Educational assessment center techniques for entrance selection in medical school

Dutch higher education is freely accessible for those who have proper high school qualifications. However, admission to medical schools has been limited by government to regulate manpower planning. Selection has been carried out by a national lottery approach since 1972, but in 2000, the Dutch government asked medical schools to experiment with qualitative selection procedures at their own institutions. The University Medical Center Utrecht School of Medical Sciences has used a technique derived from assessment-center approaches to assist in the medical school admission process. Dutch assessment centers use observation procedures in which candidates act in simulated activities that are characteristic of the vacant position.

In April 2001, 61 candidates for 23 places were invited for selection days. After a selection interview, candidates were asked to perform activities that are characteristic of course requirements: (1) studying a three-to-five page text about diagnostic and therapeutic procedures of disease A during one hour; (2) explaining the studied procedures to another candidate and receiving information about disease B, studied by this other candidate, during one hour; (3) answering the questions of a standardized patient about disease A in 15 minutes; and (4) answering the questions of a standardized patient about disease B in 15 minutes. A three-person selection committee behind a one-way screen observed the two 15-minute interviews with the standardized patients. The selection committee independently scored content quality of the information that was given to the standardized patients as well as the quality of attitude towards and communication with both patients. The average scores for these three criteria were weighted equally to arrive at a total score. In addition, each candidate received a score resulting from the interview with the other candidate who explained disease B. This score was combined with the other three to a final score.

The Utrecht medical curriculum may be viewed as a hybrid PBL program. Integration of basic and clinical sciences, patient contacts from the start, training of skills in communication with standardized patients, physical examination, extensive small-group teaching, structured independent studying, and collaboration to prepare for short presentations to peers were all characteristic of the medical school curriculum. Thus, the assessment-center technique reflected the characteristics of the medical school curriculum. First analyses showed satisfactory reliabilities of the three scores (0.79 to 0.92); the average agreement between raters was 0.60. Correlation analysis between scores supported the internal convergent and discriminant validity of the assessment activities. The predictive validity remains to be studied.