Increasing the evidence base for selection for undergraduate medicine: four case studies investigating process and interim outcomes

Abstract

Prior to 1997, the University of Adelaide, Australia selected medical students according to matriculation marks alone. After extensive consultation with relevant stakeholders and examination of empirical evidence, the selection process is now based on a national written examination of reasoning and interaction skills, a structured oral assessment and a threshold matriculation score. This paper presents a series of 4 case studies examining the process related to the procedure and early interim outcomes, with the aim of adding to the evidence base for methods of medical student selection. Data were collected from a range of sources between 1996 and 2001, including the University's central administration system, the Faculty of Health Sciences, and purpose-designed oral assessment forms and self-report student questionnaires. The oral assessment process has shown itself to be characterised by a high level of interassessor reliability. Equity of access has been addressed and the number of schools represented in the student intake has increased from between 10 and 15 in the final years of the old selection process to over 30 statewide under the new process. There has been a corresponding increase in the proportion of students from rural backgrounds (from an original 4–12% to 20–22%). These investigations add to the evidence base for medical school selection in that they demonstrate that an oral assessment process can be reliable and lead to early positive results in relation to student outcomes and access.