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The difference between selection into medical school and selection into postgraduate specialty training

Paterson et al, 2013 suggest that historically undergraduate and postgraduate selection may have had different goals with undergraduate courses selecting primarily on academic ability whilst postgraduate selection has focussed on a broader set of competencies associated with a given specialty. However, it could also be argued that increasingly medical schools are now paying attention in their selection methodologies to selecting applicants who have the competencies to succeed in a medical career, not just the academic ability to pass medical finals. Furthermore, under the 2013 ‘Shape of Training' proposals (Greenaway, 2013), students will attain full GMC registration at the end of their medical school studies. In turn, this may mean that medical schools give increasing attention to whether their graduates not only have the knowledge and skills to pass finals, but also to work as a junior doctor.

What’s the difference between assessment for selection and assessment as part of professional examinations?

In professional examinations, where the aim is to assess professional capability, all candidates could, in theory, pass the assessment. In contrast, selection for specialty training or other jobs uses a predictivist paradigm and aims to identify those with greatest potential, given the number of posts available. In this situation if the number of candidates far outweighs the number of posts, highly competent candidates may not be awarded a post.

Table B (see previous section) gives the competition ratios (i.e. number of applicants/number of posts) for all ST1/CT1 specialties in the 2013 recruitment round in England. In a specialty such as histopathology where there are 1.3 applicants for every post (and a final fill rate of 61%), it can be seen that a critical question the interviewing panel will be taking into account is whether the applicant has demonstrated the appropriate competencies (i.e. is appointable). In contrast, with a specialty such as cardiothoracic surgery where there are only 6 posts in the country and 68 applications, many of the candidates who were not selected would have been appointable had there been more openings available. In this situation, the selection process has to be capable of making fine distinctions between candidates in order to select for excellence. In order to achieve this, questions need to be sufficiently rigorous and searching to differentiate within a strong pool of candidates.

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