의과대학 학생선발 과정에 사용되는 자료들과 중요도의 변천사: 1980년대 이후로 무슨 일이 있었나? (Academic Medicine, 2013)

의과대학 학생선발 과정에 사용되는 자료들과 중요도의 변천사: 1980년대 이후로 무슨 일이 있었나? (Academic Medicine, 2013)

An Overview of the Medical School Admission Process and Use of Applicant Data in Decision Making: What Has Changed Since the 1980s?

Alicia Monroe, MD, Erin Quinn, PhD, MEd, Wayne Samuelson, MD, Dana M. Dunleavy, PhD, and Keith W. Dowd, MA

PURPOSE:

현재 미국/캐나다 의과대학의 학생선발 절차를 알아보고, 1986년과 어떻게 다른지 비교한다.

To investigate current medical school admission processes and whether they differ from those in 1986 when they were last reviewed by the Association of American Medical Colleges (AAMC).

METHOD:

2008년 MCAT점수를 활용하는 모든 미국과 캐나다의 의과대학을 대상으로 학생선발 절차에 관한 설문을 시행하였다.

In spring 2008, admission deans from all MD-granting U.S. and Canadian medical schools using the Medical College Admission Test (MCAT) were invited to complete an online survey that asked participants to describe their institution's admission process and to report the use and rate the importance of applicant data in making decisions at each stage.

RESULTS:

120개 대학이 응답하였다. 면접을 통해서 인적특성을 평가한다고 대답하였으며, 1986년과 비교하였을 때 1단계(면접대상자 선발 평가)에서 학업 성적관련 자료의 사용이 늘었다. 1986년에는 GPA가 거의 모든 단계의 합격자 결정에 있어서 가장 중요했던 반면, 2008년에는 1단계, 2단계에 따라서 중요시되는 자료가 서로 달랐다. MCAT과 학부 GPA는 1단계에서 중요했으며, 면접과 추천서 등이 최종적으로 누가 합격할지를 결정하는데 중요했다.

The 120 responding admission officers reported using a variety of data to make decisions. Most indicated using interviews to assess applicants' personal characteristics. Compared with 1986, there was an increase in the emphasis placed on academic data during pre-interview screening. While GPA data were among the most important data in decision making at all stages in 1986, data use and importance varied by the stage of the process in 2008: MCAT scores and undergraduate GPAs were rated as the most important data for deciding whom to invite to submit secondary applications and interview, whereas interview recommendations and letters of recommendation were rated as the most important data in deciding whom to accept.

CONCLUSIONS:

의과대학 학생선발절차의 복잡성을 보여주는 연구이며, 지원자의 댜양한 측면을 총체적으로 평가하는 holistic approach의 사용이 늘었음을 보여준다. 

This study underscores the complexity of the medical school admission process and suggests increased use of a holistic approach that considers the whole applicant when making admission decisions. Findings will inform AAMC initiatives focused on transforming admission processes.

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학생선발의 여러 절차에는 어떤 순환적 구조가 있다. 의과대학이 변하면 입학정책을 통해서 지원자 풀에 영향을 주고, 입학결정이 이뤄지는 법적, 사회적 맥락이 있으며, 의과대학 교육과정이 변한다.

We suggest that they have a cyclical relationship with the admission process: Changes in academic medicine affect the admission process through their influence on the applicant pool, the legal and social contexts in which admission decisions are made, and the medical school curriculum.

1980년대에는 의과대학 지원자 풀이 작아져서 지원자의 수준이 떨어질 것이라는 우려가 있었다. 또한 소수자와 여성지원자 비율이 낮았다. 그러나 2008년 지원자 풀이 넓어졌으며 여기에는 아시아계 학생과 여학생의 영향이 크다.

