Should medical school admissions be a lottery? Part 1.
Mazer BL. Accepting randomness in medical school admissions: The case for a lottery. Medical Teacher. 2020 Oct 17;1-3. doi: 10.1080/0142159X.2020.1832206. Online ahead of print.
This editorial was written in response to McMaster University’s medical school replacing their structured admission interview process with a partial lottery granting chance acceptance to a selection of pre-screened students. The author argues a case in favor of using this type of lottery system.
A point that needs clarity is that it is not a completely random lottery. These students are pre-screened for academic ability, which truth be told, is not all that different from what is done in the first step of admissions for most US Medical Schools.
What these lottery admissions leave to chance is the idea of whether or not we can clearly define what makes a “good doctor” and whether admissions committees are actually able to successfully and accurately uses their admissions process to select for those traits. Mazer argues that many of the qualities we seek are not easily measurable and therefore not easily compared between candidates.
Situational judgement tests such as CASPer and the MMI have been an attempt to solve this measurement problem and have shown to have some reliability but this begs the author’s second question is, “the skill of a practicing physician (is) predetermined in one’s youth”? In other words, are these qualities innate or fixed? or can they change over time and training? If these points are believed than randomness should lead to the same outcomes as a non standardized or validated selection process.
So what is the barrier to lottery admissions? The psychological damage of losing control over our own career path. In a country such as the United States where individualism and the ability to determine our own futures is highly valued, it would be a very difficult sell.
What would be the benefit? Fairness. Discrimination against those applicants that are systematically disadvantaged by the current metrics used for admission due to race or socioeconomic circumstances would be minimized. Lottery would also reduce the cost in time and money, for both schools and applicants, of the medical school admissions process.
Take home point: Admissions lotteries for qualified and academically equal candidates could increase fairness, remove systematic bias in admissions, and improve efficiency and decrease costs of the medical school admissions process.
Thoughts? Should we keep investing time, money and resources in attempting to quantify and qualify what will make a good doctor? or should we leave it to chance and use our curricula and training to create those good doctors?
