To the Editor: The decision by Wilkinson and colleagues at the University of Queensland to abandon interview selection methodology represents a regressive step in medical student selection.1 In particular, the problems with accepting past academic performance as an infallible “gold standard” criterion for student selection become evident when considering the less tangible but no less important issues of social equity, “fitness-to-task”, community expectations and corporate responsibility.

While prior academic achievement is the best predictor of early medical student examination performance,2 non-cognitive variables appear to become more predictive as training progresses.3 The use of academic achievement as the main or sole criterion diminishes social equity by discriminating against students from under-resourced areas.2 Fitness-to-task is relevant because mistakes in medicine cause serious consequences, as in other occupations such as military personnel, air traffic controllers, and pilots. These “restricted” occupations require specialised training preceded by mandatory selection processes typically involving physical, psychological and skills assessments. Consider also the community’s high expectations for the personal integrity of doctors, and the issue of how medical schools meet community, professional and stakeholder expectations — their corporate social responsibility. Medical schools clearly have a “duty of care” to both students and the community at large in their selection of future doctors.

Consequently, it is disappointing that Australia’s largest medical school at the University of Queensland has discontinued interviews, the study authors describing them as “inherently unreliable”.1 Unfortunately, this also reflects widespread imprecision when discussing the different interview methodologies of individual, panel or Multiple Mini-Interview formats. The Multiple Mini-Interview in particular has demonstrated promising reliability and validity.3,4

Stated bluntly, Wilkinson and colleagues’ conclusions are confusing. Despite their results suggesting the GAMSAT (Graduate Australian Medical School Admissions Test) has no predictive validity, it has been retained, while their interview procedure that demonstrated modest increasing predictive validity was dropped! In addition, their use of cognitive outcome measures to assess the predictive validity of non-cognitive variables is conceptually flawed.

Finally, an emerging body of evidence is leading to more sophisticated medical student selection methods. Community confidence in neither doctors nor the medical profession itself is endeared or strengthened by the use of selection methods that do not encourage this process. World’s best practice requires the use of evidence-based methods — this is the work ahead, so let’s not throw the baby out with the bathwater.

In reply: Harding and Wilson offer no new data or insights to the challenge of medical student selection. They also say they are confused. We will try to help.

The GAMSAT (Graduate Australian Medical School Admissions Test) provided no additional predictive value in our study1 — effectively, it measures what grade point average (GPA) does, which is academic ability. We are continuing to use it because it is highly reliable, whereas GPA, being derived from multiple courses marked by a wide range of individuals in different universities, is less so. Simply put, the GAMSAT offers a highly reliable method of ranking students.

Harding and Wilson acknowledge our finding that the interview score adds very little predictive value, but this value increases in the later years of the program. The problem is that, in our judgement, the absolute increase is so small as to be useless.

Let us be clear here. We fully agree that good doctors need to be much more than smart. Our point is simply that there is no evidence that these additional characteristics can be selected for. Having dropped the interview, we can now focus even more on the quality of our teaching and professional development programs.

Until Harding and Wilson, or others, can demonstrate a selection process that clearly works — in terms of delivering even more effective doctors to society — we will focus more on teaching, training and development. As noted in our article,1 we will carefully monitor and report on the impact of the changes we have instituted to our admissions process.