Medical School Performance Research Articles

A multi-site study on medical school selection, performance, motivation and engagement

Medical schools seek ways to improve their admissions strategies, since the available methods prove to be suboptimal for selecting the best and most motivated students. In this multi-site cross-sectional questionnaire study, we examined the value of (different) selection procedures compared to a weighted lottery procedure, which includes direct admission based on top pre-university grade point averages (≥8 out of 10; top-pu-GPA). We also considered whether students had participated in selection, prior to being admitted through weighted lottery. Year-1 (pre-clinical) and Year-4 (clinical) students completed standard validated questionnaires measuring quality of motivation (Academic Self-regulation Questionnaire), strength of motivation (Strength of Motivation for Medical School-Revised) and engagement (Utrecht Work Engagement Scale-Student). Performance data comprised GPA and course credits in Year-1 and clerkship performance in Year-4. Regression analyses were performed. The response rate was 35% (387 Year-1 and 273 Year-4 students). Top-pu-GPA students outperformed selected students. Selected Year-1 students reported higher strength of motivation than top-pu-GPA students. Selected students did not outperform or show better quality of motivation and engagement than lottery-admitted students. Participation in selection was associated with higher engagement and better clerkship performance in Year-4. GPA, course credits and strength of motivation in Year-1 differed between students admitted through different selection procedures. Top-pu-GPA students perform best in the medical study. The few and small differences found raise questions about the added value of an extensive selection procedure compared to a weighted lottery procedure. Findings have to be interpreted with caution because of a low response rate and small group sizes.

Academic performance in Iranian medical students during the pre-clinical stage.

Background: Better understanding of factors associated with medical school performance is necessary to improve admission processes and to help students succeed in their career. This study follows a group of Iranian med students during their first 2.5 years of medical education, to evaluate their academic success in accordance with their demographic, cognitive and non-cognitive characteristics. Methods: 143 of 200 matriculants of Iran University of Medical Sciences medical school in 2010, were followed for 5 consecutive semesters of the preclinical stage. Demographic and cognitive characteristics were collected using self-administered data collection forms. The NEO Five-Factor (personality) Inventory (NEO-FFI) was used to assess participants’ non-cognitive characteristics. The 5 semesters’ cumulative Grade Point Average (GPA) was the measure of academic performance. Pooled t-test, one-way ANOVA, multiple linear regression and logistic regression model, and Spearman coefficients of correlation were applied in data analysis Results: There was a significant difference in participants’ GPA regarding their gender (p=0.008), using privilege in National University Entrance Examination (NUEE)(p<0.0001), the number of times one has taken part in NUEE (p=0.034) and being occupied in paid jobs (p=0.01). There were no significant differences in participants’ GPA regarding NEO-FFI domains. Conclusions: Females and students with a better academic performance prior to their admission in medical school had better academic records. We found no association between academic performance and personality because participants were followed through a preclinical stage where non-cognitive characteristics plays a less important role in their performance and evaluations.

Predictors of residency performance: a follow-up study.

In a 1990 study we investigated resident applicant characteristics associated with successful matching into otolaryngology. Of the 175 applicants studied, 87 matched, for a 49.7% success rate. Successful matching was much more likely for applicants with a history of excellent academic achievement in medical school. Of the 88 applicants who did not match during the year that was originally studied, 30 matched to otolaryngology in subsequent years. Of the 58 who never matched in otolaryngology, there is no evidence of board certification for 30. Of the other 28, 12 are board certified in anesthesia; 3 in radiology; 2 each in family medicine, internal medicine, general surgery, psychiatry, and physical medicine, and rehabilitation; and 1 each in pathology, emergency medicine, and dermatology. Of the total of 117 who matched in otolaryngology, 109 began residency training, and 107 finished otolaryngology training. Program directors answered questionnaires about 100 of 107 of these residents, detailing aspects of residency performance. The only correlation found between a highly satisfactory residency performance and characteristics that could be evaluated at the time of interviewing for residency positions was with excellent academic performance in medical school.

