is a lack of consensus regarding the qualities possessed by the ideal doctor, and very limited research regarding the views of medical students on these qualities. AIMS: To investigate the views of commencing medical students regarding the desirable qualities of doctors. METHODS: A survey containing a set of proposed desirable qualities of doctors identified from the existing literature was completed by 158 first-year medical students. RESULTS: The survey had a 75% response rate. Students rated the individual qualities of empathy, motivation to be a doctor, good verbal communication, ethically sound, integrity and honesty as the most important. A factor analysis identified six categories of qualities: methodical processing, cognitive capacity, people skills, generic work ethic, role certainty and warmth. Significant differences in factor scores were found across subgroups of students (international and domestic students, with and without prior tertiary studies) on the following factors: methodical processing, which was scored highest by domestic students with prior tertiary studies, cognitive capacity, which was scored highest by domestic students without prior tertiary studies and generic work ethic, which was scored highest by international students. CONCLUSIONS: Medical students identified a range of desirable personal qualities of a doctor which varied according to student characteristics, including their prior educational experience. Future research aiming to define such desirable qualities should include a broader range of stakeholders, including students at different training levels and institutions.

Using personal qualities assessment to measure the moral orientation and personal qualities of medical students in a non-Western culture.

How to select candidates with appropriate personal qualities for medical school is an important issue. This study examined the psychometric properties and group differences of the Personal Qualities Assessment (PQA) to test the feasibility of using it as a tool to assess the medical school applicants in a non-Western culture. Seven hundred forty-six medical students in Taiwan completed two psychometric measures: Mojac to assess moral orientation and NACE to assess four aspects of interpersonal relationships. Thirty-one students completed the tests twice to establish test-retest reliability. A subsample of 127 students also completed a measure of the "Big Five" personality traits to examine the construct validity of these scales. Both Mojac and NACE had acceptable internal consistency and test-retest reliability. Conceptually, coherent and significant relationships were observed between test components and between the NACE and Big Five. NACE but not Mojac varied significantly between different sociodemographic groups. Both tests demonstrated acceptable psychometric properties. However, the predictive validity of PQA requires future studies.

Can personal qualities of medical students predict in-course examination success and professional behaviour? An exploratory prospective cohort study.

BACKGROUND: Over two-thirds of UK medical schools are augmenting their selection procedures for medical students by using the United Kingdom Clinical Aptitude Test (UKCAT), which employs tests of cognitive and non-cognitive personal qualities, but clear evidence of the tests' predictive validity is lacking. This study explores whether academic performance and professional behaviours that are important in a health professional context can be predicted by these measures, when taken before or very early in the medical course. METHODS: This prospective cohort study follows the progress of the entire student cohort who entered Hull York Medical School in September 2007, having taken the UKCAT cognitive tests in 2006 and the non-cognitive tests a year later. This paper reports on the students' first and second academic years of study. The main outcome measures were regular, repeated tutor assessment of individual students' interpersonal skills and professional behaviour, and annual examination performance in the three domains of recall and application of knowledge, evaluation of data, and communication and practical clinical skills. The relationships between non-cognitive test scores, cognitive test scores, tutor assessments and examination results were explored using the Pearson product-moment correlations for each group of data; the data for students obtaining the top and bottom 20% of the summative examination results were compared using Analysis of Variance. RESULTS: Personal qualities measured by non-cognitive tests showed a number of statistically significant relationships with ratings of behaviour made by tutors, with performance in each year's objective structured clinical examinations (OSCEs), and with themed written summative examination marks in each year. Cognitive ability scores were also significantly related to each year's examination results, but seldom to professional behaviours. The top 20% of examination achievers could be differentiated from the bottom 20% on both non-cognitive and cognitive measures. CONCLUSIONS: This study shows numerous significant relationships between both cognitive and non-cognitive test scores, academic examination scores and indicators of professional behaviours in medical students. This suggests that measurement of non-cognitive personal qualities in applicants to medical school could make a useful contribution to selection and admission decisions. Further research is required in larger representative groups, and with more refined predictor measures and behavioural assessment methods, to establish beyond doubt the incremental validity of such measures over conventional cognitive assessments.

