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1. Advances inHealthSciences Education 1: 3-16, 1996. 3
( 1996 Kluwer Academic Publishers. Printedin the Netherlands.
Admission to Medical School:
International Perspectives
JANINE C. EDWARDS*, EUGENE K. JOHNSON and JOHN B. MOLIDOR
*MedicalCollege ofWisconsin, 8701 WatertownPlank Road, Milwaukee, Wisconsin53226, U.S.A.
Abstract.Admission to medical school is thegoal of many students inmany countries. Theadmission
process varies from country to country. In some countries, students compete in an open market togain
a position in medical school. In other countries, "intake" is a more routine, planned beaureaucratic
process. Where competition reigns, the interview is an important part of the selection process. The
interview has been defined by Bingham and Moore [1] as:
A serious conversation directed to a definite purpose other than satisfaction in the conversation
itself... We mustrecognize that notonly spoken words, but othermeans of face-to-face communication
also are used. Inflection, qualities of voice, facial expression, glint of the eye, posture, gestures, and
general behavior supplement what issaid. They allcontribute to thepurposeful exchange ofmeanings
which is the interview.
Faculty members in medical schools interview patients all the time. This type of interview,
however, is different from the admission interview conducted for applicants to medical school.
Patient interviews are highly patterned and structured to obtain specific information. Interviews of
applicants, on the other hand, usually are more open-ended. The psychology of the two types of
interviews differ also. Applicants to medical school, ifaccepted, will in time become colleagues with
their interviewers and willhave increasing levels of responsibility and respect. Patients, however, will
always be dependent upon the physicians who treat them.
In this article, we present basic facts, conclusions, and recommendations from a review of
literature about the interview [2]. Results of a survey of admission interviews at Canadian and
United Kingdom medical schools arepresented for the first time, and comparisons with United States
interview practices are drawn. Finally, descriptions of the selection process at several medical schools
with problem based learning curricula are provided and comparisons are noted.
Key words: admission, medical education, problem-based learning
Purposes of Interviewing
Interviewing applicants to medical school can serve four purposes: 1) gathering
information; 2) making the decision to accept or reject; 3) verifying information
provided in the application; 4) recruiting particular applicants. Gathering informa-
tion may be the most important purpose of interviews. Quantitative information,
such as transcripts and background information, is obviously gathered most expedi-
tiously by paper or by computer. The more elusive information, such as motivation,
leadership, altruism, and interpersonal skills, referred to by McGaghie [3] as non-
cognitive information or nonacademic information, is best evaluated in interviews.

2. JANINE C. EDWARDS ET AL.
A serious, face-to-face conversation can probably reveal more non-cognitive infor-
mation about an applicant than any other form of evaluation.
Purposes of the interview may be weighted differently for various groups of
applicants. There is no legal impediment to evaluating different subgroups by
different criteria because these subgroups are self-selected; that is, their credentials
are the basis for inclusion in the subgroup. However, all individuals within a
subgroup must be treated consistently. The interview will be most effective if it is
tailored to fulfill various purposes.
Decision making, of course, is the end result of the application process. Most
medical schools make decisions after gathering written and interview information.
The written information is usually reviewed first and then invitations to interview
are issued on the basis ofthe written information. Decisions to accept or reject are
a combination ofall the available information.
Verifying information is another important function of interviewing. Checking
out the veracity of information provided in personal statements, autobiographical
sketches, secondary information materials, and the like can be done during the
course of interviews. By linking the interview to the initial review of application
materials, the admissions committee can doublecheck or verify the authenticity of
what has been presented.
Finally, the interview can serve a recruitment function. Many medical schools
want to recruit particular types of applicants or to generate good will toward the
school. The interview is usually regarded as the centerpiece of an applicant's visit
to a medical school. If the applicant is treated well during his/her visit and is
encountered with respect and dignity, the school is more likely to attract desirable
candidates. For applicants with top academic qualifications, interviewers may wish
to focus first on determining whether the person has the necessary personality and
character traits to become a physician. After that determination is made positively,
the interviewers may wish to focus on recruiting the applicant.