Since the mid-1980s, the number and composition of medical school applicants have changed dramatically. At that time, there were concerns about a declining applicant pool and a potential decline in the academic quality of applicants.5 Additionally, the percentages of minority and female applicants were relatively low.6 By 2008, the applicant pool had grown and become more diverse with respect to Asian and female applicants.*

지원자의 수와 구성이 변한 것이 입학정책에도 영향을 주었다. (1)평가의 단계가 더 늘어났고, (2)좀더 정량화가능한 자료를 많이 사용하게 되었으며 (3)양적 자료와 질적 자료(학업적-비학업적 자료)를 모두 사용하게 되었다.

We suggest that these changes in the size and composition of the applicant pool may have affected the admission process in several ways when compared with that of the mid-1980s. 

• Given the increase in applicants, admission committees—especially those with large applicant pools—may add stages to the process to reduce the number of applicants remaining at each stage. 
• Second, with more applicants in the pool, admission officers may rely more heavily on data that are quantifiable and easily incorporated into pre-interview screening tools. 
• Third, in light of the changes in composition of the applicant pool, admission committees may use a combination of quantitative and qualitative (academic and nonacademic) data in order to achieve broad diversity in the student body.

법적 환경도 영향을 많이 주는요인이다.

The legal context in which admission committees operate has changed substantially, however. For example, the Supreme Court’s 2003 decision in Grutter v. Bollinger13 affirmed the importance of mission-driven, evidence-based admission decisions and introduced the concept of educational benefits of diversity.† It also established that all applicants must be considered through the same admission process, which allowed schools to change their diversity and admission policies. In 1986, only 28% of U.S. medical schools included diversity as a primary goal of their admission process,‡ whereas 57% did in 2008.14,15

법적, 사회적 환경의 변화는 적어도 다음의 두 가지를 통헤 입학에 영향을 준다. (1)1980년대보다 학생선발 과정에서 지원자에 대한 더 많은, 다양한 자료를 활용하게 되엇다. (2)지원자의 민족/인종, 성별. 사회경제적수준 등에 대한 고려가 많아졌다.

We suggest that, together, these legal and social context changes may have affected the admission process in at least two ways. 

• First, admission committees may now consider more and varied information about applicants in making admission decisions than they did in the mid-1980s. 
• Second, with a slightly more diverse applicant pool and a more permissive legal environment, admission committees may now be more likely to consider information about applicants’ race/ethnicity, gender, and/or SES background in the admission process.

1990년대와 2000년대에 의과대학에 많은 변화가 있었음.

In the 1990s and 2000s, a series of structural modifications to the medical school and residency accreditation processes, as well as new curricular resources, paved the way for fundamental changes in medical education. For example, the Liaison Committee on Medical Education18 (LCME) and the Accreditation Council for Graduate Medical Education19 revised their accreditation standards to require medical schools and residency programs to teach and assess professional attributes. LCME standard MS-31-A states, “A medical education program must ensure that its learning environment promotes the development of explicit and appropriate professional attributes in its medical students (attitudes, behaviors, and identity).”18 In addition, the AAMC Medical School Objectives Project series20 and the Institute of Medicine (IOM) report on behavioral and social sciences in medical school curricula21 identified— and, importantly, provided curriculum materials to help medical schools modify their curricula to teach—the broad knowledge, skills, and attitudes that graduating medical students should possess.

The admission process in 2008

Slightly more than half (57%, 68/120) of the respondents reported that their medical school’s admission decisions are made using a two-stage process that includes an initial application and an interview.

Slightly less than half (43%, 52/120) of the respondents reported that their schools use a three-stage process to make admission decisions, the same as reported by Mitchell4 in 1986 (43%, 49/113).

Overall, admission officers rated a wide range of data as important to admission committees’ decisions about which applicants to invite to submit secondary applications, interview, and accept into medical school (Table 1). However, the uses and importance of these data differed by the stage of the process.