Using the ACMGE Milestones as a Handover Tool From Medical School to Surgery Residency

To map current medical school assessments for graduating students to the Accreditation Council for Graduate Medical Education (ACGME) milestones in general surgery, and to pass forward individual performance metrics on level 1 milestones to receiving residency programs. The study included 20 senior medical students who were accepted into surgery internship positions. Data from medical school performance assessments from the third-year surgery clerkship, fourth-year surgery rotations, fourth-year surgery boot camp, Clinical Competency Assessment Examination, and United States Medical Licensing Examination (USMLE) Step 1 and 2 examinations were used to map each student's competency assessments to the General Surgery Milestones based on a scoring system created and validated by independent assessors. This Milestones Assessment was then provided to each student's receiving program director. The study was conducted at the University of Michigan Medical School, in Ann Arbor, Michigan. Fourth-year medical students entering into surgical internship. Of 16 Accreditation Council for Graduate Medical Education (ACGME) General Surgery Milestones subcompetencies, 12 were able to be evaluated with current medical school assessments. Of the 20 students, 11 met criteria for all the level 1 milestones and 9 needed improvement in at least 1 domain. It was feasible to use medical school assessments to feed forward information about senior medical students on 12 of the 16 General Surgery Milestones subcompetency domains.

The construct validity of HPAT-Ireland for the selection of medical students: unresolved issues and future research implications.

Aptitude tests are widely used in selection. However, despite certain advantages their use remains controversial. This paper aims to critically appraise five sources of evidence for the construct validity of the Health Professions Admission Test (HPAT)-Ireland, an aptitude test used for selecting undergraduate medical students. The objectives are to identify gaps in the evidence, draw comparisons with other aptitude tests and outline future research directions. Our appraisal of the literature found that stakeholder feedback indicates that there is reasonable evidence for test content validity for two of the three sections of HPAT-Ireland. By contrast the Non-Verbal Reasoning section is widely criticised as having limited relevance to medical school performance and future clinical practice. In terms of concurrent validity there is a significant small to medium, negative correlation with school exit examinations, but not consistently so across all studies (r=-0.18, -0.28, 0.017). Likewise predictive validity studies vary, from negative to moderate strength correlations with examination performance during early years at medical school. Five studies indicate that HPAT-Ireland is supported in principle by the majority of stakeholders. While one consequence of its introduction is that successful applicants are now coming from more diverse academic backgrounds, there is no evidence that the socio-economic background of medical school entrants has been altered significantly. Negative perceptions of unfairness relating to gender, coaching and socio-economics remain. The evidence to date suggests that while there are slight gender differences, initially favouring males, these vary year on year. In conclusion, the attitudes towards, and performance of, HPAT-Ireland is not unlike that of other aptitude tests widely used internationally. The main justifications for its introduction have been achieved, in that Ireland no longer relies exclusively on a single measure of academic record for selection to medical school. However a number of areas require further research and exploration.

An Effective Evidence-Based Student Run Near-Peer Support Group for the USMLE Step 1 Exam

Despite the existence of data describing student factors and test-taking habits associated with success, preclinical medical students preparing for the USMLE Step 1 exam face the challenges of creating a study plan and selecting between study-aid resources while preparing for this high-stakes test. This is often an expensive and anxiety-provoking experience. A near-peer support group for second year medical students studying for the USMLE Step 1 exam at the Albert Einstein College of Medicine (Einstein) provided evidence-based recommendations with goals of facilitating study planning and raising scores. An annual survey evaluating study habits and group perception was collected to identify study habits associated with higher Step 1 scores, evaluate group effectiveness, and refine the evidence-based recommendations for optimal exam preparation. Over a 3-year period, 302 students responded to the survey. After simultaneous adjustment for factors associated with Step 1 performance in bivariate analyses, preclinical medical school performance (P 4000 practice questions (P = 0.05) remained independently associated with Step 1 scores. There was a significant increase in the average Step 1 score from 226.8 to 230.5 (P = 0.002) after the group began providing evidence-based advice to students. Over 90 % of respondents were aware of the group and 64 % followed the group’s advice. Sixty-seven percent would recommend the group to subsequent students and 79 % found the near-peer format useful. A student run near-peer support group was a popular and effective mechanism to assist students preparing for the USMLE Step 1 exam by accumulating and disseminating evidence-based study habit recommendations. Certain habits including a start date approximately 6 months in advance and completion of >4000 test-like practice questions may be beneficial in preparing for the Step 1 exam. The increase in average Step 1 score at Einstein may be in part due to this intervention or may represent part of a national trend.