For the large pool ofaverage candidates, the interviewers may focus on obtaining
non-cognitive information and verifying the written information. Making fine dis-
tinctions about character and personality among large numbers of applicants who
have similar academic qualifications is a worthwhile endeavor. Ruling out candi-
dates requires a somewhat different process. Interviewers skilled in psychological
analysis, such as psychiatrists and psychologists, may be the best interviewers
for candidates who give evidence of psychological problems. Any evidence of
abnormality may trigger additional evaluation.
The interview in the medical school application process will no doubt be used
in different ways depending upon the size of the pool of applicants. Kassebaum
and Szenas [4] described the decline and rise ofthe applicant pool in U.S. medical
schools during the 1980's and early 1990's. They found that the decline of the
applicant pool in the mid-1980's was related to changes in the number and pattern
of undergraduate majors and changes in employment conditions for college grad-
uates at that time. More precisely, employment of college graduates increased at
4

3. ADMISSION TO MEDICAL SCHOOL: INTERNATIONAL PERSPECTIVES
that time; thus, many fewer college graduates were interested in further training
because they could obtain profitable jobs immediately after college. This also may
explain the phenomenon that fewer applicants who were rejected applied to medical
schools a second time. Furthermore, fewer college students were majoring in the
biological and physical sciences, "the most common antecedents ofmedical school
applicants." From 1988 until the early 1990's, the number of medical school appli-
cants rose dramatically. During that period, there was deterioration in employment
of college graduates and the number of degrees awarded in the biological sciences
increased. Repeat applications also increased during this period. Therefore, trends
in college majors and employment of college graduates seem to be related to the
decline and rise of applications to U.S. medical schools during the past decade.
At the current time, the applicant pool in the U.S. is at an all time high. The
interview is particularly helpful in choosing among all the academically qualified
applicants those who most closely match the desired characteristics or the ethos
ofthe medical school. That requires, however, that the admissions committee have
done some careful analysis of the criteria for selection and for interviewing. Struc-
turing the interview is the most productive method of ensuring that the applicants
who are most desirable are, in fact, chosen.
To summarize then, the interview can serve various purposes. Itcan be weighted
differently as a result of the size of the applicant pool, and different subgroups of
the applicant pool may be evaluated in different ways within the interview. All
individuals within a subgroup must be treated consistently. Gathering information,
verifying information, recruiting individuals, and making the decision to accept or
reject are all useful purposes of the interview.
Interview Formats
Several formats of interviews are possible, including 1) one-on-one; 2) group;
3) panel; and 4) combination. The one-on-one interview is self-explanatory. The
group interview consists of several interviewees and one interviewer. The panel
interview is conducted by many interviewers with one applicant. The combination
interview might consist, for instance, ofa one-on-one interview followed by a panel
interview.
Types of Interviews
Three types of interviews have been identified and researched: structured, semi-
structured and unstructured. To be considered structured, an interview must meet
these criteria: 1) interview content is developed from ajob analysis or what we call
a Success Analysis ofMedical Student (SAMS); 2) the questions are standardized;
that is, the same questions are asked of every applicant; 3) sample answers to the
questions are provided to the interviewers to help them give consistent ratings; 4) a
panel interview is conducted. Interviews that have some, butnot all, ofthese criteria
5

4. JANINE C. EDWARDS ET AL.
are termed semi-structured. Interviews that have none of these criteria are called
unstructured. Research studies during the 1980's indicated that adding structure
improves the validity and reliability ofinterviews.
The key to improving the validity ofinterviews is structuring the content, which
is accomplished by conducting a job analysis or Success Analysis of Medical
Students (SAMS). A SAMS ensures that all interviewers focus their questions on
the agreed upon content or objectives. Two methods of conducting a SAMS are
described here - the Critical Incidents Technique and the Delphi Method. Other
methods of forming consensus are possible, ofcourse.
The Critical Incidents Technique consist of "a set of procedures for collecting
direct observations ofhuman behavior in such a way as to facilitate their potential
usefulness in solving practical problems and developing broad psychological prin-
ciples" [5]. To conduct a SAMS using critical incidents, medical school faculty
members would reflect on and write critical incidents of medical students. These
incidents are typically recollections of actual events, those that reveal successful
and unsuccessful behaviors, attitudes, and performance. Approximately 50 to 200
critical incidents are needed to adequately describe the objectives of medical stu-
dents. After the incidents have been written as descriptions, these are edited for
clarity. Then a second group ofexperts reads the critical incidents and groups them
into a few major categories. Any critical incidents on which the experts disagree
are discarded. Finally, within each category, the incidents are scaled from high
(effective) to low (ineffective) values. The resulting set of categories and critical
incidents define the objectives of medical students and provide the content upon
which to develop questions in the interview. A study that developed critical inci-
dents for interviewing applicants to medical school was completed by Johnson
[6].
