Selection of medical students

Editor—Tutton and Price raise several points about the selection of medical students that need to be clarified.¹ They rightly say that scholastic achievement, aptitude tests, and selection interviews can all be faulted as means of selecting students for a career in medicine, but they seem to agree that general intelligence, allied with emotional stability and social integration, is a good predictor of achievement.

The main thrust of their editorial, however, is to advocate affirmative action to increase the intake of students from lower socioeconomic groups. The justification for this is to “redress inequities from the past” and admit students who have “genuine, rather than apparent, merit.” To further this end at Witwatersrand University in South Africa, interviews have been abandoned because those in low socioeconomic groups scored badly in the criteria of teamwork, leadership, and social involvement. I assume that prior scholastic achievement is also ignored. Selection can then be made only on the basis of social class and perhaps some kind of personal statement.

This attitude is now prevalent in the United Kingdom, where the Higher Education Funding Council for England is putting pressure (including financial) on universities to admit students on the basis of several “access indicators,” including the postcode and the social class of their parents (www.hefce.ac.uk).

Is it necessary or desirable to use affirmative action in the United Kingdom? The experience of my colleagues whose families came from the Indian subcontinent and were classified in the lowest socioeconomic groups on arrival is pertinent. Without affirmative action they have come through the system to become articulate, intelligent doctors. Affirmative action requires medical schools to preferentially take students with lower academic achievement and communication skills. Do British medical schools have the resources to turn these students into well rounded and competent doctors? The experience in the United States is that “many of the preferentially admitted students from minority groups could not pass their licensing examinations, despite greater resources being directed towards helping them than other students.”²

This is social engineering. Can and should medical schools be expected to reverse the deficiencies of the school and social system? We have been harangued by the politicians about the problems of supposedly inadequate doctors. How can medical schools produce good doctors if political dogma restricts their freedom to select those they feel are most able?