Medical School Admissions: Striving for fairness despite “ill-designed” tools

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February is, easily, the most difficult month of the year for many involved in undergraduate medical education, including Deans, admissions committees and administrative staff.  This is not simply because of the long and dreary Canadian winter.  It’s during this month that letters go out to applicants for admission indicating whether they’ve advanced to the next stage of the process: the on-site interview.  All those involved in the selection process struggle with the knowledge that, for every letter that brings welcome relief and encouragement, several will result in bewildered disappointment.  Two brief applicant profiles may serve to illustrate the issue.

Jessica is a bright, articulate and engaging young woman who, for as long as she or anyone can remember, has wanted to be a Doctor.  She graduated from high school at the top of her class, with numerous awards recognizing not only her academic accomplishments, but also student leadership and community involvement.  She received multiple university entrance scholarships and undertook an undergraduate program with courses that would provide a basis in biologic and physical science, which she feels is relevant to the study of medicine, but also selected to optimize her marks.  She is very successful, maintaining a 3.8 GPA over her first three years.  She also undertook a variety of volunteer activities, locally and abroad, involving health care in various settings.  She took the Medical College Admission Test (MCAT) after both studying from a manual and taking a preparation course at significant expense.  She did generally well, but was concerned about her mark in one of the four exam categories.  Jessica applied to our medical school, but failed to even get an interview.  This was related entirely to the MCAT score, as she feared.

Matt is not only an excellent student finishing in the top 5% of his high school graduating class, but also an elite athlete who accepts a full scholarship to an Ivy League university.  He chooses this school because it will allow him to pursue his interests in philosophy and political studies at an institution with an international reputation for excellence in both disciplines.  While there, he continues to excel academically, while becoming an accomplished varsity athlete.  He also develops an interest in Medicine and, specifically, Public Health.  He decides to apply to medical school and takes the MCAT, in which he excels in all categories.  He would like to return to Canada for medical school, but also fails to even get an offer for an interview, largely because the grades for his philosophy and political science courses, although near the top of the class for every course, fall below our GPA cutoffs.

Jessica, Matt, their families, and everyone who knows them and their career aspirations, are understandably devastated and rather perplexed.  “How can this be?”

Although these are both fictional accounts, a recent review of our applications at Queen’s shows that no fewer than 247 submissions matched the “Jessica” scenario almost exactly.  The number of “Matts” is more difficult to determine, but likely similar and probably underestimated because many people in such circumstances will decline to even apply, recognizing the GPA issue.

For every jubilant success, we know there are about 7 “Jessicas” and “Matts” who will be very disappointed and may have to set aside or delay their life’s dream, despite being very capable, motivated and deserving.  That reality is also personally distressing to the faculty and staff involved in the admissions process who, recognizing they cannot admit every applicant, endeavor diligently to develop fair and equitable processes.

A few realities about the medical admission process in Canada:

Among Canadians, there is a very high demand for medical education.  At Queen’s we received 3818 applications for our 100 positions this past year. All Canadian schools receive many times more applications than they can accommodate. Statistics collected and published annually by the Association of Faculties of Medicine of Canada indicate that the Canadian schools collectively received 34,048 applications for their 2,877 total available positions in 2011.  Assuming an application per candidate ratio of 3.3 (as Ontario statistics would suggest), it would appear that at least 10,318 individuals submitted applications that year.  The hunger for a career in medicine is such that increasing numbers of Canadians are enrolling in medical schools in Australia, the Caribbean, Ireland and other countries, at considerable personal expense and with no assurance of postgraduate training or eventual qualification in Canada.  Although no accurate data is available, it’s estimated that there are now more Canadians studying Medicine outside Canada than within.

Applicants to Canadian medical schools are knowledgeable regarding the process, and highly accomplished academically.  Although, again, no data is collected on this subject our observation at Queen’s, which seems to be shared by other schools, is that the average GPA, MCAT scores and personal experiences reported by our applicants are increasing each year.  Applicants understand the “system” and are highly strategic as they undertake their education and personal activities.

The number of medical school positions in Canada is fixed by public authority.  Medical education is expensive and largely subsidized by provincial governments.  Those governments therefore define the number of available positions, based loosely on anticipated demands for physicians.  These estimations have fluctuated in the past such that we have seen periods of both contraction and expansion.  At present, there are no plans in Ontario for expansion.

Medical schools place a priority on fairness and equity in their application processes.  In the face of the virtual impossibility of selecting the “most worthy” from so many worthy applicants, schools opt to ensure objectivity and fairness in their processes.  They are therefore drawn to metrics that provide some basis for objectivity.  Unfortunately, all available metrics are inherently blunt and imperfectly aligned with the qualities all would agree are important.

Winston Churchill could have been talking about medical admissions when he famously described golf as “a game whose aim is to hit a small ball into a small hole, with weapons singularly ill-designed for the purpose”.   Academic records, the MCAT, and quantified assessment of reported personal experiences all have significant shortcomings, as our examples above illustrate, but have the significant advantage of providing a numerical assessment by which candidates can be ranked without prejudice.  Panel interviews and mini-medical interviews (MMIs) are being used increasingly by medical schools to better assess applicants personal qualities, and are certainly an improvement, but are very resource-intensive and difficult to conduct and evaluate in a reliable manner.  It’s therefore not possible to apply such methods to the large number of applicants.  Hence the staged application process and reliance on other academic and test metrics.

So, one must ask, do we have a problem?  Despite all these shortcomings, the students who are finally admitted to our medical schools are an exceptional group of very talented, intelligent and capable young people who, with rare exceptions, have all the necessary qualities to become outstanding physicians.  Our processes, although inherently blunt and likely misaligned, are objective and scrupulously fair to all applicants.  Importantly, the Jessicas and Matts of the world, and their families, can perhaps take some small comfort in the knowledge that they are far from alone and have been treated fairly.  Furthermore, medical schools recognize that even if they could personally interview or meticulously assess every applicant, most would still be disappointed.  So, should we change and, if so, how?  I welcome viewpoints, and will make that issue the subject of the next blog.

Anthony J. Sanfilippo, MD, FRCP(C)
Associate Dean,
Undergraduate Medical Education

53 Responses to Medical School Admissions: Striving for fairness despite “ill-designed” tools

  1. Steve Hawrylyshyn says:

    A definitely well written and thought out piece. If we begin with the presupposition that no system is perfect and our goal is just to make the best of what we’ve got, I think our medical admissions are doing a fine job.

    When we look at the issue of having enough doctors, I have to agree with the stance that the problem lies more in health human resource planning than with medical admissions. There was a great piece on CBC’s The Voice earlier in the week talking about this. Also, the effects of the increased medical trainees is only beginning to be felt and the papers and research I’ve read lead me to believe an increase in medical enrolment isn’t the answer (happy to discuss further via email)

    Lastly, there are academics looking into improving the admissions process, and Dr Ken Trinh has done some influential work here at McMaster that has led to several changes in admissions criteria. The changes follow the evidence; first it was the MMI and now the CASPER is being utilized. I feel we’re making do with the best that we’ve got and constantly refining the process. I was glad to stumble upon this blog; raising the issue and inviting comments is definitely the right way forward.