The Delphi Method is a method of structuring a group communication process
so that a group of individuals, as a whole, deal with a complex problem. In the
1950's the Rand Corporation developed the Delphi Method to forecast technology
futures [7, 8]. This method was widely used throughout the 1960's and 1970's as
a consensus building method. The Delphi Method is useful when a group is too
large to meet in person to carry out a nominal group process or when it would be
too inconvenient to do so. More specifically, the Delphi Method is valuable when
the problem can benefit from subjective judgment on a collective basis; individuals
have diverse expertise, disagreements need refereeing, for individual heterogeneity
must be preserved. Medical school faculty members with their time constraints
certainly meet these conditions, making the Delphi Method a feasible method of
forming consensus among them. The first step in the Delphi Method is to generate
ideas through a paper and pencil questionnaire from the group as a whole or from
a subgroup. Then the entire group assigns a priority score to each item through
ranking or through the use of the Likert scale. Several such rounds of assigning
priority are usually necessary before consensus develops about a core of items or
objectives.
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5. ADMISSION TO MEDICAL SCHOOL: INTERNATIONAL PERSPECTIVES
Another method of improving the validity of interviews is to standardize the
questions asked of every applicant. This ensures that the same material is covered
in every interview and that one applicant's chance ofbeing accepted is not impaired
or boosted by lack of key data or influx of extraneous information. Some faculty
members have suggested that standardized questions would soon be memorized
and passed on to applicants through "the grapevine." Standardized questions could
have enough variations that this "copying" problem would not be likely to occur.
Interrater reliability can be improved by providing each interviewer with sam-
ple answers for each level of performance for the categories. Sample answers are
usually "behavioral anchors," that is, behaviors describing a level of performance.
Thus, for the category of interpersonal skills, there might be six levels of perfor-
mance, with anchors such as "establishes rapport with a variety of people" (high
rating) and "frequently alienates people" (low rating).
Research studies on the validity and reliability of interviews using classic mea-
surement theory have found that panel interviews yield greater reliability than
one-on-one interviews. Panel interviews eliminate much of the interrater variance.
More recently, generalizability theory has pointed out that a researcher should
attempt to identify all the likely sources of error in a measurement situation rather
than trying to minimize sources of error as a panel interview does [9]. Therefore,
generalizability theory would encourage us to conduct multiple one-on-one inter-
views rather than one panel interview in order to arrive at a true measurement of
the applicant. If it is not feasible for an admissions committee to conduct multiple
one-on-one interviews, then the recommendation to conduct one panel interview
is useful.
Recommendations from Research
Relatively little research has been done on the interview in medical education. We
do know, however, that focusing on nonacademic interview data influenced the
decision of admission committees to select more applicants with high ratings on
attributes such as leadership, motivation, range ofinterests, and interpersonal skills
[10-13]. Some slight evidence exists that the selection interview that emphasizes
nonacademic criteria predicts success in clinical training [14-17].
A large body of research in the psychology and business literature, however,
has developed a number of sound recommendations about the interview. For many
years, psychology researchers studied the various types of bias in what are now
referred to as "indirect" or "microanalytic" studies [18]. Webster [19] initiated this
line of research because he believed that many microbased social psychological
factors moderate the validity ofthe interview. A number ofuseful findings resulted
from this long line of research.
Bias can arise from a number of sources, including, but not limited to, rater
tendencies, stereotyping, and interviewer background. The following findings are
supported by research:
7

6. JANINE C. EDWARDS ETAL.
1. Unfavorable information carries more weight than favorable information [20-
22].
2. Rating errors, including the halo effect and distribution errors (leniency, sever-
ity, central tendency) can be corrected. These tendencies may be reduced
by manipulating scale formats, such as using an even number of points on
the scale, by making raters aware of their tendencies or by using statistical
corrections [23].
