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Australian Journal of Social Issues Vol. 21 No. 3, August 1986. pp. 228-232.
PERSONAL QUALITIES OF STUDENTS SELECTED FOR ENTRY TO MEDICAL SCHOOL
Jake M. Najman, Murray Davis and John J. Ray
The ability to pass examinations has long been the sole criterion for entry to medical school. In these circumstances, are those who are presently being selected into medical courses the students who will make the best doctors, given the needs of the community as a whole? Is academic ability both a necessary and sufficient quality of those who become the community's doctors?
This research investigates the consequences of the selection procedures used in a large Australian medical school. Specifically it examines some personal qualities of students in first year medicine and compares these with the qualities of students who are enrolled in computer science, English and sociology.
Personal Qualities of Medical Students
A number of writers have suggested various personal qualities, in addition to ability, which medical practitioners should manifest. Magraw (1973, p.44) for-example has emphasised the importance of such qualities as humaneness, humanitarianism and humanism in proper medical care.
In a recent report on medical education the Queensland Medical Board (MBBS Evaluation Committee 1981, p.82-83) stipulated five essential features of the desirable medical practitioner. These were a commitment to the practice of medicine, a concern for patients, a sense of responsibility, a critical, questioning approach, and receptivity to new ideas.
In this report we select a small number of values and determine whether medical students have these qualities in greater or lesser measure than students from other faculties.
Methods and Results
Questionnaires were distributed to first year students, over a two week period, in four different courses. Clearly the response rate for students of medicine was the best. The response rate for the English students, while undoubtedly the lowest is not as poor as it may seem in Table 1. The figure of 286 represents the total number of students enrolled in two first-year subjects. Many students were enrolled in both subjects which makes the total number of individuals fewer.
Table 1
Comparison of Students Enrolled to Students Sampled
Groups...................Enrolled.......Sampled.....Response Rate (%)
Medicine 1.................220...............212..............96
Sociology 1................285...............158..............54
English 1....................286................90...............31
Computer Science I....228..............109...............49
N =...........................1019...............569..............56
Medicine students were generally younger than other students. Computer science students were predominantly male while sociology and English students were predominantly female.
The complete questionnaire contained 112 items. A balanced Ambition scale of 20 items was created containing such items as: 'Do you take the trouble to cultivate people who may be useful to you in your career?' (27 % yes, Scale alpha =.73, mean r=.12). Ambition scores were uncorrelated with the demographic characteristics of the respondents.
A twelve-item Deferment of Gratification scale was created. A typical item is: 'Are you good at saving your money rather than spending it straight away?' (47% yes, Scale alpha=.70, mean r=.15).
Third, an Altruism scale was created with items such as: 'Do you tend to give money to beggars if they approach you?' (36% yes, Scale alpha=.68, mean r=.15). Altruism is strongly related to the gender of the respondent, with females having higher Altruism scores than males (Table 2)
Table 2
Altruism and Intellectual Interest by Gender
..........................................................................Males...Females
Percentage High Altruism*................................... 37........50
Percentage High Intellectual interest....................39........53
N.........................................................................269.......309
*Kruskal Wallis p <.01
Fourthly, an intellectual interest scale of eight items was created. A typical item was: "Does the idea of getting involved in research of some kind appeal to you?' (66% yes, Scale alpha=.70, mean r=.22).
Table 3 compares the student groups on the four value scales. Computer science students are less ambitious than other students.
Table 3
Mean Scale Scores for Students from Four Faculties and Four Value Scales*
(Multiple Classification Analysis)
...............................Ambition..........Defer. Grat. .......Altruism....Intellectual Int.
Medicine I...................23.5................23.1....................23.1............22.9
Sociology I..................23.2................23.2....................23.7............24.9
English I.....................23.4................22.0....................22.9............24.5
Computer Science I....22.1................23.2....................22.0............22.7
................................p <.01..................NS...................p <.01.........p <.001
*F ratio is used to test the significance of differences
There are, surprisingly, no differences between the student groups on the Deferment of Gratification scale. Sociology students appear to be the most, and Computer science students the least Altruistic. Given the manner in which Intellectual Interest has been conceptualised (general interest in contemporary issues) in this paper it is not surprising that Sociology and English students score highly while medicine and computer science students score poorly.