    Cha Gheill

    • Thank you Steve. Agree the issue of human resource planning is crucial, and certainly our students are becoming increasingly aware and concerned about this. Unfortunately, their concerns are driven largely by scattered information regarding the current vacancies in various specialties rather than any credible projections regarding what they can expect at time they enter the workforce. I think most would agree that medical schools have a obligation to align with societal needs, but how that should occur and what information should guide that process requires considerable thought, discussion and cooperation, all of which seem hard to come by given our rather siloed structures.

      McMaster has been leading the way in the development and validation of innovative admission tools for many years. We all continue to struggle with the pragmatic challenge of implementation given the large number of applicants. Be happy to continue this discussion with you.

  2. Veer says:

    Very well written article Dr.Sanfilipo.I agree overall with your assessment of the situation.I am familiar with the situation being an examiner for potential candidates first & then being the parent of 2 candidates who successfully made it to med school.being a physician myself I have had the opportunity to interact with aspiring students who were shadowing with me while preparing to apply.Many succeeded,others went overseas & some gave up.everyone had a story to tell.I feel that many prospective applicants have become so savvy that they choose to do undergrad degrees at easy schools, take easy courses,pad their resumes with volunteer & charitable work,get glowing references from people who are biased & once in med school turn back to “Mr.Hydes”.I believe there should be less emphasis on GPAs,have more screening like the “casper” at mac,only rely on the verbal part of MCAT & more MMI screening.There will never be a perfect system- one can only hope for the best possible system.There is certainly no point in increasing med school admissions.You just need to look at all the fully trained orthopedics,anesthesia,radiation oncology fellows with no jobs to go to.It is certainly disheartening to see that after some 14 years of post secondary education these people are unemployed.I wonder how many of these med school applicants would still want to be doctors if they were aware of this truth.I believe many of these are misguided in their real agenda to become doctors.

    • Thank you for this, and congratulations on your family success. I certainly agree that the realities of the admission process and the practice environment into which our students eventually graduate is changing, but there seems to be a lack of credible workforce projections. I recently reviewed two separate analyses, one based on current vacancies in Ontario, and another 10 year projection based on population demographics and disease prevelance statistics. Surprisingly, the two yeilded quite disparate estimates of specialty needs. This makes it very difficult for those of us counseling undergraduates to provide valid guidance. I think we have to admit that the expectation that every graduate will have thier open and free choice of practice specialty and setting at the moment they’re ready to start is increasingly unrealistic. Having said that, the vast majority of our graduates are successful in entering postgraduate programs of their choice and eventually find satisfying and stable career opportunities. Medicine, I firmly believe, remains a great career choice. Your two medical student offspring should remain optimistic.

  3. Michael Fridman says:

    This was an extremely interesting piece to read and it is very encouraging to see that such philosophy is being discussed in the process of medical admissions. The strange part about my experiences in application, rejection, and acceptance is that the entirety of the process involves this reductionist approach to condense a candidate into the objective, quantifiable sum of their experiences. This, however, is what reveals to me the dire nature of it all. How experience is quantified has not been entirely transparent, which results in the stories you so articulately characterized in your post. The ‘Matt’s and ‘Jessica’s of the world truly are being denied access to education at no fault of their own. Understandably, there is an inevitable disappointment for many applicants but is there a way to avoid this?

    Having recently been an interviewee and presently being involved in the admissions process for the University of Toronto, it seems to me that the Fairness Doctrine that has permeated through admissions systems has actually made being objective more difficult. To be able to rank and file candidates is nice but does that truly demonstrate the actual potential? This rhetorical question is best illustrated by a simple thought experiment.

    The medical admissions process has been set up with a series of gates. Should an individual meet the requirements for these gates, they increase their likelihood of being granted an interview. Once interview invitations are sent out, each applicant is assigned a random number. A computer-based model runs a program several thousand times to come up with a randomly-generated list (the computational equivalent of flipping a coin) and the students are ranked based on this assignment, essentially giving seats in the medical class by lottery. Would these students be any more or less successful than the current medical classes? Would these students make better or worse doctors?

    The answer to these two questions would be revealing. Firstly, if there is a difference between the two groups, what would it be? Secondly, how could we screen for these individuals in an objective way before interviews are given out based on this reducto ad numero approach to assigning interviews? Lastly, what can we do to modify the initial process to tend to the plights of the Matts of the world who provide a wide berth of experience outside the biomedical sciences that would be invaluable to group learning and collaboration?

    In my limited experience speaking with candidates during my admissions process, something incredible dawned on me. The realization that, on paper, we were all so similar that the most minor hair-thin details divided us became the sudden jolt I needed. It felt as though an enormous burden was lifted from my shoulders. I remember saying to a peer, “It is amazing. Everyone in this room is essentially the same on paper. I do not envy the task of the interview committee…” This, surprisingly, relaxed me (at least a little bit) for the remainder of my interviews. “If these people all deserve admissions, why wouldn’t I?”

    To return to the question eloquently posed by Dr. Sanfilippo, is there something that should be done? I do believe so. The fairness described is, I believe, misaligned as is beautifully outlined in Matt’s story. In that situation, an outstanding candidate was lost simply because, in his program, a high seventy or low eighty is considered to be truly exceptional by their professors. The Queen’s English department, during my studies there, had a similar ideology. Only about 15-20% of the class should be scoring 80’s and above with fewer than 1% in the 90’s. Compare that with the distribution in the Life Sciences in which between 40 and 60% were often in the 80’s and 90’s. How can this be better accounted for? What do we need to do to show that breadth of experience and diversity of knowledge can be as important as someone achieving academically? What metrics truly define whether a candidate is (and I use this word rather tongue-in-cheek) “worthy” of an invitation to interview?

    • Hello Michael, and thank you for this most thoughtful reflection on the process, made so vivid by your own experiences. Your final series of questions frame the key issues nicely and challenge us to to do better. I can’t help but agree that we need to do so. The Matts and the Jessicas of the world deserve no less.

  4. Chi Yan Lam says:

    Dr. Sanfilipo, thank you for this post. I found your discussion candid and insightful. Your discussion was grounded in measurement theory, and you were able to translate those ideas succinctly to the audiences of this blog. I think one of the implicit themes you were addressing here is the notion of fairness, which as you’ve demonstrated in your writing, goes beyond the stats and the ‘quantification’ of lived experiences. What I appreciated most is your recognition of the high social cost to even apply to medical schools, how trying the experience can be, and what they might mean for individual applicants. It is refreshing to hear that perspective. I l look forward to more of your posts. Thank you.

    • Thank you. The process does appear to be giving rise to a number of unintentioned but significant barriers, one of which is financial. This is becoming more recognized. The recently released Future of Medical Education in Canada project, an initiative of the Association of Faculties of Medicine of Canada, recognized this by describing admissions processes as one of its 10 key recommendations. To quote the document “…in order to achieve the desired diversity in our physician workforce, Faculties of Medicine must recruit, select, and support a representative mix of medical students”. . The challenge, it would seem, has been well articulated.

