Effectiveness of selection in medical school admissions: evaluation of the outcomes among freshmen

Context In 2000 our medical school introduced a selection procedure (SP) for 10% of the otherwise randomly selected (RS) applicants. Students with excellent high school grade point averages (GPAs) were allowed direct access (DA) to our medical school. The selection procedure focused on medical comprehension, social and ethical understanding of health care, and communication and interpersonal skills. Objectives We aimed to establish how SP students compared with RS and DA students on motivation, academic achievement, study behaviour and extracurricular activities, and how these variables were interrelated within these groups. Methods In 2003, all Year 1 and 2 students were given a questionnaire on motivation, study behaviour and extra‐curricular activities. Primary year GPAs were obtained from our administration department. Student groups were compared using descriptive statistics. The interrelationship between outcomes was tested using structural equation modelling. Results The questionnaire was returned by 418 students (76%). Selection procedure students were significantly more highly motivated (59.4) than RS students (56.6) and DA students (52.1). This was not reflected in academic achievement (6.7), which was highest among DA students (7.2). Selection procedure students carried out more extra‐curricular activities, often health care‐related, and displayed more study behaviour. Academic achievement could not be explained by motivation and study behaviour but motivation affected study behaviour and health care‐related extra‐curricular activities. Conclusions The more profound commitment of selected students to health care is not primarily reflected in academic achievement but in motivation, extra‐curricular activities and study behaviour. Follow‐up research including all pre‐clinical and clinical years should demonstrate the stability of these characteristics and their effects on graduates' post‐qualification clinical performance as practising doctors.