의과대학 입학에 있어서 인적특성 평가(Med Educ, 2005)

의과대학 입학에 있어서 인적특성 평가(Med Educ, 2005)

Assessment of personal qualities in relation to admission to medical school

Mary Ann Lumsden,1 Miles Bore,2,3 Keith Millar,4 Rachael Jack1 & David Powis2

의과대학 학생선발 절차의 목적은 학부의학교육을 잘 이수하여 미래에 좋은 의사가 될 사람을 뽑고, 전문직에게 악평을 남길 사람을 배제하는 것이다.

The aim of a medical school admissions procedure is to select those who will perform well as undergraduates and make good doctors in the future, and to exclude those who will bring the profession into disrepute.

추가로, 의과대학 졸업생의 사회적, 문화적, 인종적 배경 구성이 어떻게 되어있느냐는 전체 환자집단의 다양성을 반영해야 한다.

In addition, the social, cultural and ethnic backgrounds of medical graduates should reflect the diversity of the patient population.

고등학교졸업생을 대상으로 한 영국의 의과대학생 선발은 높은 학업성취도를 이룬 학생을 주로 선발하며, 그 절차는 비밀스럽고 다양하다.

The admission of school-leavers to medical schools in the UK is usually based upon high academic attain- ment, the procedures often being secretive and varied.2

그러나 학업성취도가 높은 학생을 선발하는 것은 그 성장배경이 애초에 불리한 사람들을 차별하는 결과를 가져올 수 있다. 그리고 이는 지원자와 교사 모두의 의욕을 꺾는 일이다. 더 나아가서 불리한 성장배경에서 자라난 지원자는 현재의 의과대학 선발요건을 달성하기 어려운 경우가 많은데, 이는 그들의 학업적 역량을 최대로 발휘할 기회가 주어지지 않았기 때문이다.

However, high academic thresholds may discriminate against those from disadvantaged backgrounds7,8 as these discourage both applicants and teachers. Furthermore, applicants from disadvantaged backgrounds find current admissions requirements difficult to attain because they often lack opportunity or encouragement to maximise their academic potential. 

더 광범위하게는, 의사들은 우수한 역량과 더불어 공감과 윤리성을 갖추어야 한다. 

More broadly, it is generally accepted that doctors need to be competent, empathic and ethical. (Leaving aside particular psychomotor skills, generic competence in this context refers to the intellectual ability to solve problems by applying acquired knowledge and using logical reasoning.)

psychometric 검사는 학습자료 이외에서 드러나는 인적특성을 측정하는 도구로 사용될 수 있고, 따라서 이는 사회적 배경에 영향을 덜 받는다.

Psychometric tests can be used to measure personal- ity characteristics and abilities rather than learned material, and accordingly, performance should be less influenced by social background.

의과대학 지원자에 대한 Psychometric testing은 미국과 호주에서 몇 년간 사용되어왔다. 인지능력은 그 자체로 혹은 지원자의 다른 학업기록과 함께 사용될 경우에도 의과대학 수행능력의 신뢰도 높은 예측인자임이 확인되어왔다.

Psychometric testing of applicants to medicine has been used in the USA and Australia for some years. Cognitive ability scores alone, and in combination with the academic record of the applicant, have been shown to be reliable predictors of medical school performance.10

PQA가 호주에서 개발되었으며 세 가지 검사를 포함하고 있다.

A test battery called the Personal Qualities Assess- ment (PQA) has been developed by researchers in Australia. The battery consists of 3 tests, of which the 

• first is designed to measure individual differences in cognitive reasoning ability, 
• the second to identify an Involved (empathic and confident with others) or Detached (narcissistic and aloof) personality trait, and 
• the third to determine ethical ⁄ moral orientation.

PQA에 대한 추가 정보

Further details are available from the PQA website.13

인성검사과 윤리/도덕 지향검사는 그러한 특성이 강하게 발전된 개개인을 대상으로 활용될 수 있다. 예컨대 그 검사를 통해서 공감이 높은 사람 혹은 자기확신이 강한 사람을 찾을 수 있으며, 자기애적인 사람과 무관심한 사람을 찾을 수 있다. 이 두 가지 검사도구 결과를 병합하면 Table1 과 같은 결과가 나온다.

The personality and ethical ⁄ moral orientation tests can be used to identify individuals in whom certain characteristics are strongly developed. For example, they allow for identification of those who are very empathic or self-confident, as well as those who are particularly narcissistic or aloof. In addition, the scores from these 2 assessment tools can be combined, enabling an empirically-based definition of different personality types (Table 1).

요약하자면 PQA는 다음과 같은 것을 검사한다.

In summary, the PQA is used to determine: 

• cognitive reasoning ability; 

• the degree to which individuals are involved or detached, and 

• the extent to which individuals value individual freedom at the expense of societal needs or the needs and expectations of society at the expense of the individual.

The tests ⁄ questionnaires

Participants completed the following tests.