Factors influencing nursing students' academic and clinical performance and attrition: an integrative literature review.

Predicted workforce shortages have resulted in government initiatives to increase student numbers in preregistration nursing education. In tandem schools of nursing need to ensure students' progress and complete. The aim of this review was to identify factors that influence preregistration nursing students' academic performance, clinical performance and attrition. An integrative review of both quantitative and qualitative literature was conducted using validated appraisal checklists. The review included studies published from 1999 to 2011 in the databases: MEDLINE, CINAHL, Proquest nursing, Proquest Education (via Proquest 5000), ERIC, Journals@Ovid, PsychINFO and ScienceDirect. Studies were categorised according to their impact on academic progression, clinical progression and attrition. Forty four studies were found; most used quantitative methodologies. The review identified that few studies explored factors that impact on students' clinical performance. The four categories that potentially impact on nursing students' academic performance and attrition were: demographic, academic, cognitive and personality/behavioural factors. The challenge for universities committed to students' success is to develop strategies aimed at addressing these factors that are appropriate to specific contexts and student cohorts.

Predictive validity of the personal qualities assessment for selection of medical students in Scotland.

BACKGROUND: The Personal Qualities Assessment (PQA) was developed to enhance medical student selection by measuring a range of non-cognitive attributes in the applicants to medical school. Applicants to the five Scottish medical schools were invited to pilot the test in 2001 and 2002. AIMS: To evaluate the predictive validity of PQA for selecting medical students. METHODS: A longitudinal cohort study was conducted in which PQA scores were compared with senior year medical school performance. RESULTS: Consent to access performance markers was obtained from 626 students (61.6% of 1017 entrants in 2002-2003). Linkable Foundation Year (4th) rankings were available for 411 (66%) students and objective structured clinical examination (OSCE) rankings for 335 (54%) of those consenting. Both samples were representative of the original cohort. No significant correlations were detected between separate elements of the PQA assessment and student performance. However, using the algorithm advocated by Powis et al. those defined as 'non-extreme' (<±1.5 SD from the cohort mean scores; SD, standard deviation) character types on the involved-detached and on the libertarian-communitarian moral orientation scales were ranked higher in OSCEs (average of 7.5% or 25 out of 335, p = 0.049). CONCLUSIONS: This study was limited by high attrition and basic outcome markers which are insensitive to relevant non-cognitive characteristics. However, it is the largest currently available study of predictive validity for the PQA assessment. There was one finding of significance: that those students who were identified by PQA as 'not extreme' on the two personal characteristics scales performed better in an OSCE measure of professionalism. Futures studies are required since psychometric testing for both cognitive and non-cognitive attributes are increasingly used in admission process and these should include more and better measures of professionalism against which to correlate non-cognitive traits.

Assessment for selection for the health care professions and specialty training: consensus statement and recommendations from the Ottawa 2010 Conference.

Assessment for selection in medicine and the health professions should follow the same quality assurance processes as in-course assessment. The literature on selection is limited and is not strongly theoretical or conceptual. For written testing, there is evidence of the predictive validity of Medical College Admission Test (MCAT) for medical school and licensing examination performance. There is also evidence for the predictive validity of grade point average, particularly in combination with MCAT for graduate entry but little evidence about the predictive validity of school leaver scores. Interviews have not been shown to be robust selection measures. Studies of multiple mini-interviews have indicated good predictive validity and reliability. Of other measures used in selection, only the growing interest in personality testing appears to warrant future work. Widening access to medical and health professional programmes is an increasing priority and relates to the social accountability mandate of medical and health professional schools. While traditional selection measures do discriminate against various population groups, there is little evidence on the effect of non-traditional measures in widening access. Preparation and outreach programmes show most promise. In summary, the areas of consensus for assessment for selection are small in number. Recommendations for future action focus on the adoption of principles of good assessment and curriculum alignment, use of multi-method programmatic approaches, development of interdisciplinary frameworks and utilisation of sophisticated measurement models. The social accountability mandate of medical and health professional schools demands that social inclusion, workforce issues and widening of access are embedded in the principles of good assessment for selection.