The differences in Table 3 do not take into account age and gender differences between the student groups. Table 4 compares the student groups with adjustment for age and gender differences.
Table 4
Mean Scale Scores for Students from Four Faculties on Four Value Scales Adjusted for Gender and Age Differences Between Student Groups*
(Multiple Classification Analysis)
...............................Ambition......Defer. Grat...........Altruism.......Intellectual Int
Medicine I..................23.7..............23.4......................23.4................23.3
Sociology I.................23.1..............23.0......................23.4................24.8
English I.....................23.3..............22.1......................22.6................24.2
Computer Science I...22.3..............23.3......................22.5................23.0
.................................p <.01..............NS........................NS.................p <.05
*F ratio is used to test the significance of differences
Medicine I students emerge as the most Ambitious group in the study while computer science students are the least ambitious. Again students do not appear to differ in their Deferment of Gratification. Previously observed differences in Altruism are virtually eliminated with adjustment for age and gender, with Medicine and Sociology students manifesting apparently similar levels of Altruism. Adjustment also reduces but does not eliminate previously observed differences in scores on the Intellectual Interest scale.
Discussion
The findings raise some issues warranting further discussion. At the University of Queensland, selection for entry to medicine is almost solely according to academic merit, largely in science based subjects. It is sometimes suggested that such a system of selection is 'efficient' as it produces the largest number of graduates with the least likelihood of repeating years of study. While the merits of this claim are arguable, the emphasis on academic merit has a number of perhaps unintended consequences.
In 1984, the year the data were collected, 220 students were enrolled in Medicine I. In comparison to the population at large such students were more often male, young and from upper class backgrounds. When we examine the personal qualities of these students, they appear appropriately ambitious but score poorly on the Intellectual Interest scale. It could also be argued that medical students should be more altruistic than other students (there are no differences in the adjusted comparisons on the Altruism scale). Thus, at the present time, the primacy that is given to academic ability selects students who score more poorly than might be desired on some personal qualities.
In the above context the true 'efficiency' of present selection procedures is in doubt. While few would wish to question the need to select able and competent students, the present issue seems to be whether a slightly lesser concentration on ability (say students in the top 5-10 per cent academically rather than 1-2 per cent as at present) might provide a pool of students with more desirable personal qualities. Arguments against such a selection change are of three types. Firstly, a lowering of the standard at entry would produce less able practitioners. Secondly, higher failure rates will increase teaching costs and perhaps reduce the number of available graduates. Thirdly, it is suggested that it is presently not possible to validly select for some important personal qualities. Each of these propositions is arguable, and together they appear an unconvincing group of rationalisations for inactivity on an issue of major community concern.
Conclusion
The impact of selection procedures on the personal qualities of medical students at Queensland University has been assessed. By contrast with some other students, medical students appear ambitious and less likely to report a broad based set of intellectual interests but are otherwise little different. Current selection procedures are insensitive with respect to altruism. It is possible to argue that selection procedures should attract medical students who are more altruistic than other students. This could possibly be achieved by selecting more female students or, one supposes, students who have manifestly demonstrated their altruism. Changes in the selection process which might produce the above end are clearly worthy of further consideration.
References
Gjesme, T. (1979), 'Future Time Orientation as a Function of Achievement Motivation, Ability, Delay of Gratification, and Sex' Journal of Psychology, 101, 173-188.
Magraw, R. M. (1973), 'Science and Humanism' in Bulgar, R. J. (ed), Hippocrates Revisited, New York: Medcom Press.
MBBS Evaluation Committee Report (1979), Brisbane: University of Queensland.
Wispe, L. G. (1972), 'Positive Forms of Social Behavior: An Overview', Journal of Social Issues, 28(3), 1-21.
For further information about the research reported here contact Dr. J. M. Najman, Departments of Anthropology and Sociology and Social and Preventive Medicine, University of Queensland, St Lucia, Queensland 4067.
POST-PUBLICATION ADDENDUM
See also:
Ray, J.J. & Najman, J.M. (1986) The generalizability of deferment of gratification. Journal of Social Psychology 126, 117-118.
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