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  11. Jim Wallace says:

    How can anyone view panel interviews and MMIs as “an improvement”. They are completely subjective. I would rtaher have someone admitted to the limited resource of a medical school than someone who was tutored and practiced to perform in an artificial interview session with subjective analysis criteria. I do not view your assessment of an applicant’s “personal qualities” – at a short interview- as productive. It simply turns the process into an academic sham, rife with the potential for nepotism and fraud (i.e. his marks may have been poor, but “oh he did so well at his interview”) Very poor analysis sir.

    • Admittedly no perfectly objective system exists, but the MMIs do provide an opportunity to develop assessment rubrics based on criteria that can developed in advance and applied by all examiners. The stations can also be designed to address whatever attributes the school feels appropriate. For these reasons, I believe they provide some advantage over the open-ended panel interview.

  12. Jimmy S says:

    Thank you Anthony for bringing this topic.

    I personally believe in an education that requires nothing from students but just a simple desire to learn. If you visit ancient temples and shrines in Asia, you will see that there are no gates or fences that keep people out. They always have “everyone is welcome” mentality. The philosophy is that education and desire to learn is an intrinsic right of all citizens.

    Needless to say, open-door policy in medical school admission is not feasible and only a wishful thinking. But I do really urge medical school admission officers to shy away from mindset of “weeding out” (for lack of better term) students from entering medical school. I personally know many students like Jessica being rejected at medical schools just because one of their section scores on MCAT was slightly below the requirements. Considering that a single question can change one’s score from 10 to a 9 and vice versa, screening out applicants based on MCAT score is too blunt in my opinion.

    If a prospective medical student has a passion for medicine, curious about curing diseases and solving world’s problem I really think that having GPA or MCAT a tad lower than average should not have any bearing on his or her candidacy. Perhaps more holistic approach may be more acceptable alternative than simple cut offs for the interests of the applicants.

    • Thank you for this comment. An open-door policy is certainly an enticing concept but, as you say, not feasible given the current realities. I appreciate your advice to admissions committees to remain focused on quality and character based assessment practices. We will certainly continue to do so, while maintaining fairness to all applicants.

  13. Jen says:

    Dr. Sanfilippo, this is a very well written article.

    In my opinion I believe that medical schools should place more emphasis on the personal characteristics of the applicant than the GPA scores. For example, I have a friend who is in the Canadian Military and studied Astrophysics Engineering in his undergrad, which is definitely a lot more difficult than science-based degrees. He aspires to be a physician yet, his low GPA of 3.0 (which is not low by Engineering standards) prevents him to be eligible for approximately all Canadian universities. It is highly unfortunate that the low GPA is the only thing that stands between him and his medical career. The Canadian medical system is losing out on a wonderful candidate in his case.

    Medical knowledge can always be taught but personal characteristics such as integrity, honesty, fortitude, emotional intelligence, etc. are inherent to the individual. It’s time for the medical system to take “a leap of faith” and invest in these non-traditional applicants who have a high likelihood to become great physicians.

    • Thank you Jen. You’re right – there is considerable variation in how institutions award marks, even for courses in the same subject area. The content and depth of those courses can also vary. Unfortunately, it’s very difficult to develop fair and reliable ways to account for these differences within our application processes. Also couldn’t agree more with your comment about the importance of personal characteristics. For what it’s worth, I can assure you that finding fair and practical ways to identify applicants such as your friend is the biggest challenge and ongoing preoccupation of our admission committee.

  14. James Check says:

    Here is an issue that has not been discussed, and yet it is one of the greatest problems facing education today. Grade inflation. It starts at the primary and secondary school level, and has been creeping its way more and more into the university level. Over the past 30 years that I have been teaching at the university level, I have seen more and more students crash and burn when they get to university, because their expectations were unrealistically raised by high grades coming out of high school. Worse yet, these ostensible “A” students cannot be distinguished from the truly good students, because they all have the same high grades. (In statistics, which is one of the courses I teach in Psychology, we call this the “restriction of range” problem, and it is a serious threat to the predictive validity of a grading system.) So, it is not until university that they get “weeded out” by a system that does not have the same “ceiling effects” as their high school system did. Nonetheless, there is increasing pressure on professors to give higher and higher grades to students for various reasons, such as “I just need a couple more percent to get an A because I am trying to get into Medical School”.

    At the same time, however, I see a contradiction in the above discussions so far. Dean Sanfilippo argues (and laments) that the medical schools have to reject many, many students who would make fine doctors because, well, they have to – there are just not enough seats to go around to all these well-qualified applicants. On the other hand, Veer argues that there are “Mr Hydes” that carefully work the system and come in looking very good, but then we find out too late that their admission was indeed a mistake. My guess is that Dean Sanfilippo is more likely to be right, which would be very comforting to us as a society of future patients of these future doctors. The answer of course would come from looking at dropout rates (and the reasons), and perhaps even expulsion rates, if such date even exist.

    But even if all the accepted applicants will make good doctors, don’t medical schools want “the best of the best”? And if they do, this is where the real problem lies. As the ostensible “quality” of the applicants rises over time, so do the criteria for admission, to the point where criteria like the GPA no longer make sense. (Again, due to the restriction of range problem.) Simply put, at the top end of the scale, these grades no longer have any predictive utility, because the factors that underlie differences between, say a 92% average and a 90% are virtually meaningless. As one poster put it, a single question can put you in or out of the running on, say the MCAT, and similarly, a teacher who, for example, subtracts one point from a three point question because the student used 3 significant figure rather than four has just doomed that student’s medical career. (This is not a random example, either. I have seen a student drop below 90 on a Chemistry test for just this error, and then the following year a different Chemistry teacher gave a different rule for significant figures!) And the sad part is, in many cases the students writing a test do in fact all know their material, and in essence do not differ from each other in any meaningful way. (As another example, the class average halfway through a Grade 11 Physics course was 91%, not because of grade inflation – the course was tough – but because they were all excellent students who all really knew their stuff.)

    Nor does adding multiple (quantitative) indicators help, if the applicants all score high on each one. You still have the same problem. (As an anecdote, I recall a recent conversation with one medical school admissions team member telling me how stressful her job was, because she had to choose between so many qualified applicants, ALL of who had high grades, high MCATs lots of volunteer experience, out of country experience, etc., etc.. Again, we in the stats business call this a “ceiling effect”.) And it is particularly frightening to learn that the response to this crisis has been for medical schools to rely even more heavily on these quantitative indicators, because as a testing buff I know full well how easy it is to deify such measures and thus divest oneself of the responsibility for having to say “no”. (A bit harsh, I know, but nonetheless true in my opinion. No one likes to be the bad guy, and it is so much easier to blame it on the numbers.)

    And then there are the interviews, and the very interesting MMI. More on that perhaps in another post, as this topic has grabbed my attention big time. (My training as an academic is in Social Psychology, Testing, and Statistics, so no surprise here.)

    Getting back to the original grade inflation issue, unfortunately the only way to increase the predictive validity of, say, the restriction of range problem is to increase the range in a meaningful way (some people use the evil “Bell Curve” system, which I do not agree with), or to simply lower the cutoff to some reasonable level where ALL of the qualified students pass the first “gate” and then use other criteria that spread the applicants out more reasonably. (Indeed, the medical schools are crying out for more indicators already.)