Do personality traits assessed on medical school admission predict exit performance? A UK-wide longitudinal cohort study

Traditional methods of assessing personality traits in medical school selection have been heavily criticised. To address this at the point of selection, “non-cognitive” tests were included in the UK Clinical Aptitude Test, the most widely-used aptitude test in UK medical education (UKCAT: http://www.ukcat.ac.uk/). We examined the predictive validity of these non-cognitive traits with performance during and on exit from medical school. We sampled all students graduating in 2013 from the 30 UKCAT consortium medical schools. Analysis included: candidate demographics, UKCAT non-cognitive scores, medical school performance data—the Educational Performance Measure (EPM) and national exit situational judgement test (SJT) outcomes. We examined the relationships between these variables and SJT and EPM scores. Multilevel modelling was used to assess the relationships adjusting for confounders. The 3343 students who had taken the UKCAT non-cognitive tests and had both EPM and SJT data were entered into the analysis. There were four types of non-cognitive test: (1) libertariancommunitarian, (2) NACE—narcissism, aloofness, confidence and empathy, (3) MEARS—self-esteem, optimism, control, self-discipline, emotional-nondefensiveness (END) and faking, (4) an abridged version of 1 and 2 combined. Multilevel regression showed that, after correcting for demographic factors, END predicted SJT and EPM decile. Aloofness and empathy in NACE were predictive of SJT score. This is the first large-scale study examining the relationship between performance on non-cognitive selection tests and medical school exit assessments. The predictive validity of these tests was limited, and the relationships revealed do not fit neatly with theoretical expectations. This study does not support their use in selection.

Selection into medical school: from tools to domains.

BackgroundMost research into the validity of admissions tools focuses on the isolated correlations of individual tools with later outcomes. Instead, looking at how domains of attributes, rather than tools, predict later success is likely to be more generalizable. We aim to produce a blueprint for an admissions scheme that is broadly relevant across institutions.MethodsWe broke down all measures used for admissions at one medical school into the smallest possible component scores. We grouped these into domains on the basis of a multicollinearity analysis, and conducted a regression analysis to determine the independent validity of each domain to predict outcomes of interest.ResultsWe identified four broad domains: logical reasoning and problem solving, understanding people, communication skills, and biomedical science. Each was independently and significantly associated with performance in final medical school examinations.ConclusionsWe identified two potential errors in the design of admissions schema that can undermine their validity: focusing on tools rather than outcomes, and including a wide range of measures without objectively evaluating the independent contribution of each. Both could be avoided by following a process of programmatic assessment for selection.

The role of personality in the prediction of medical school performance

Attitudes are mental representations that help to explain why stimuli evoke positive or negative responses. Until recently, attitudes were often thought of as associations in memory. This idea inspired extensive research on evaluative conditioning (EC) and implicit evaluation. However, attitudes can also be seen as propositional representations, which, unlike associations, specify relational information and have a truth value. We review research on EC and implicit evaluation that tested the basic tenets of the propositional perspective on attitudes. In line with this perspective, studies show that both phenomena are moderated by relational and truth information. We discuss implications for the prediction and influencing of seemingly irrational behavior such as excessive alcohol intake and implicit racial bias.

Learning strategies, study habits and social networking activity of undergraduate medical students.

ObjectivesTo determine learning strategies, study habits, and online social networking use of undergraduates at an Irish medical school, and their relationship with academic performance. MethodsA cross-sectional study was conducted in Year 2 and final year undergraduate-entry and graduate-entry students at an Irish medical school. Data about participants’ demographics and educational background, study habits (including time management), and use of online media was collected using a self-report questionnaire. Participants’ learning strategies were measured using the 18-item Approaches to Learning and Studying Inventory (ALSI). Year score percentage was the measure of academic achievement. The association between demographic/educational factors, learning strategies, study habits, and academic achievement was statistically analysed using regression analysis. ResultsForty-two percent of students were included in this analysis (n=376). A last-minute “cramming” time management study strategy was associated with increased use of online social networks. Learning strategies differed between undergraduate- and graduate-entrants, with the latter less likely to adopt a ‘surface approach’ and more likely adopt a ‘study monitoring’ approach. Year score percentage was positively correlated with the ‘effort management/organised studying’ learning style. Poorer academic performance was associated with a poor time management approach to studying (“cramming”) and increased use of the ‘surface learning’ strategy. ConclusionsOur study demonstrates that effort management and organised studying should be promoted, and surface learning discouraged, as part of any effort to optimise academic performance in medical school. Excessive use of social networking contributes to poor study habits, which are associated with reduced academic achievement.

