A Qualitative Study of a New Generation of Irish-Trained Doctors' Views on Selection for Medicine

Student selection for Medicine degree programmes is a complex and high-stakes process. In Ireland, students entering from secondary school are selected based on combined scores achieved in the state school exit examination (Leaving Certificate) and the Health Professions Aptitude Test (HPAT-Ireland), introduced in 2009 to broaden entry assessment beyond academic achievement alone. Questions remain about the validity, fairness, and alignment with the skills required for medical practice of this approach. This study explored the views of the "HPAT generation" (doctors admitted via HPAT-Ireland) on ideals and processes of medical student selection, including the relevance and equity of the Irish system.

An interpretivist qualitative study using semi-structured interviews was conducted and analysed using reflexive thematic analysis.

Twelve Irish-trained doctors admitted post-2009 were interviewed. Four themes were identified. Participants identified Threshold criteria as foundations of selection (Theme 1) highlighting academic ability and motivation as essential, with the Leaving Certificate viewed as an appropriate threshold measure. They also identified Further criteria as top-level differentiators (Theme 2) including problem-solving, critical thinking, and communication skills. Interviews, multiple mini-interviews, and selection centres were seen as authentic assessments albeit limited by bias and nepotism. HPAT-Ireland was criticised for limited scope, artificial format, and socioeconomic inequity. Under Personal diversity and potential for development (Theme 3) participants emphasised varied personalities, and recognition that desirable qualities can be cultivated during training. Under Equity, access, and exploitation (Theme 4) participants expressed concerns that any selection method may be prone to financial inequity and exploitative score inflation without systems-level change.

Findings highlight tensions between academic thresholds, authentic assessment of differentiators, and equitable access. Doctors of the HPAT-Ireland generation support a two-stage selection system but are sceptical of HPAT-Ireland's ability to fulfil its intended role. Policy reforms must address these tensions to ensure fair and sustainable medical student selection.