    One of these indicators that is being explored is McMaster’s CASPer test, which they say “assesses interpersonal skills and decision making abilities”. This is indeed intriguing, and I will most certainly check into it, because I keep hearing again and again from friends and colleagues who complain that the traditional indicators used to screen applicants don’t tell you enough about what, for example the future doctor’s “bedside manner” is going to be like. Thus, we not only need our doctors to be skilled and knowledgeable about our bodies, we also need them to be able to talk to us.

    More to come….

  15. ELizabeth says:

    Dr. Sanfilippo,
    I came across your blog as I was trying to find info about admission to medical schools. My son (16 years) is interested in choosing medicine as his future career. I am very much disturbed understanding these admission processes. My apology but I do not know what was the driver for this blog. Is it to make us more comfortable that it is Ok to be part of rejection process and we are not alone . Or is it really about finding a way to solve this issue. If so, why not design a survey for all Canadians to input their feed back into this process.
    As I read your article two main point come to mind: The large number of applicant that wants to become a doctor (limited positions available) due to cost of medical education. Before we really get into details of the selection process, we could analyze the driver for above issues.

    What drives so many applicants to apply for medicine?
    Is it the need to help people, or is it the good salary and comfortable independent career.
    Why in spite of these complex admission system for selecting the best physician, public do not feel that they are getting good care? Why is that we feel that we have become an object and a source of income for our doctors?

    What if we remove the greed motivation factor – Capped/fixed salary .
    I feel becoming a doctor has similar analogy with becoming a Priest. One takes care of the soul and another takes care of body. But the work emotions are really related. It is always difficult to find a good Priest or Doctor that really cares about people.

    Cost of education: When was the last review of medical system teaching framework. With the advancement in the simulation technologies, can we change the way we teach and enhance the teaching process?
    Why the process of selection cannot be started at high school. Why high school, does not start using advance computer generated teaching technology systems to teach the biology and chemistry and physics and its interaction. Why wait till university to teach medicine. Today’s generation can absorb much more information than previous generation due to access to internet, podcasts, computer generated animation. What stops them from learning medicine by playing a video game that teaches them better anatomy? – Why not distribute the teaching cost over time .
    I am not saying that we do not need the real hospital teaching environment, what I am trying to say is to start sooner and do not get stuck in the past. We need to evaluate our next generation and tap into their change intelligence.

    In summary:
    Reduce Salary – to find all those compassionate souls that really want to help people and not the lucrative life style- this is not something you can be evaluate by any software testing, this only can be evaluated by taking away the economic greed factor.
    Give a face-lift to Medical education by use of technology teaching and start early from high school. This could result in cost reduction (like teaching pilots, it is expensive due to flight training factor, but use of simulators can reduce this cost by orders of magnitude). Cost reduction can in turn, result in an increased authorized number of allowed medical positions.
    Evaluate Doctors performance and let their salary be dependent on their patient evaluation. Why not, If public tax is used to subsidize the cost of education, then we should have say in how doctors are treating their patient. Every organization, private of public sector has performance reviews. What are doctors performance review metric, number of patient alive! or fund acquired for hospital, cost saved, their net profit .
    I hope I have not been harsh in stating above opinion, but it let us try to address the cause and not the symptoms. I understand that most of the above suggestion is beyond the scope and mandate of Universities but till such action is performed by Gov. of Canada, we have to live with an inefficient system that really cannot choose the right person for such a blessed profession which has been given the highest order of authority for human life.


    • Dear Elizabeth,

      You raise a number of interesting points. Let me try to respond to some of them.

      With regard to the purpose, I felt it worthwhile to clarify issues related to the process and invite commentary that might be of use to medical schools as they develop or revise their admission processes. As I mentioned in the initial articles, all schools struggle with the challenge of making fair selections among so many worthy candidates.

      I believe there is much more than financial award that drives people to the study of Medicine. Having worked with medical students for many years, I can assure you that most enter medical school with only the vaguest idea of the eventual financial benefits. The intrinsic interest and potential to provide positive contributions are much stronger drivers. Certainly, selection processes search for appropriate motivation. In addition, the highly accomplished people who apply have many avenues open to them, many much more lucrative and associated with considerably less stress and responsibility. The model you suggest of capitated incomes is already in place in many parts of our province and country. In fact, most of the physicians who teach at my medical school are members of an alternative funding plan.

      I can also assure you that we try very hard to select and reinforce the personal qualities you value and feel are lacking in medical practitioners. I’m sorry to hear of your experiences, but feel the vast majority of graduates aspire to the very qualities you describe.

      The concept of beginning medical education earlier and developing a more cost effective process is intriguing. We have developed an early entry program with these goals in mind. Other initiatives are under discussion and I suspect other approaches will be tested in the future. These obviously have to be undertaken carefully and with appropriate review in order to ensure that quality is not sacrificed in the pursuit of expediency.

      Your thoughts about alternative teaching modalities are also very perceptive, and already underway at all Canadian schools. I expect these approaches will be broadened in the future.

      Again, thanks for sharing your thoughts, and best wishes to your son as he pursues his career goals.

  16. Jaren says:

    Dear Dr. Anthony Sanfilippo,

    Thank you for your candid thoughts on medical school admissions. It’s refreshing to hear someone discuss the process so openly. I wish more people at publicly funded institutes would be more transparent and candid about medical school admission processes.

    I have two major points that I want to bring up:

    1) How do medical schools assess the quality of the institution, program and degree an applicant comes from? It’s clear that grades are different between departments and universities across Canada. A student who achieves an A average at one school may have the exact same capability as someone who achieves a B+ average at a second institution that’s more rigourous. Based on the current system, the student with the A average is more likely to succeed in gaining admission.

    For example when I was an undergraduate student in the life sciences at a rigourous Canadian institution, fewer than 10% of our graduating class would graduate with a cGPA above 3.5. I graduated in the top 10-20% of my class in genetics but was never considered a serious medical school applicant, even though I developed an incredibly strong work ethic and learned so much. I continued with my studies and graduated with an A average during my Master’s and have 3 publications in peer-reviewed medical journals. I’ve given talks at international conferences and was selected to attend prestigious think-tanks at places like Cambridge University and TEDx. Yet, it does not matter what I do since my cGPA will always be lower. It’s like an old scar that can never be healed; this is particularly frustrating since some grades from my undergraduate degree are almost 10 years old. I know that I’ve changed over that time period and have accomplished more things that strongly suggest I can be a successful physician.

    2) Something that scares me is the number of students who apply to become a doctor but never get into a medical school. Do you have any statistics on the thousands of students who never receive admission to medical school? What happens to them? What do they do? Pursuing admission to medicine through the traditional life sciences route is a double edged sword. You can easily gain all the prerequisites to apply, but if you never get into a medical school the career options are limited and require more training. I feel like life sciences education at more institutions should have built-in co-ops and professional development to help transition students to the work place. This is even an issue at higher levels of life sciences education such as Masters and PhD. A slight shift in perspective would be incredibly helpful to the thousands of students who never end up being a doctor; at least they’d be able to change careers easily instead of being handcuffed with a degree of limited value.

    Thank you again for your candor. I hope other medical educators follow your lead, and are transparent about this process.