Impact of Pre-Matriculation Instruction on Student Acculturation and First-Year Academic Performance in Medical School

The Texas A&M University Health Science Center College of Medicine recently implemented a pre-matriculation program (MedCamp) for a targeted group of first-year students. This pilot study was conducted to correlate the MedCamp experience with academic performance in the first-year biomedical science disciplines in gross anatomy, histology, physiology, biochemistry, and genetics. The academic performance of students who participated in MedCamp was compared with that of students who did not participate in MedCamp. The components of this 4-week MedCamp included activities geared toward preparing students for the rigor of the medical curriculum, social and professional expectations as medical students, and insight into areas for improvement. Twenty-four students participated in MedCamp. Students ranged in age from 21 to 51, with 10 females and 14 males that represented many ethnic groups, and had an average MCAT score of 29.17 and overall BCPM (biology, chemistry, physics, and math) GPA of 3.61. Quantitative analyses of overall performance in the first three basic science foundation blocks indicated that the MedCamp participants did not show a significant difference in performance when compared with their peers (two tailed t tests, α = 0.05). Qualitative results were positive from the participants, highlighting expectations, acculturation, mentorship, and professionalism.

Ethically Related Decisions in Different Scenarios of Medical School Applicants for Graduate‐Entry Program

Assessment tools for non-academic qualities such as ethics frequently employ hypothetical scenarios to lay out a contextual framework underlying the corresponding criteria of assessment. Due to the context-specific nature of the assessment criteria, details of the scenarios become very important in obtaining accurate results. This study aims to explore how medical school applicants differ in ethical decision making depending on the types of ethical dilemma scenarios, and how they correlate with academic achievements after admission. In 2014, all 82 applicants invited for an admission interview for a graduate-entry program were asked to complete a questionnaire comprised of 13 hypothetical scenarios. There were three domains (unethical business decisions, unethical academic decisions, and sexual quid pro quos) and participants were made to choose between the profitable-but-unethical choice or the unprofitable-but-ethical choice, using a four-point Likert-type scale. On average, tendencies toward unethical decisions were lowest for sexual favors (1.34±0.46), and highest for gaining academic advantages (2.22±0.56). Unethical decisions for academic advantages and sexual benefits showed significant correlation respectively with the female gender and those who graduated from overseas universities. In addition, the propensity for choosing unethical academic decisions was significantly correlated with high academic achievements in medical school (r=0.396). Not only does this study demonstrate that different levels of ethical decision making depend on the scenarios, but also those differences may be a determinant factor in subsequent academic performances in medical school. In conclusion, given the possible influence of the details of the hypothetical scenarios to the applicant’s responses, careful consideration must be given during their development.

Predictors of Undergraduate and Postgraduate Clinical Performance: A Longitudinal Cohort Study

Though many medical schools applied various admission criteria in the selection process, the evidence of using those criteria is unclear. This study examined the predictive validity of each admission criterion for student competency. We conducted a prospective cohort study of all students who matriculated to Seoul National University School of Medicine from 2002 to 2008. Demographic characteristics, admission criteria scores, and clinical competencies based on grade point average (GPA), objective structured clinical examination score, and internship score were obtained for each student to analyze the predictive validity of admission criteria. Graduate GPA at the end of 4 years positively correlated with preadmission GPA (p < 0.0001) and written test score (p = 0.012) but negatively correlated with essay test (p = 0.049). Internship score significantly correlated with preadmission GPA and graduate GPA. Regression analysis revealed that the preadmission GPA of the affiliated college and young age at admission could predict GPA, and preadmission GPA and graduate GPA could predict the internship score, which indicates postgraduate clinical performance. These findings suggest that preadmission GPA is a reliable predictor of academic achievement during medical school and postgraduate clinical performance. For assessing nonacademic competencies, further research is needed.