3. Gender differences exist in interview ratings. Women are rated lower by both
male and female interviewers [24-27].
4. Nonverbal, as well as verbal interactions, influence decisions [28-30].
5. Interviewers develop a stereotype of a good applicant and then try to match
the candidates to the stereotype [30].
6. An average candidate following several outstanding (or marginal) applicants
will be rated worse (or better) in comparison. This is called the "contrast
effect" [30].
Several research reports indicate that training interviewers can improve per-
formance in interviewing [30]. Training, of course, does not directly affect the
decision to accept or reject applicants into medical school. Schuh [31] describes
three dimensions ofa good training program: instruction, coaching, and supervised
practice. Wexley and colleagues [32] gave workshops to college students, and
Latham and colleagues [33] trained corporate managers using these dimensions.
Keenan [34] found that interviewers with training were more confident and that
candidates were more likely to accept jobs with firms whose interviewers were
trained.
Recently, psychology researchers have shifted emphasis from the microanalytic
variables that had been thought to moderate interview validity to direct models
of validity. Interview structure is a major variable that has been found to directly
affect validity. A number of studies (both individual studies and meta-analyses)
of structured interviews give evidence that validity and reliability are higher than
that ofsemi-structured or unstructured interviews. However, validity and reliability
figures for semi-structured interviews are higher than unstructured interviews and
even approach those of structured interviews. Review ofthe data that support these
conclusions are presented in a previous publication [2]. In practical terms, this
means that admissions committees can achieve greater validity and reliability in
their interviews by using only one or two of the criteria for structured interviews,
such as performing a SAMS or using behavioral anchors for rating scales. The
unstructured interview has considerably less validity and reliability than structured
or semi-structured interviews.
Several important findings emerged from the review of literature published in
1990, and these continue to be important.
1. Various purposes of the interview may be weighted differently for different
groups of applicants.
2. Bias in the interviewing process can be reduced by training interviewers.
8

7. ADMISSION TO MEDICAL SCHOOL: INTERNATIONAL PERSPECTIVES
3. Adding structure to the interview improves its validity and reliability.
4. Fourmethods ofadding structure have been described: performing a job analy-
sis or SAMS; asking the same questions of all applicants; developing sample
answers or behavioral anchors for rating scales; having multiple one-on-one
interviews or using panel interviews.
Survey of Admission Interviews at Canadianand United Kingdom Medical
Schools
A survey of admission interviews was conducted in United States, Canadian, and
United Kingdom medical schools in late 1989. Information about practices in U.S.
medical schools was published in 1991 [35]; the data from Canadian and United
Kingdom medical schools are presented here for the first time.
METHOD
A questionnaire was developed that asked detailed questions about interview prac-
tices based on variables and practices extracted from research on both medical
school admission interviews and general selection interviews. A previous survey
by Puryear and Lewis also was a source for the questions onthis survey. Staff mem-
bers of the Association of American Medical Colleges (AAMC) and the Student
Affairs National Committee on Admissions of the AAMC reviewed the question-
naire and made suggestions for its development. Pilot tests were made of the first
draft questionnaire with an admission committee member, an admission committee
chair, and a dean of admissions.
RESULTS AND DISCUSSION
Data were received from 12 of 16 (75%) Canadian medical schools and 10 of 28
(36%) U.K. medical schools. The overall response rate for U.S., Canadian, and
U.K. medical schools was 63%.
Nine of the 12 responding Canadian schools and eight of the 10 responding
U.K. schools used interviews. This was somewhat lower than the 98% of U.S.
schools that used interviews. Still, a majority ofmedical schools use interviews in
the selection process.
We asked the question, "Do interviews differ for different types of applicants
(i.e., academically strong vs. weak applicants)?" All of the Canadian and U.K.
schools that responded to this question answered "No." Interviews in the majority
of U.S. medical schools did not differ for different types of applicants either. This
finding may indicate that admission committees are afraid oflegal repercussions if
they evaluate subgroups of applicants differently. There is no legal impediment to
doing so, as we stated earlier in this article, as long as individuals within subgroups
are treated consistently. For example, residents within a defined geographical area
may be evaluated differently than residents of other areas. It is likely that medical
9

8. JANINE C.EDWARDS ETAL.
schools do evaluate subgroups differently, but administrators are aware that the
"socially correct" answer is consistency, and, therefore, give that answer on ques-
tionnaires. Medical schools may be more constrained, because of unfounded legal
fears, in tailoring the interview than they need to be.