Table 2 compares the relative importance of 15 types of data in making acceptance decisions in 1986 and 2008. Among the most important types of data, 64% (7/11) were nonacademic in 2008 compared with 50% (5/10) in 1986,4 suggesting that nonacademic data are more important to admission decisions today than in the past.

The admission interview in 2008

All responding admission officers reported that their medical schools conduct admission interviews.

Interviews were described as one-on one by 83% (99/119) of the responding admission officers. Most respondents (87%, 104/120) reported that interviews are conducted by admission committee members, whereas 17% (20/120) reported that they are conducted by staff and 68% (81/120) indicated that, in some cases, they are conducted by medical students.

Results showed that the admission interview is somewhat structured. The majority of respondents (65%, 77/119) indicated that interviewers are given general guidance about the content of the questions they should ask. 

Admission officials indicated that interviews are most often used to assess nonacademic characteristics and skills: Over 85% (more than 100 of 119) reported that interviews include questions about applicants’ motivation for pursuing a medical career, compassion and empathy, personal maturity, oral communication skills, service orientation, and professionalism.

학부 GPA와 MCAT점수가 중요함을 보여준다. 그러나 이것만이 전부가 아니라는 것을 보여주는 결과는, UGPA와 MCAT이 모두 최상위권인 1233명의 지원자 중에서조차 9%의 학생은 모든 의과대학에 불합격했다는 점이다. 

Chart 1 shows that although UGPAs and MCAT scores are important factors in admission processes, they are not the sole determinants of acceptance decisions. For example, 105 (9%) of the 1,233 applicants with UGPAs of 3.80 to 4.00 and MCAT total scores of 39 to 45 were not accepted by any of the medical schools to which they applied in 2008–2010. In contrast, 597 (18%) of the 3,324 applicants with UGPAs of 3.20 to 3.39 and MCAT scores of 24 to 26 were accepted by at least one medical school. These findings buttress the importance ratings data presented earlier, suggesting that a wide variety of data are important to admission decisions.

변하지 않은 점 Aspects of the admission process that have not changed

변하지 않은 점은 다음과 같다. (1)다양한 자료를 활용하고 있다. (2)두 단계 혹은 세 단계로 구성되어 있다. (3)MCAT점수를 중요하게 보고 있으며, MCAT과 학부GPA를 서로 비교하여 활용한다. (4)면접의 수, 길이, 형식이 거의 비슷하다. (5)인구통계학적 특성의 중요성은 낮다고 응답했다.

Certain aspects of the admission process are largely unchanged since the mid- 1980s. 

• First, as in 1986,4 admission officers today use a variety of data in making decisions, which suggests that they remain committed to evaluating both academic and nonacademic information.
•  Second, our data suggest that, as in 1986, schools’ admission processes are structured into two or three stages.
•  Third, in both 1986 and 2008, admission officers rated MCAT scores as important to each stage in the process and indicated that they use MCAT scores and UGPAs to provide an interpretive context for each another. 
• Fourth, the number, length, and format of admission interviews are the same as those described by Johnson and Edwards3 in 1991. Similarly, the admission interview continues to be the primary source of information about applicants’ personal characteristics.
• Finally, as in the 1986 survey,4 admission officers in our survey rated the importance of demographic characteristics in the admission process as relatively low

일부 의과대학의 입학위원회에서는 holistic review를 하는 것 자체가 소수인종이나 농촌지역 지원자들이 자신의 잠재력을 충분히 보여줄 수 있는 것이라고 생각하여, 명시적으로 인구통계학적 변인들을 고려할 필요를 낮추는 것으로 보인다.

We suggest, on the basis of the data presented in this article and comments made by focus group participants during site visits, that some medical school admission committees may feel that conducting holistic reviews allows URM and rural applicants to show their full potential and precludes the need to consider demographic variables explicitly.

변한 점 Aspects of the admission process that have changed

1980년대와 마찬가지로 두 단계, 세 단계의 과정을 거치나 각 단계에서 중요하게 보는 것이 달라진다.