    • The disparity between university programs, and even between programs or courses at the same university, is widely appreciated. Unfortunately, and despite considerable thought, no practical approaches have been developed which can fairly equilibrate these differences. On the positive side, many medical schools, including ours, have developed approaches that recognize increasing profiles through undergrad, or postgrad accomplishments like your own. I share your concerns about those who are not accepted to medical school, and I’m not aware of any statistics or studies on the subject. Certainly the applicants we see are very talented individuals who would be suited to success in a variety of scientific, educational or administrative careers. We continue to counsel students to consider alternatives during their application process, and certainly agree that undergrad programs should provide diversity of opportunity.

  17. Zhimin Feng says:

    Dr. Sanfilippo,

    With this extremely interesting article to read and encouragement to see that such philosophy is being discussed in the process of medical admissions. I am wondering how Jessica and Matt are to be considered for medical school admission in the real world of Canadian Universities. Do they get a chance to be accepted or not? My daughter received multiple university top entrance scholarships in Canada and USA and undertook an undergraduate program with Piano performance and Biology/Chemistry/Physics courses with a 3.93 GPA over her first three years at University of Michigan currently. Even though she won numerous Canadian and International Piano performance and invited to perform in Carnegie Hall, New York in Feb. 2012 as the second place winner of The International Crescendo Music Competition and in Kennedy Center, Washington, DC in the Feb. 2014 as the finest Musician in USA, her dream is still being a medical doctor to serve community in home country – Canada. With a lot of hospital volunteer experience at University of Michigan hospital and Asian hospital and community nursing homes, her dream is to save kids life with cancer/disease. But She have similar concern as Jessica had with MCAT and she is applying for admission for other Medical school than Queen’s University for Fall 2015 admission. How could she improve her admission chance in Canadian Medical school ?

    Below link is her performance at Kennedy center in Feb. 2014. Her portion starts at 34 minutes after the program started.


    • Thank you Mr. Feng. You obviously have a tremendously talented daughter in whom any parent would take great pride. It sounds like she’s going about the application process very thoughtfully. Many students undertake the MCAT multiple times in order to optimize their application. I wish her every success.

  18. Chantal says:

    I have somewhat of a different view from most who have posted on this forum. I am an aspiring mature medical student that has already accepted that I may not be accepted to medical school. I am actually very positive regarding my application process and will do all that I can to get where I would like to be. I think other university programs should adopt some of the acceptance criteria set for medical school. Not that I want to crash the dreams of others, but I think that it is better to crash the dreams sooner than later. Many graduate university and cannot secure employment in their field of study all while paying off their education. I find this unfortunate. I have never heard of medical school graduates unable to secure employment in their field.

  19. J says:

    This has been a very intriguing piece that addresses every concern I’ve had with the medical school admission process. When Canadian medical school admission standards are compared with the rest of the world, they seem to be unreasonably high. A vast majority of schools across the country have a minimum GPA requirement of 3.7, whereas medical schools in the US and the UK only require something along the lines of a 3.5. As a fourth-year undergraduate student in a life sciences program, I have extreme anxiety over admissions. I feel that my MCAT score and my secondary application (extracurriculars, volunteering, research, etc.) are pretty competitive; however, I feel that they will not even be looked at because of my GPA. I faced some hardships during my first year of university and my marks were very low. During the past two and a half years, my marks have shot up considerably; I have been getting 3.7+ in every class since the beginning of second year and have even taken summer classes the past two summers to boost my GPA even further. Unfortunately, although I will be graduating with a GPA that is considered to be very good as I attend what is often called “the hardest university in the country” (I’m sure you can figure out which school I’m talking about), it still will not be high enough to get into medical school in Canada. It would, however, be enough for an acceptance to a medical school in the US. I do not wish to travel abroad for my medical education as I know the chances of being able to come back and practice in Canada are slim to none, having family members who have been unsuccessful in achieving this. The US is as equally an advanced country as Canada; the rest of world may even say it is more so. Why are their GPA requirements a bit more reasonable than ours? Why do we not have more medical schools in this country? If I do not get accepted, I will be almost sure that it is because of my GPA, and I really do not know what I would do with a degree in biology that would lead to a secure career. I honestly do not believe that there is any way to measure a person’s potential for something; it is how they will perform in the future, and no one can know about something that has not happened yet. I have seen students with astounding marks in high school who plunder in undergrad and can never recover. I have seen students with horrible marks in high school maintain a 3.9 GPA from start to finish of their undergrad. I have also seen students, like myself, who have started undergrad with poor marks but have rapidly and greatly increased in a short amount of time. There is also the account that some prerequisite courses are not always interesting to the student; for me, I absolutely hated studying things like physics, calculus, or statistics. What you learn in undergrad and what you learn in medical school are two different things; you may not be as interested in the science taught in university but when it comes to medicine and the human body, your courses have your undivided attention. Maybe there are people who struggled to get high marks in undergrad purely because they had been studying things they had no interest in and their real passion had been medicine. How do you know why they did poorly and how do you know they won’t change? A person with a good academic record in undergrad may start failing once they start medical school but they’re still given a chance. It’s so hard to tell how someone will perform in the future and their past performances are not a good indicator of their potential as people really can change in a short period of time. I have grown and matured as a person throughout my time in undergrad and have developed so many useful skills for learning and academia that I did not even know existed when I started undergrad. I am certainly not the same person I had been four years ago, and I think that it would be unfair for me to be rejected because of some mistakes I made four years ago when I am nowhere close to being that same person today. When I started university, I did not feel ready for medical school, and had I stayed that same person for all of these years, I would know that I still would not be ready. Now that I am a different person, I know I’m ready to handle medical school and try my best to be a good doctor, but I have sleepless nights over the fear that I will not get the chance to do so.

    • You raise many very valid points that also trouble admissions committees and everyone involved in this process. The overriding issue they struggle to deal with as fairly as possible is a product of the very high demand. This year, our school received 46 applications for every available position, most of which are from very qualified and motivated students. This rather stark reality, combined with our desire to be fair to all, requires approaches that are measurable and objective. Having said that, it’s difficult comment on your particular case. Schools may choose to give more weght to recent academic performance. I would encourage you to explore those processes and your own record more closely before drawing conclusions.

  20. HK says:

    This is an outstanding review of the medical school admission process in Ontario.

    I am a physician in Ontario and I have a few children that are interested in becoming physicians. So I have a keen interest in the current application process and requirements.

    My main concerns regarding the application process in Canada, is the selection bias towards accepting students who are from the geographic area of the school, favouring French speaking students and the difficulty of differentiating the “toughness” of getting good grades in varying programs and universities.

    First of all, I believe universities should take the best candidates. There should be no “affirmative” action for any group. For example Western University allows in students from “Southwestern” Ontario with significantly lower MCAT scores and GPAs than those from outside of the area. The admission requirements change literally from one neighbouring township to the one next door. I understand that medical schools want their graduates to stay in the area after graduation, but it is ridiculous to have different requirements for a student from Woodstock compared to neighbouring Ayr, Ontario. We should be selecting the best qualified students, not the students who grew up in the “right” postal code. I am picking on Western here but as you are aware, many Canadian schools take this approach and it leads to many better students not being accepted for lesser students.