The structure of the interview is ofparticular interest as the preceeding sections
ofthis article explain. Ofspecial interest was the question regarding analysis ofthe
characteristics leading to success as a medical student. Of the 12 responding Cana-
dian schools, six (50%) answered that they had analyzed success characteristics, a
figure somewhat higher than the U.S. percentage (42%) that had conducted success
analyses ofmedical students (SAMS). Four ofthe six that had conducted analyses
used the educational mission of the institution and course objectives as a basis
for their analyses; three had used characteristics identified by other institutions or
reported in the literature for their bases. Only one had examined the performance
and records of prior successful students to suggest successful characteristics. Of
the 10 responding U.K. schools, only one answered that it had analyzed success
characteristics; nine (90%) had not done such analyses. Prior to 1990, there were
seven reports from medical schools of semistructured interviews in the literature;
several ofthese reports were from United Kingdom medical schools. Nearly all of
these studies involved some sort of job analysis or SAMS; however, the process
each school used was not described. None of the medical schools reporting semi-
structured interviews in the literature responded to this questionnaire. Therefore,
weknow little about how the content for interviews in U.K. schools is determined.
It would be interesting and valuable to learn more about the content ofthe interview
in U.K. medical schools.
Assessment of language skills can be done quite well in interviews. The vast
majority of U.S. medical schools stated that they did assess language skills in the
interview. The majority ofboth Canadian (66%) and U.K. (80%) schools also stated
that they assessed language skills. Three specific methods of evaluating language
skills were given on the questionnaire and "Other (please explain)" was a fourth
option. The respondents were encouraged to circle as many of the four options as
applied; therefore, the number ofresponses totaled more than 100%. Four Canadian
schools indicated they used directrating oflanguage skills and four did not formally
assess language although extremely good or poor language skills affected the
overall interview rating. Three Canadian schools indicated that their interviewers
rated language indirectly. Only one U.K. school assessed language directly; five
schools did not formally assess language, but extreme skills in either direction
of the continuum would affect interview rating. Three of the ten U.K. responding
schools used language as an indication ofprofessionalism or communication skills.
The number of interviews granted each applicant is of considerable interest.
Interviewing applicants is a time consuming enterprise; faculty members' time is
particularly valuable and the logistics ofarranging interview sessions is complicat-
ed. The majority ofU.K. and Canadian schools (70% in each nation) hold only one
interview for applicants. This contrasts with U.S. schools, the majority of which
10

9. ADMISSION TO MEDICAL SCHOOL: INTERNATIONAL PERSPECTIVES
give two interviews to each applicant. This difference may be accounted for by the
fact that the majority of Canadian and U.K. schools hold panel interviews instead
of one-on-one interviews.
Both physician faculty members and Ph.D. faculty members interview appli-
cants in Canada and the U.K. In the schools from the U.K. responding, students,
residents, alumni members, staff members, and community representatives did not
conduct interviews. In some Canadian schools, all of these types of persons did
interview applicants, as they do in many U.S. schools.
Structuring the questions asked in interviews has been found to increase the
validity and reliability of interviews. Therefore, the extent to which interview
questions were standardized was queried. In Canadian schools, questions seem to
be standardized more than in U.S. or U.K. schools. Three of the ten Canadian
schools indicated that interviewers must ask standard questions; however, addi-
tional questions were permitted. Among the 96 U.S. schools responding, only four
schools had interviewers ask standardized questions. None of the U.K. schools
asked standardized questions; six of the ten schools indicated that interviewers
were not regulated about the questions they asked.
A series of questions were included on the survey to determine whether or to
what extent medical schools had studied their own interview process. Only two
Canadian schools had conducted follow-up studies to evaluate the effectiveness of
the interview in predicting success in medical training; none of the U.K. schools
claimed to have done so. On the other hand, four of 12 (33%) Canadian schools
had assessed the interrater reliability of their interviewers. In contrast, only one
U.K. school out often and 14 of 96 U.S. schools had done so.