The effect of curriculum sample selection for medical school

In the Netherlands, students are admitted to medical school through (1) selection, (2) direct access by high pre-university Grade Point Average (pu-GPA), (3) lottery after being rejected in the selection procedure, or (4) lottery. At Radboud University Medical Center, 2010 was the first year we selected applicants. We designed a procedure based on tasks mimicking the reality of early medical school. Applicants took an online course followed by an on-site exam, resembling courses and exams in early medical school. Based on the exam scores, applicants were selected or rejected. The aim of our study is to determine whether curriculum sample selection explains performance in medical school and is preferable compared to selection based on performance in secondary school. We gathered data on the performance of students of three consecutive cohorts (2010–2012, N = 954). We compared medical school performance (course credits and grade points) of selected students to the three groups admitted in other ways, especially lottery admissions. In regression analyses, we controlled for out of context cognitive performance by adjusting for pu-GPA. Selection-admitted students outperformed lottery-admitted students on most outcome measures, unadjusted as well as adjusted for pu-GPA (p ≤ 0.05). They had higher grade points than non-selected lottery students, both unadjusted and adjusted for pu-GPA (p ≤ 0.025). Adjusted for pu-GPA, selection-admitted students and high-pu-GPA students performed equally. We recommend this selection procedure as it adds to secondary school cognitive performance for the general population of students, is efficient for large numbers of applicants and not labour-intensive.

The Association Between Premedical Curricular and Admission Requirements and Medical School Performance and Residency Placement

The curricular elements of undergraduate premedical education are the subject of an ongoing debate. The Warren Alpert Medical School of Brown University (AMS) matriculates students via the traditional premedical route (TPM) and an eight-year baccalaureate/MD program-the Program in Liberal Medical Education (PLME)-which provides students with a broad and liberal education. Using the juxtaposition of these two admission routes, the authors aimed to determine whether there is an association between highly distinct premedical curricular and admission requirements and medical school performance and residency placement. The cohorts studied included all of the PLME (n = 295) and TPM (n = 215) students who graduated from the AMS between 2010 and 2015. Outcome variables consisted of multiple measures of medical school performance, including standardized multiple-choice examination scores and honors grades, and residency placement. The authors employed unadjusted tests of averages and proportions (independent t tests and chi-square tests) to compare variables. The TPM students attained marginally, but statistically significantly, higher average scores on standardized multiple-choice examinations than their PLME counterparts. The number of undergraduate premedical science courses completed by PLME students accounted for less than 4% of the variance in key metrics of medical school performance. The residency placement record of the PLME and TPM cohorts proved comparable. These findings suggest that the association between medical school performance and residency placement and undergraduate premedical curricular and admission requirements is weak. Further study is needed to determine the optimal premedical preparation of students.

Going beyond the situational judgment test: the true impact of the educational performance measure, publications, and extra-degree performance on the foundation program application.

Dear editor We read with great interest the expert opinion of Singagireson et al and agree with the key points raised.1 However, this can be seen to be only one part of the multidimensional foundation program application. It is important to add that we feel there are multiple inequitable components that impact on UK medical students’ foundation program application. The author emphasizes that the situational judgment test (SJT) and medical school performance make up two points of the application performance; however, there are two factors that have a larger-than appreciated impact on the foundation program application – “PubMed-referenced publications” and additional degrees (eg, an intercalated BSc or PhD).2 The author raises the question of significant disparities between the opportunities available at medical schools across the UK. This is clearly shown in the national variability in intercalation opportunities – some medical schools offer compulsory BSc-intercalated programs, whereas some schools offer only intercalated degrees to up to a maximum of one-fifth of their students.3,4 Similarly, the foundation program accepts applications from postgraduate medical students who may have previous masters or even PhDs. There are up to five points available for an extra degree in the foundation program application, out of 100; the presence of a PhD adds five application points, with a Master’s or Bachelor’s degree contributing up to four points.2 In addition, publications are valued at up to two points in the foundation program application where one point is available for each PubMed-referenced publication a student has authored, up to a maximum of two points.2 It can be argued that the skills learnt from extra degrees give medical students a far greater opportunity to do research and publish work in a particular field.5 Thus, individuals who have been given an opportunity to study for an extra degree are at an advantage in more than one way when approaching their foundation program application.

Academic Performance of Students in an Accelerated Baccalaureate/MD Program: Implications for Alternative Physician Education Pathways.