    As well, some schools such as Ottawa favour French speaking students. I appreciate that this will lead to more French speaking doctors, but again if the French speaking students are accepted before better qualified English speaking students, I believe lesser qualified students will be accepted. If we believe that language is an issue, in today’s Canada, we should consider accepting some Cantonese, Serbian, Hindi, Spanish etc speaking students with lesser qualifications to serve their respective groups. It is a tricky issue, so we should just cancel favouritism based on language.

    And finally, as you have pointed out, it is very difficult to estimate the “toughness” of any given university or program. I think most academics know that getting a 4.0 GPA at the University of Waterloo Engineering is very different than getting a 4.0 GPA at most undergraduate science programs. And some programs have been better at teaching students “the game” better than other programs. Again I believe most academics in the know in science would favour a McGill or Queens cell biology candidate over a McMaster health sciences candidate if their GPAs are equivalent. The class average in McMaster health sciences are likely way higher. Medical schools should look at class averages when taking GPSs into account. It is just tougher getting a good GPA in some programs. I feel that all of the universities in Canada should review the statistics of specific high school marks, undergraduate university marks and correlate them. If there is enough data for the high schools, universities and undergraduate programs there could be a degree of difficulty attached to them. Then the student’s grades could be multiplied by the degree of difficulty. This approach of course is used in diving and gymnastics and it makes sense. I suspect the data is there and perhaps this approach is already being used. But it seems like a “fair” approach.

    All of this favouritism leads to some of the best students being rejected. I believe this contributes to fewer Canadian trained physicians performing at the highest levels internationally both clinically and scientifically. We would have more impact on research, an improved reputation and even more international awards.

    Keep up the great work!

    I’m a Western grad, but I still respect the opinion of a smart Queens person! 🙂

    • Thanks for the thoughtful comments. The issue of geographic preference is quite common, generally related to a school’s sense of responsbility to support it’s region, and support development of the local medical communities. This is particularly relevant for provinces with single medical schools, schools, like Saskatchewan and Manitoba, or regions such as Atlantic Canada. It doesn’t apply to all schools, Queen’s being a notable exception. We’ve explored the feasibility of indexing marks to overall means for courses or schools, but concluded that we don’t have the means to do it reliably or consistently. However, we continue to explore this as an option. Best wishes, and best of luck to your children in their career aspirations.

  21. Daniel says:

    Do the application processes take into account the financial situation of an applicant at all? It seems to me the application process is actually more related to the parental income of applicants than their actual academic capabilities. The number of students accepted from the highest income levels is far above the low income levels. Do rich kids make better doctors than poor ones? I realize you wrote an article on this subject but I was just wondering if anything is being done for the application processÉ

    Data from 2002, I am sure it has only gotten worse…
    “17% of parents of medical students had household incomes greater than $160 000, although just 2.7% of Canadian households had incomes higher than $150 000. Roughly 15.4% of parents of medical students had annual household incomes less than $40 000 in 2002, although the income group represented 39.7% of Canadian households.”

    Kids who have enough money to not need to work get to volunteer more. They also can spend more time studying and spend money on preparations for the MCAT. They have less work and financial stress which helps them do better in school.

    17/2.7 = 6.3x more likely than average Canadian to get into medical school
    15.4/39.7 = 0.39x as likely than average Canadian to get into medical school

    6.3/0.39 = 16

    So if you are born into a family with an income over 160K you are 16x more likely to end up in medical school than someone born into a family who makes 40k.

    Seems to me the entire process favors those from financially well off backgrounds. Some things never change

    • These socioeconomic barriers are certainly real and well described. Many schools, including ours, have made a commitment to develop ways to address these issues, including our early entry program which will allow students to access medical school with less university related debt, less need sacrifice income generating employment, and no need for MCAT expenses. It will obviously take time for such programs to have an impact, but they do represent a start, and raise consciousness of the problem. Be happy to hear further suggestions.

      • Ahmad Hakemi,MD says:

        It appears to me that it is MCAT , grades, grades,grades,research + everything else is the way to get to a med school these days. The differentiating factor then is volunteerism, MMIs etc. I know that in Michigan many med schools separate the applicants into the schools that they graduated from. So as an example all Northern Michigan university applicants are compared to each other and not go the University of Michigan graduates. Is this happening in Canada? On another note, Canadian applicants should apply to US DO schools instead of going overseas.

  22. priya says:

    I found this article really intriguing as I am a current applicant to medical school myself, however, am likely going to be heading abroad. From observing other students and reading the commentary I’d have agree with a lot of what has been said. There is a significant financial investment that must be made by students wishing to pursue a career in medicine, as they not only have to invest in a bachelor degree but also a post-graduate degree. By having such a barrier many qualified candidates are easily deterred. This is exacerbated for some students by the uncertainty involved with coming from a specific geographic background; they need to take political factors into account. For example, schools favour students from their own geographical location, and thus, discriminate against “outsiders”. As an “outsider” I faced this challenge because I was not really “favoured” by any location; I am from a small rural region in the middle of nowhere. In addition, while at school I decided to take classes in an subject area that interested me, biochemistry. For many students a bachelor’s degree is just a stepping stone, and thus, they tend to take courses that are undeniably easier. I can easily attest to this because I changed my module in my last semester and barely have to do any work to achieve amazing grades. (I did still take one in biochemistry just for fun). Additionally, through this module I could not help but notice that the pace of it was incredibly slow compared to my previous one and much less demanding. Moreover, when talking to a student that was interviewed for medical school by Western (she was in the easy module and thus had an amazing GPA), I could not help but think “man, I would never trust her as my doctor.” If entering medical school is a “game” then it is really the patients that are suffering at the end of the day. Moreover, this might help explain the dissatisfaction and stress associated mental illnesses of some medical students (they were never exposed to this previously). Overall, my main points are that Canada needs to find a way to integrate the courses taken into the GPA calculation and also needs to stop discriminating against geographical location. The primary method I would propose for integrating courses into the GPA is by considering the overall difficulty of the subject matter in terms of complexity and the class average. Moreover, to entice doctors to remain in a city there should be an incentive offered to them; like perhaps applicants that are willing to commit 10 years or 5 years in the city will be favoured. If this is done strategically, Canada’s region based doctor issue can easily be overcome.

  23. North York Dental says:

    Great article! Very informative. I’ve been speaking with Dr Steven Chow of HealthOne medical who has given similar commentary of the admissions process.

  24. Jason B says:

    Thank you for making a forum where people from all walks of life can discuss medical school admissions process openly! It’s incredibly profound for the public to have this degree of accessibility at a Canadian medical school. It’s great that a concerned parent, a hardworking student, or a seasoned physician can make their voices heard. My questions is: do you find other schools are considering the issues you bring up in your post with respect to their admission process?

    I ask because because I have had a difficult time trying to discuss the points highlighted in this blog with other medical schools. I’ve even tried discussing studies looking at this type of problem in medicine and other fields. I’ve often been met with a mix of defensive, dismissive and condescending tones. It can also be difficult as there are no accessible forums to ask questions at medical schools. In my experience it can take several months to schedule a phone call or meeting with an individual. A medical school may have blogs, but sometimes the comments are screened before hand; sometimes your posts are never accepted. The comments section may never have the engaging discussions like the ones in your blog.

    In your opinion will a medical school openly admit their admission process has limitations? I think if a medical school can’t publicly acknowledge that there are current limitations to their processes, how can it be expected to improve.