Because training interviewers holds the promise of increasing validity and reli-
ability, training interested us. Only two of the ten U.K. schools provided training
for interviewers. Eight ofthe twelve (66%) Canadian schools gave training, and 60
ofthe 96 (almost 66%) U.S. schools gave training to interviewers.
In response to the final summary question on the survey about the degree of
structure in interviews, the majority of U.S. schools indicated that they conducted
loosely or moderately structured interviews. One-third of Canadian schools con-
ducted highly structured interviews; more than half claimed to conduct moderately
structured interviews. Seven of the ten U.K. schools described their interviews as
loosely structured. Schools could circle more than one response to this question;
therefore, the percentages total more than 100%.
CONCLUSIONS FROM SURVEY
We can draw a few conclusions about the process of interviewing in Canadian
medical schools, but due to the low response rate from U.K. schools, we cannot
draw valid conclusions for medical schools in the United Kingdom. The majority
of Canadian medical schools use interviews in the selection process. About half
of the Canadian schools had analyzed the success characteristics of their med-
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10. JANINE C. EDWARDS ET AL.
ical students, a somewhat larger percent than U.S. medical schools. About half of
Canadian schools assessed applicants' language skills either directly or indirectly
in interviews. Seventy percent of Canadian medical schools give one interview to
applicants, but that tends to be a panel interview with several interviewers assess-
ing one applicant. The interviewers in Canada, as in the U.S., include physician
faculty members, Ph.D.'s, students, residents, alumni members, staff members,
and community representatives. Interview questions were standardized in three
of the twelve Canadian schools, a higher incidence of structure than in U.S. or
U.K. schools. More Canadian schools had studied interrater reliability than either
U.K. or U.S. schools although all numbers were far less than majority. Far more
Canadian medical schools provide training to interviewers than do schools in the
United States or the United Kingdom. In general, Canadian medical schools seem
to be more aware ofand also seem to have implemented more of the practices that
research indicates will improve the validity and reliability of interviews. Mean-
ingful comparisons between medical schools in the United Kingdom and other
medical schools await the gathering of more information.
The Admission Process in Problem-Based LearningPrograms
During the past twenty years, problem-based learning has become a major inno-
vation in United States medical schools. The University of New Mexico, Southern
Illinois University, and Harvard University Medical School have all experimented
with problem-based learning curricula. A number of other U.S. medical schools
have also developed problem-based learning programs, either as an alternate cur-
riculum or as the sole curriculum.
McMaster University in Canada is one ofthe few medical schools in the world to
have developed a problem-based learning curriculum as its sole curriculum which
it did from its inception. McMaster, therefore, represents problem-based learning
in a "pure" state. The 1993-94 academic term was the occasion of the twenty-
fifth anniversary of the founding of the McMaster University Faculty of Health
Sciences. As part ofits academic celebration, faculty members and administrators at
McMaster "took alook" in a formal way atmany oftheir educational processes. For
the first time since its creation, the admission process for the problem-based learning
programs in medicine, nursing, and physiotherapy was examined critically. This
critical examination of the McMaster admission process provided an occasion to
examine the admission processes of several U.S. medical schools having problem-
based learning curricula as well. A description ofthe original McMaster admission
process and its current changes, as well as descriptions of the admission processes
of the New Mexico University School of Medicine, Southern Illinois University
School of Medicine, and Harvard Medical School are presented here. Finally, a
few comparisons are noted.
At McMaster University three health science programs developed parallel
admission processes in the 1970's: the undergraduate medical, nursing, and occu-
12

11. ADMISSION TO MEDICAL SCHOOL: INTERNATIONAL PERSPECTIVES
pational therapy and physical therapy programs. Recently, a midwifery program
has been developed with a similar admission process. The first step in the process
is screening of academic qualifications. For the undergraduate medical program,
students must have a minimum grade point average of 3.0 on a 4.0 scale or a letter
grade of"B" in three undergraduate years. A simple (unweighted) and a weighted
grade point average are computed; the higher of the two averages is then used in
the remainder of the process. The undergraduate medical program uses the grade
point average continually in its process; that is, the medical admission committee
seeks to select those students who have the highest academic qualifications and the
best fit of human qualities as well. The nursing program, however, in recent years
has used a "cut score" in its academic screening; once an applicant had satisfied
the minimum grade point average, academic qualifications were not considered
further in the admission process. The second step in the admission process for
all programs is the assessment of the Autobiographical Submission (Auto Sub), a
detailed written document unique to McMaster University. A fine-grained assess-
ment, requiring several hours oftime for each Auto Sub, is done by several faculty
members. Letters ofreference are then screened. Applicants are invited to interview
based upon the preceding process. In the undergraduate medical program, appli-
cants who are interviewed also are assessed as they participate in a problem-based
group simulation. The final step in the admission process is termed "collation,"
which involves a review of the entire file by faculty members and assignment of
a final score to each file. Positions are then offered to those applicants having the
highest collation score.
