Abstract
This article was migrated. The article was marked as recommended. Concerns related to fairness of medical school admissions through selection have led some scholars to consider selection as an expensive lottery and suggest that lottery may be fairer. This paper considers the issue of selection versus lottery from the perspectives of three groups of stakeholders: 1) applicants, 2) medical schools, and 3) society. This paper contributes to the discussion by addressing advantages and disadvantages of the use of selection and lottery for these stakeholder groups, grounded in the findings from research. Themes that are discussed are reliability and validity issues, perceived influence on selection outcomes and student uptake, effects on student diversity, financial costs, impact on rejected applicants, transparency, and strategic behaviour. For each stakeholder group both lottery and selection yield a combination of advantages and disadvantages, which implies that none of the currently available admissions strategies completely fulfils stakeholders' needs. Research indicates that selection yields only small gains compared to a lottery procedure, while the student diversity, necessary for serving the increasingly diverse patient population, may be compromised. We argue that society's needs should drive admissions policies rather than institutional gains, which means that until a selection procedure is developed that does not disadvantage certain types of students, a lottery procedure should be preferred.
Highlights
Medical students are admitted to the medical study either through a qualitative selection procedure or a lottery
For each stakeholder group both lottery and selection yield a combination of advantages and disadvantages, which implies that none of the currently available admissions strategies completely fulfils stakeholders’ needs
We argue that society’s needs should drive admissions policies rather than institutional gains, which means that until a selection procedure is developed that does not disadvantage certain types of students, a lottery procedure should be preferred
Summary
Medical students are admitted to the medical study either through a qualitative selection procedure or a lottery. While in most countries admissions boards have relied on a thorough assessment of applicants’ qualities and developed a variety of selection tools, the Dutch have employed a lottery; a random lottery at first, and a lottery that was weighted for pre-university performance in later years (Ten Cate, 2007) In this weighted lottery, the chances of. The interests of applicants in medical school admissions pertain to perceived fairness and transparency, perceived influence on admissions outcomes and perceived chances of success, impact of rejections, and strategic behaviour. Applicants may game the system by behaving according to what they understand is expected of them instead of showing their true nature, undermining the purpose of the assessment tool Such strategic behaviour reflected in applicants’ medical school choices (which can be only one per year in the Dutch setting), which is dominated by the type of selection procedure employed (Wouters et al, 2017c). The gains in selection seem to be small compared to lottery, and some researchers have advocated the use of a lottery system after certain academic standards have been met (Benbassat and Baumal, 2007; Hubbeling, 2017)
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