    Do you think more medical schools should engage the public (i.e. with the issues surrounding fairness around medical school admissions)? I think they should as these institutes are financially supported by the public. There should be accessible forums like yours where we can ask our questions.

    Thanks again.

    • Thanks for your comment and feedback. I think all medical schools struggle with the issues that have been discussed in this blog, and do their best to maintain admissions practices that are both effective and fair. To address your question, I don’t think any school believes its processes are perfect. They review and refine their processes continuously. You’re quite correct that they have public accountabiity, and must also maintain confidentiality of applicants. All this may account, in part, for the difficulties you’ve encountered with your queries, but we all benefit from full discussion. Thanks again for your interest.

  25. Clarke says:

    Thank you for the insightful blog post. Do you ever use feedback from applicants (both successful and failed) when setting your admission policies and processes? I’ve spoken with administrators from a few schools and I get the sense that some schools may not fully appreciate what it’s like to be an applicant today.

    For one, I think medical schools tend to romanticize their admission process; they truly believe that they have a fair, meritocratic process that only picks the best and brightest students. However, no Canadian medical school formally considers things like course difficulty of a program or a university. Some current medical students and practicing physicians that I have spoken with will freely admit they took the path of least of resistance (i.e. an easier course, program or school) to achieve their goal and would happily do so again.

    Personally, I have no problem with this strategy; these people haven’t broken the rules and did what is in their best interest. I’d even encourage any student who has the goal of entering a Canadian medical school to become a physician to do the same. Similar to your post on Entrepreneurship, some Canadian universities will even market their programs by stating that their students achieve high GPAs with a high percentage of them have successfully gained admission into Canadian medical schools. Perhaps this is to drive up enrollment at their schools.

    What I can’t tolerate is the blind belief by medical school administrators that this type of thing could never happen. I’ve spoken with administrators who have claimed there is no such thing as an easy or hard program without offering any substantial evidence. I’d have to say it’s highly unlikely that all the programs across different universities would offer the same level of difficulty. Simply put there are some schools where only 5-10% of the class will achieve GPA >3.5, while there are others where 40-60% of the class will achieve GPA >3.5. Just based on those statistics alone, a student clearly has a higher probability of success in one of those classes. Another administrator at another school said that anyone taking easier courses will likely lose out in the end. How though? The current system does not penalize anyone for taking easier courses. Even if a small percentage of students (i.e. 5-10%) do this, you could be dealing with 250-500 applicants.

    Medical schools should be more honest and realistic about issues like this. I agree, it’s unlikely an entire class is comprised of people who took the easy route. However, this probably happens and I think it’s disingenuous for a medical school to dismiss this phenomenon from ever occurring. What are your thoughts?

    • With regard to the first question, we certainly receive and review feedback from applicants. Our current students are actively involved in both the Admissions Committee and admission process itself. Their recent involvement in the application process provides invaluable insights. The issue of differential course difficulty and marking is well appreciated and has been the topic of much discussion at our school and, I’m sure, at others. Finding a practical and fair way to somehow equilibrate undergraduate marks remains elusive. I’d be interested in workable suggestions. The alternative approach we an others have taken is, as your comments suggests, to reduce the impact of GPA in the overall assessment.

      • Clarke says:

        One of my first suggestions is to standardized all data regarding student’s GPA and class averages. As of right now, medical schools never consider the class average when assessing a candidate’s academic record. It would make sense to judge a candidate’s GPA compared to their class average; this way student’s who take harder programs wouldn’t necessarily be excluded due to lower averages and lower class averages. The biggest stumbling block is that not all universities report their class averages.

        Why is that? It’s 2016. All universities have this data available but do not report it; there’s no real reason to keep this data off a candidate’s transcript. Universities should standardize the way they report their grades. It should include a student’s percentage, GPA, and letter grade in addition to the class average. You could then see if there are any trends with your selection process (maybe selecting students who have higher GPA, but also come from classes with higher averages; combating against grade inflation).

        It’s a simple fix that doesn’t interfere with a university’s operations or philosophy to teaching. Med schools need to be active on this front to improve their process; they need to communicate with other departments and schools to come up with a solution.

  26. Ryan Wilson says:

    The points brought up about medical students reverting back to “Mr. Hydes” cannot be emphasized enough. My allied health program requires shared classes with medical students (among other programs) and there is an “entitled medical student stereotype” which we see fulfilled again and again to the point where it’s refreshing when you meet one who is non-condescending and genuinely respects the MD responsibility. Once that presiding authority figure is removed, MD candidate stereotype comes back into full play and that teamwork/individual/basic respect that was just shown is thrown right out the window. In it’s place I’ve seen unmasked contempt towards lesser educated professions, objectively derogatory comments and blatant racism/discrimination. It’s really something to see an accomplished, positive young leader switch gears right in front of you when the teachers weren’t around. It was only comical the first time, though.

    Everyone’s entitled to their privacy and personal opinions, but if more Admissions Officers heard/saw their prospective MDs in a candid setting, they might be less willing to bet they’ll eventually grow and become the caring MDs we want to manage our care.

    I’d like to see more schools like UofC Cumming’s School process where their reviewers have the option to put more weight on trends in grades over time, types of courses taken, extenuating circumstances in points of time (10%) and their Evidence of Non Cognitive Attributes where they really put the human element into asking whether a candidate shows the attributes they claim in their history (10%). Some of UofCs other selection criteria (only full time years used in calculation; GPA only 20%, MMI a whopping 50%) shows that they’re really trying to select against those students described above in the Jekyll and Hyde situations. Their Head Admissions Officer Dr. Ian Walker says as much in his podcasts. The amount of transparency and work they put in is unreal. Realistically, it’s a ton of extra work compared to my own school: “No special considerations, no discrimination based on degree difficulty.” They’re sure proud of their highest GPA/MCAT entrance averages. They consider Aboriginals and rural applicants at least.

    Huge topic: there are students simply unable to afford to volunteer/research during summers because their hard summer work is what pays for school and what drives them to be an educated professional physician in the first place. Higher interview weighting and Maturity Index scores will help these people who might make better MDs have a fighting chance. It might also be true that young, wealthy and ambitious academics make the best physicians on average.

    If I’m ever considered for admission, I hope more weight will be on how I’ll handle the responsibilities rather than on my academic/test writing abilities.

    • Ian Marshall says:

      What I’d like to be put into place is a constant evaluation of medical students and residents while they’re completing their education. Sort of a checks and balances, and this would also allow for medical students to potentially flunk out. It’s very rare that ever happens with the current system of medical education. It seems to me that once students get accepted into medical school, they let down their guard and just coast. Unfortunately I have heard of one too many cases where this also manifests itself later once they are fully practicing. It’s a sad state of our economy when more emphasis seems to be placed on the prestige and money, and obvious job security of being a doctor. I think universities should also be offering more alternative programs that give students the career options besides a doctor. It’s a shame that someone goes into science and their only two options are either research (which is basically stifled as a career, unless you end up as a faculty member) or medicine. Research should be a more attractive career option. I worked with one group for 2 years and they are developing cutting edge technology that could revolutionize hospital care. Yet this group faces little funding and the employees are underpaid for their contributions. If people have this strong desire to help people, research should represent a viable alternative, not as a transition to medical school, or to an eventual complete change of careers out of pure frustration for the lack of growth and opportunities.