As was the case in the mid-1980s, most admission committees use a multistage process to make decisions. However, our data suggest that admission committees now place different emphasis on applicant data at each stage of the process. For example, in summarizing the results of the 1986 survey, Mitchell4 noted that although test scores decreased in importance as decision making proceeded, importance ratings did not differ appreciably across the stages of the admission process. In contrast, our data suggest that admission committees now consider slightly different data when deciding whom to invite to submit secondary applications, interview, and accept. Academic data seem to be slightly more important in deciding which applicants to invite to submit secondary applications and to interview than in deciding whom to accept.

This difference is likely due to the increasing size of applicant pools and the ease of incorporating academic data into automated screening processes

However, we interpret the 2008 survey data reported in this article—and the qualitative data from the 2008 medical school site visits—as indicating that the inclusion of multiple stages does not preclude the use of a holistic admission process.

비학업적 자료에 대한 중요도가 높아진 것 역시 중요한 변화 중 하나이다.

Arguably, the most notable change in the admission process is the increased importance placed on nonacademic data in making acceptance decisions. In 2008, admissions officers rated more nonacademic data as “of high importance” than did admission officers in 1986. Further, all types of academic data dropped in ratings of relative importance in the 2008 survey compared with the 1986 survey (except MCAT scores), whereas nonacademic data such as interview recommendations, letters of recommendation, and personal statements gained in importance.

합격률 자료를 보아도, 서로 다른 학업성취도의 학생들이 다양하게 의과대학에 입학하고 있다. 

Acceptance rate data provide additional support for this change, showing that applicants with different levels of academic preparedness (i.e., the combination of cumulative UGPA and MCAT total score) are accepted into medical school. Together, these data and the high importance ratings given to both academic and nonacademic data in the 2008 survey suggest that many medical schools are conducting a more holistic admissions process than they have in the past.

대학마다 학점의 인플레이션이 있다는 것이 보고되고 있다. 그러나 이러한 인플레이션에 대한 정보가 UGPA 활용방식에 영향을 주었는지는 불분명하다.

Additionally, grade inflation occurs at many undergraduate institutions.26 It is unclear whether knowledge of such inflation affects admission officers’ use of UGPAs in their decision making;

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Acad Med. 2013 May;88(5):672-81. doi: 10.1097/ACM.0b013e31828bf252.

An overview of the medical school admission process and use of applicant data in decision making: what haschanged since the 1980s?

Monroe A1, Quinn E, Samuelson W, Dunleavy DM, Dowd KW.

Author information

• 1Educational Affairs, University of South Florida Health Morsani College of Medicine, Tampa, Florida, USA.

Abstract

PURPOSE:

To investigate current medical school admission processes and whether they differ from those in 1986 when they were last reviewed by the Association of American Medical Colleges (AAMC).

METHOD:

In spring 2008, admission deans from all MD-granting U.S. and Canadian medical schools using the Medical College Admission Test (MCAT) were invited to complete an online survey that asked participants to describe their institution's admission process and to report the use and rate the importance of applicant data in making decisions at each stage.

RESULTS:

The 120 responding admission officers reported using a variety of data to make decisions. Most indicated using interviews to assess applicants' personal characteristics. Compared with 1986, there was an increase in the emphasis placed on academic data during pre-interview screening. While GPA data were among the most important data in decision making at all stages in 1986, data use and importance varied by the stage of the process in 2008: MCAT scores and undergraduate GPAs were rated as the most important data for deciding whom to invite to submit secondary applications and interview, whereas interview recommendations and letters of recommendation were rated as the most important data in deciding whom to accept.

CONCLUSIONS:

This study underscores the complexity of the medical school admission process and suggests increased use of a holistic approach that considers the whole applicant when making admission decisions. Findings will inform AAMC initiatives focused on transformingadmission processes.

PMID:

 

23524917

 

[PubMed - indexed for MEDLINE]