During the 1980's the Harvard Medical School developed a "hybrid curriculum"
using problem-based learning and other methods as well. The admission process is
the same for all applicants to the medical school. The total application is evaluat-
ed; the admission committee looks for evidence of integrity, maturity, concern for
others, leadership potential, and an aptitude for working with people. Academic
excellence is expected. Academic records and the applicant's essay are evaluated.
Letters of reference are reviewed, and MCAT scores are screened. On the basis
of this entire application, applicants are invited to interview. The admission com-
mittee makes the final selection based on a total and comparative appraisal of the
applicant's suitability for medicine.
The University of New Mexico School of Medicine has two curriculum tracks:
the conventional track and the Primary Care Curriculum (PCC), problem-based
learning program. Candidates apply for admission to the medical school. Ifthey are
admitted and if they desire to enter the PCC, they gothrough an additional admission
process, which includes another interview. The faculty who select students for the
problem-based learning program look for those who have a background giving
evidence of self-guided experiences; frequently these are older, non-traditional
students. Twenty students are selected for the PCC from the total pool of 73
students admitted to the medical school.
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12. JANINE C. EDWARDS ET AL.
Admission to the problem-based learning (PBL) curriculum at the Southern
Illinois University School of Medicine (SIU) also involves a second process. All
candidates use the same application initially. Those candidates who wish to enter
the PBL curriculum submit a supplemental application to the PBL curriculum at
the same time. The PBL applicants are expected to investigate the PBL curriculum
and request a PBL interview. Twenty students are selected each year for PBL based
on their knowledge ofthe PBL curriculum, interpersonal skills and interest in PBL.
These twenty students engage in the PBL curriculum during the first two years; the
third and fourth years ofclinical training are the same for all students.
A few comparisons are immediately evident. McMaster and Harvard have one
curriculum for all students. McMaster's curriculum is "pure" problem-based learn-
ing; Harvard's curriculum contains PBL and traditional curriculum elements as
well. Both of these schools have one admission process. Harvard's essay may be
compared to McMaster's Autobiographical Submission except that the Auto Sub is
more highly structured. New Mexico and SIU both have supplemental admission
processes because these schools have two curriculum tracks. The SIU supple-
mental application bears some resemblance to McMaster's Auto Sub. Southern
Illinois University, however, requires applicants to answer only these two ques-
tions: describe academic, work, or volunteer experience relevant to small group
tutorial process and self-directed learning process whereas McMaster's Auto Sub
is much more detailed.
Problem based learning curricula occur worldwide, notably at the University of
Limburg in Maastricht, The Netherlands, the University of Newcastle, Australia,
and Ben Gurion University in Reer-Sheva, Israel. Descriptions of the selection
processes for these schools would be an interesting and useful contribution to the
literature in medical education.
Conclusions
Inthis article, we have restated some basic facts, conclusions, and recommendations
about the interview in the admission process to medical school. Some interesting
new information from a survey of admission officers in Canada and the United
Kingdom has been presented and comparisons made with United States practices.
Unfortunately, the lack of a majority response from the United Kingdom schools
leaves us at the present time without a complete picture of admission practices
in the U.K. Hopefully, more information from those schools can be gathered
and disseminated. Problem based learning curricula have been developing during
recent years, and we have taken a partial look at the selection processes for those
programs. These international perspectives will whet the appetite, we hope, of
medical school faculty members around the world to describe, examine, question,
and study selection processes for physicians in training.
14

13. ADMISSION TO MEDICAL SCHOOL: INTERNATIONAL PERSPECTIVES
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