  27. Kam says:

    Medical school admission criteria must be very difficult to develop.

    But my major concern about the whole process and the changes made to them are done without randomized controlled data. The interviewers should be literally blinded to the interviewer. We all have bias when meeting people. This bias may be due to differences in race, sex, attractiveness, height etc. I apologize if I have missed any studies in this area. But many medical schools have flipped to using the MMI as a major selection criteria. Why is this interviewing process better than others used historically? Is it better? Where is the data to prove this is better?

    In medicine, we should follow science and not a “belief” in an arbitrary interviewing approach.

    Many students are great actors and will perform wonderfully on an MMI. But are they better physicians?

  28. Kam says:

    Sorry to clarify.

    There should be a randomized controlled trial to assess whether students that are selected using the MMI compared to a traditional interview or even no interview turn out to be better physicians. The students can be assessed during medical school, residency and in practice. A number of different outcome measures can be used such as grades during medical school, success with CARMS match, LMCC grades etc.

    McMaster has lead the way with these new interviewing techniques, but we don’t know if they are leading us the wrong way. We should follow the teachings of the McMaster teaching on the randomized controlled trial.

    • Anonymous says:

      I’m not sure if you can feasibly design a randomized control trial with regards to the medical school application process, but there is some literature demonstrating predictive validity of the MMI, which assesses difficult-to-quantify people skills. The reasoning is that today’s doctors are certainly not lacking in knowledge, but interpersonal skills have never traditionally been stressed as important for clinicians despite being a major complaint by patients. Published evidence with regards to the MMI is enough that faculties of medicine and other professions throughout North America and the world are implementing it into the selection process. Despite what appears to be a collection of small surface-level interactions, there are very few assessments of these qualities that have been designed as meticulously as the MMI.

      With regards to the blinding of an interviewer, I don’t believe this will ever happen. Part of the interview process is full communication between participants. Non-verbal communication can be very telling about individuals, no matter how much we want to control these things. Otherwise a phone interview or even instant messaging would do most of what you’re looking for, without the need for the expenses incurred over the entire process. This point is iffy with regards to the MMI, but I hope you know what I’m getting at.

      While medical schools in Ontario can vary in their selection criteria, it is impossible to definitively say there is something wrong with the selection process, though much of the scrutiny about the current process has been discussed thoroughly here. Likening this to a pro sports draft, everybody’s ‘draft board’ is a little different, and the results are imperfect, but generally along the right idea. I don’t believe that any school is definitively doing anything wrong with regards to selecting medical students who demonstrate potential, while maintaining a relative degree of fairness.

  29. Anonymous says:

    This was a really insightful read! As a prospective future applicant, I don’t envy the difficult choices that admissions committees have to make in selecting our future physicians from such a strong, if not overqualified, pool. At this point, in Ontario at least, the selection process itself difficult to complain about; each school generally focuses on different factors in their admissions criteria, so that a student who may have one or two weaknesses is not completely excluded from all schools. The process only looks convoluted when schools have to separate top students from other top students, as in the case of Jessica and Matt.

    Are you ever concerned that the rising standards of the admissions process produces cynicism among applicants? From my own experience, the pursuit of extracurricular activities has been wholly meaningful and important to my personal development, though I cannot help but feel that part of the shadow looming over my decisions is essentially “playing the game,” to bolster my personal credentials for selection processes such as the one used by Queen’s. I believe I’ve struck a good balance with experiences that are fulfilling while improving my candidacy, but it is easy for these two factors to dissociate from one another.

    Additionally, has the use of a long-distance video interview ever been considered? I realize this has various control issues, especially for the multiple mini-interview process, but it might lead to the potential to holistically review a greater number of applicants. Admittedly, this would produce a whole other conundrum and perhaps outrage at the idea of selecting future doctors that nobody has even met yet.

    • There’s no question that the process drives behaviour and promotes what one might call “strategic” decisions on the part of applicants. Admissions committees are fully aware and try very hard to factor this into their selections. Long distance interviews have been considered but continue to have significant limitations. A major advantage is that they may impact socioeconomic barriers to the application processes. As technology improves, I imagine they will provide a greater role.

      • Anonymous says:

        Speaking with regards to socioeconomic barriers, those with low socioeconomic status (SES) are plausibly less likely to volunteer or engage in extracurricular activities, particularly if they need to be working over the course of their studies. Since we want to have physicians that are representative of the population, and can potentially fill more healthcare gaps in underprivileged communities, how might this factor into pre-interview screening? Perhaps such an applicant might not stand out when filling out their autobiographical sketch, whereas they may still have all the desirable qualities we seek in our doctors. While I’m not advocating favouritism towards doctors from low SES communities, the potential for these individuals to fall through the cracks may certainly fall under scrutiny. At the same time, completely eliminating this part makes the interview selection process even more difficult at a school like Queen’s, considering the applicant pool may very well reach 5000 in the coming years, and I believe there is a hesitancy among some schools to increase GPA or MCAT cut-offs to a point which undermines other characteristics of applicants.

  30. Pingback: Applying to U.S. Medical Schools as a Canadian Student | CWZ

  31. Dili Chen says:

    This was a very interesting article that pointed out the many difficulties and dilemmas that members of the Admissions Committee often face when reviewing a well-qualified pool of medical school applicants. I certainly understand that the interviews in particular take up more time and efforts, but I am wondering how reliable they are at evaluating the key qualities that every doctor should have in applicants. From the point of view of an applicant, if I knew how to respond perfectly to an ethical dilemma in a medical setting, what am I going to medical school for? An all-time favourite question of admissions committees is “why do you want to become a doctor?” The general answer, as I would imagine, is passion and interest; yet, saying so in an interview would risk giving just another “boring” answer that would make the applicant more unimpressive. Personally, I have known many pre-med students who clearly do not have the communicative skills or core competencies of future doctors, yet are still accepted into many medical schools after being invited to interviews. Could it just be that some applicants are better than others at acing medical school interviews, but that their performance are not reflective of their true abilities or behaviours in daily life?

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Published Mon, September 11, 2017

What’s in a name? That which we call a rose By any other name would smell as sweet.  So mused the ill-fated heroine in Romeo and Juliet, about her equally ill-fated love. In medicine and in teaching, however, names can mean a lot. The late Dr. Kate Granger of the United Kingdom was one of the strongest advocates for using … Continue reading

Welcoming Queen’s Meds 2021
Published Mon, September 4, 2017

The academic cycle is such that, for a few short weeks each summer, our student population reduces by a quarter. Last May, we graduated and congratulated the class of Meds 2017, who have now gone on to engage the next phase their careers. This week, our school continues its cycle of annual renewal, welcoming another eager and very promising group … Continue reading

Anatomy studies begin with focus on respect
Published Mon, August 28, 2017

Each September, first year students in the Queen’s Undergraduate Medical program quietly begin their studies in anatomy with a service acknowledging the donation of bodies that will be used in the lab assignments. This year the short service will be held on Tuesday, September 5 at 3 p.m. in room 032 of the Medical Building, following the introduction to the … Continue reading