Medical education

To the Editor: Reading the article on the task of selecting candidates for medical school,1 I recalled my own trajectory into the profession. I was interviewed by a surgeon, who was the sole interviewer, our interaction being one of genteel conversation. My peers at the time had a similar interchange with the university officials. Uniformly, we have all proceeded to remain in medicine. Our careers have lasted. One has to wonder whether a selection process that is more time consuming is actually better than the above straightforward approach. Considering personality type, there will be a wide spread of introverts and extroverts. Academically adept and generally bright, the hopefuls can perform on the day to leap over any clever tests for entrance. Moreover, the profession has niches for all of them. The introvert can quietly tend towards microbiology, while the extrovert might heartily choose to be a surgeon. Like politics, the profession needs representatives from different areas of society. We should not aim to standardise too much. There will be nations today where entry into medicine is still standardised with reference to social status. If we recruit only the well-to-do youngsters, we will not have the level of understanding that can be brought into the profession from those of humbler backgrounds. Someone from a lower economic stratum will understand the community to which they wish to return after qualifying as a doctor. I have first-hand experience of observing such a course of career in my peers. It cannot be forgotten that the aspirants keen to join medicine are very young people whose personalities have yet to ripen through living. If they can pass tough exams, then they have an admirable trait as embryonic personalities. They can focus and work with diligence. They also hold an ambition to become doctors. If they can apply themselves and do not have any overt oddities of personality, they should be given a chance to become doctors. This has been a time-tested method in medical schools — in a world that needs more doctors than ever — and I fail to be convinced that finer filters on the path into medicine will be worthwhile.

Jagdeep Singh Gandhi

All study designs have their strengths and weaknesses, and it is critical to be aware of these when thinking about how best to address a particular research goal

Jennifer A Cleland · Steven J Durning · Erik Driessen

Doctors need not wait until they get sick to understand what it is like on the other side

Benjamin D Bravery

Medical neurobiology, 2nd edition

David Mor

Building a medical workforce that understands the impact of climate change on health and health services and will create change

Diana L Madden · Michelle McLean · Graeme L Horton

To produce a fit-for-purpose medical workforce, Australia needs streamlined training pathways in all medical disciplines

Roger P Strasser

Medical schools require selection processes that reflect the type of doctor they aim to produce

Paul Garrud

Objectives: To estimate the efficacy of selection tools employed by medical schools for predicting the binary outcomes of completing or not completing medical training and passing or failing a key examination; to investigate the potential usefulness of selection algorithms that do not allow low scores on one tool to be compensated by higher scores on other tools. Design, setting and participants: Data from four consecutive cohorts of students (3378 students, enrolled 2007–2010) in five undergraduate medical schools in Australia and New Zealand were analysed. Predictor variables were student scores on selection tools: prior academic achievement, Undergraduate Medicine and Health Sciences Admission Test (UMAT), and selection interview. Outcome variables were graduation from the program in a timely fashion, or passing the final clinical skills assessment at the first attempt. Main outcome measures: Optimal selection cut-scores determined by discriminant function analysis for each selection tool at each school; efficacy of different selection algorithms for predicting student outcomes. Results: For both outcomes, the cut-scores for prior academic achievement had the greatest predictive value, with medium to very large effect sizes (0.44–1.22) at all five schools. UMAT scores and selection interviews had smaller effect sizes (0.00–0.60). Meeting one or more cut-scores was associated with a significantly greater likelihood of timely graduation in some schools but not in others. Conclusions: An optimal cut-score can be estimated for a selection tool used for predicting an important program outcome. A “sufficient evidence” selection algorithm, founded on a non-compensatory model, is feasible, and may be useful for some schools.

Boaz Shulruf · Warwick Bagg · Mathew Begun · Margaret Hay · Irene Lichtwark · Allison Turnock · Emma Warnecke · Timothy J Wilkinson · Phillippa J Poole

Improving GP registrars’ readiness for vocational training and transition into practice

Susan M Wearne · Parker J Magin · Neil A Spike

Medical education is a rapidly developing field requiring specific research approaches to provide evidence that can effectively translate into clinical practice

Lambert WT Schuwirth · Steven J Durning

Concepts of epidemiology: integrating the ideas, theories, principles, and methods of epidemiology; 3rd edition

Lisa Hall

Why had we all chosen specialties that walk hand in hand with the spectre of death — at once fighting and accepting its inevitability?

Catriona McNeil

Training in medicine

Lambert WT Schuwirth

Health protection: principles and practice

Kudzai N Kanhutu

Tom had been non-compliant with all medications

Kirsten Due

Unwarranted variation in health care requires action from all players in health — including clinical colleges

Helen Francombe · Heather A Buchan · Anne Duggan

In published research, a statistically significant result is often wrongly interpreted as representing a clinically important finding

Ian A Scott

Mayo Clinic internal medicine board review

Simon O'Connor

A commitment to understanding and improving medical expertise is fundamental to training, practice and evaluation of doctors’ performance

Jeffrey CL Looi · Choong-Siew Yong

Overseas experience offers insights into providing sustainable health care for remote communities

Roger P Strasser

Three-dimensional printing could revolutionise the way we practise medicine

Jasamine Coles-Black · Ian Chao · Jason Chuen

Explicit training in appropriate decision making about pathology test ordering should be provided early

Justin J Beilby

Good pathology test ordering habits need to be instilled early in a GP’s clinical career

Parker J Magin · Amanda Tapley · Simon Morgan · Kim Henderson · Elizabeth G Holliday · Andrew R Davey · Jean Ball · Nigel F Catzikiris · Katie J Mulquiney · Mieke L van Driel