Answer to "What outcomes are the right outcomes in medical admissions?"
As mentioned earlier, longitudinal studies examining predictors of success after graduation and/or registration as a doctor are currently lacking, and the research focus is predominantly on the relationship between academic performance (e.g., Grade Point Average [GPA]) and academic attainment as one progresses through medical school and beyond. There is little research linking personal attributes assessed at the point of selection with outcomes during medical school and thereafter.
It is of interest that the discourse around what has “worked” is changing because of changes in the careers-related behaviour of early career stage doctors in many countries. For example, many localities and specialties under-recruit, and there is a draw to urban, specialist practice in many countries. Recently authors such as Gorman (2017) and Cleland (2017) have suggested shifting the focus of selection to attract and recruit applicants who are fit-for-purpose in terms of meeting the health care needs of the public.
Cleland JA. The Medical School Admissions Process and Meeting the Public’s Health Care Needs: Never the Twain Shall Meet? Academic Medicine: December 19, 2017 - Volume Publish Ahead of Print - Issue - doi: 10.1097/ACM.0000000000002104
Gorman D. Matching the production of doctors with national needs. Medical Education, 2018: 52(1): 103-113.
This requires different measurements of medical school admissions outcomes, shifting the focus from performance on undergraduate and postgraduate examinations, to thinking more about career-related outcomes (e.g., working in underserved regions and/or working in certain specialties: see later for further discussion). This is not a straightforward matter of selecting students with certain characteristics (e.g., rural origin) who will go on to work as predicted (e.g., in rural practice) (see later for further discussion), and the development and evaluation of new selection processes and tools may be needed. Moreover, there needs to be critical reflection and empirical evidence as to whether selection can meet the purpose of providing a diverse workforce (see later for further discussion).