Over one-third of U.S. medical schools offer combined baccalaureate/MD (BA/MD) degree programs. A subset of these truncate the premedical phase, reducing total time to the MD degree. Data comparing educational outcomes of these programs with those of conventional pathways are limited. The authors reviewed demographic characteristics and medical school performance of all 2,583 students entering Northwestern University Feinberg School of Medicine from 1999 to 2013, comparing students in the Honors Program in Medical Education (HPME), an accelerated seven-year program, versus non-HPME medical students. They evaluated Alpha Omega Alpha (AOA) selection, quintile performance distribution from the Medical Student Performance Evaluation, United States Medical Licensing Examination (USMLE) scores, and Match outcomes. A total of 560 students (21.7%) entered through the HPME. HPME students were on average 2.2 years younger and less likely (15/537 [2.8%] versus 285/1,833 [15.5%]) to belong to a racial/ethnic group underrepresented in medicine. There were no significant differences in AOA selection, quintile performance distribution, or USMLE scores. More HPME students entered internal medicine (161/450 [35.8%] versus 261/1,265 [20.6%]), and fewer chose emergency medicine (25/450 [5.6%] versus 110/1,265 [8.7%]) and obstetrics-gynecology (9/450 [2.0%] versus 67/1,265 [5.3%]). The academic performances of medical students in the two programs studied were equivalent. Accelerated BA/MD programs might play a role in ameliorating the length and cost of a medical education. The academic success of these students absent the usual emphasis on undergraduate GPA and Medical College Admission Test scores supports efforts to redefine medical student selection criteria.

A test of Myers - Briggs type indicator in health professions: A literature review

Myers -Briggs Type Indicator (MBTI) has been widely used in medical education in specialty choice, academic achievement, academic performance appraisals and management research. The objective of this review is to study the literature on the application of MBTI in health professions. In this review, it has been found that MBTI mostly used in specialty choice but with the assurance, it cannot be said that in medical education which personality type performs better, and in a specific specialty and subspecialty which personality type predicts student's interest. In general, the MBTI does not seem to be a valuable tool in predicting specialty choice, academic performance and academic achievement in medical school and in predicting physician and other health professions job satisfaction.

Predicting Medical Student Success on Licensure Exams

Many schools seek to predict performance on national exams required for medical school graduation using prematriculation and medical school performance data. The need for targeted intervention strategies for at-risk students has led much of this interest. Assumptions that preadmission data and high stakes in-house medical exams correlate strongly with national standardized exam performance needs to be examined. Looking at prematriculation data for predicting USMLE Step 1 performance, we found that MCAT exam totals and math-science GPA had the best prediction from a set of prematriculation values (adjusted R2 = 11.7 %) for step 1. The addition of scores from the first medical school exam improved our predictive capabilities with a linear model to 27.9 %. As we added data to the model, we increased our predictive values as expected. However, it was not until we added data from year 2 exams that we started to get step 1 prediction values that exceeded 50 %. Stepwise addition of more exams in year two resulted in much higher predictive values but also led to the exclusion of many early variables. Therefore, our best step 1 predictive value of around 76.7 % consisted of three variables from a total of 37. These data suggest that the preadmission information is a relatively poor predictor of licensure exam performance and that including class exam scores allows for much more accurate determination of students who ultimately proved to be at risk for performance on their licensure exams. The continuous use of this data, as it becomes available, for assisting at-risk students is discussed (251).

The Foundation Programme application: an alternative to the Situational Judgement Test.

Dear editor We read with great interest the article by Singagireson et al on the fairness of the Situational Judgement Test (SJT) as a method for ranking medical students applying to the UK Foundation Programme.1 The SJT assesses the applicant’s approach to hypothetical, yet realistic, situations which could be encountered by a newly qualified, Foundation Year 1 (FY1) doctor. To perform well, applicants should be familiar with the roles and responsibilities of an FY1 doctor. However, as the SJT is not an assessment of clinical knowledge, revision is difficult and therefore students aiming to do well cannot necessarily rely on extensive preparation. Many would argue that this is unfair. The lack of correlation between the performance at medical school and the performance in the SJT is also worrying.2 We strongly believe that students who excel in medical school should excel as doctors since the curricula of all UK medical schools are individually approved by the General Medical Council – the organization which sets standards for doctors and oversees their education and training. Accordingly, we believe that the SJT should be replaced by an assessment that correlates more strongly with performance in medical school. This is likely to be the one evaluating the clinical knowledge of the candidates. We find it difficult to understand why this would pose a problem as the SJT is essentially used as a tool to compare medical students across the country. An additional advantage of using such an assessment is that students are better able to prepare for it. Another alternative to the SJT is to interview and subsequently score all Foundation Programme applicants. However, due to the vast number of candidates every year, this is unlikely to be practical. Nevertheless, we feel that it is important for all medical students to have good insight into the role of an FY1 doctor and therefore an assessment similar to the SJT could perhaps be integrated into undergraduate medical education as a summative examination.