• Test 1: Cognitive Skills (TUNRA, University of Newcastle, Australia): This comprised a 38-itemtest to measure the ability to reason logically and to apply logic to problemsolving.

• Test 2: Mojac Scale11,14–16: This provides a relative measure of a libertarian-dual-communitarian dimension of moral ori- entation (LibCom score).

• Test 3: NACE⁄ (ECAN) Scale12,16: This provides scores on narcissism(N), aloofness (A), self-confidence(C) andempathy (E). Anoverall ECAN score was calculated: highscores indicate a tendency to be involved with others (high empathy and self- confidence) while lowscores indicate a tendency to be detachedfromothers (highaloofness andnarcissism).

도덕성 유형 

Moral types

이 연구를 위해서 평균에서 1.5SD 떨어진 것을 임의로 기준으로 삼았다.

For this research the types were defined arbitrarily as a score on either dimension greater than 1.5 standard deviations from the mean. The raw scores were converted to T scores, having a mean of 50 with an SD of 10. Accordingly, outlying scores lie below 35 or above 65 on either dimension.

통계 분석

Statistical analysis

Results are expressed as means (SD) for normally distributed data. The Kruskall)Wallis and Mann–Whitney tests were used to examine non-parametric data.

부모의 직업 자료는 얻는 것이 불가능해서 DepCat 분류를 사용했다.

As data on parental occupation were not available, social class was defined by deprivation category (DepCat), whereby the individual’s postcode serves as a proxy for socioeconomic class.19

1~7까지이며, 1,2 / 3,4,5 / 6,7로 구분하였음.

DepCats range from 1 to 7, the latter indicating areas of severe deprivation. DepCat data were available on 427 individuals. Due to the small numbers inDepCat 6and7particularly, the cohort was divided into 3 groups for analysis.19 Group 1 comprisedthoseinDepCats 1and2 (n ¼ 164, 38.4%); group 2 comprised those in DepCats 3, 4 and 5 (n ¼ 229, 53.6%) and group 3 comprised those in DepCats 6 and 7 (n ¼ 34, 8.0%).

PQA 프로파일

Profile of the PQA

인지기술

Cognitive skills

The range and normal distribution of the scores shown in Fig. 1 indicate that there are widely differ- ent cognitive abilities in this sample, which is other- wise uniformin terms of its members having achieved high grades in school-leaving examinations.

MOJAC과 NACE 점수

MOJAC and NACE scores

Figure 2 shows the distribution of applicants by moral type:

Gender

Educational background

Deprivation category (DepCat)

선발절차에 PQA를 포함시키는 것의 효과

The effect of incorporating the PQA into theselection process 

평균보다 2SD이상 떨어지는 지원자는 의학에 부적합하다고 볼 수 있다. 이 지원자들을 배제하고, 성격검사에서 극단에 있는 사람들을 제외한다면, 109명의 학생이 남는다. 그러나 이 중에 실제로는 15명만이 선발단계에서 배제되엇다.

It may be hypothesised that those applicants withrelatively poor cognitive skills (> 2 SD below thecohort mean score) are less suited to a career inmedicine. If these individuals are excluded, together with those whose personality traits lie at the extreme ends of the scale, 109 (23%) of the Scottish applicants would not have obtained a place. Only 15 of these applicants were in fact excluded on the standard admissions criteria applied. Figure 4 shows the actual acceptance and rejection rates of the present sample in their applications to study medicine, and their application outcomes if the PQA or standard criteria had been applied.

DISCUSSION

인지기술 점수는 가우시안 분포를 따랐으며, 이 전체 지원자의 학업성취가 전반적으로 극도로 높음에도 이러한 인지적 능력에는 상당한 차이가 있는 것을 보여준다. 이는 'A레벨을 받는 것'자체로는 - 이미 그러한 학생들이 수가 늘어나서 - 충분히 쓸모있는 선발기준이 되지 못한다는 여러 기관의 우려와 일치한다.

The scores of the cognitive skills test component of the PQA follow a Gaussian distribution and it is possible to distinguish different degrees of cogni- tive ability despite the fact that academic attain- ment across the cohort is extremely high. This is an important finding in light of the concerns expressed by both the media and organisations such as the Council of the Heads of Medical Schools that A-levels are becoming less useful as a selection criterion because increasing numbers of candidates achieve the top grades.

인지적 능력 뿐 아니라 PQA는 NACE과 Mojac도 확인한다. PQA에서 드러난 특성은 교육적 배경에 따라 영향을 받지 않으나, 일부 DepCat에 따라서 약간의 차이는 있다. 더 Deprivation이 심한 집단에서 ECAN점수가 높으며, 이는 이들이 더 공감적이고 자신감이 있으며, 덜 자기애적이고 덜 무관심하다는 것을 보여준다.

As well as cognitive ability, the PQA has also been developed to identify empathy and related and opposing traits (NACE) and moral ⁄ ethical orienta- tion (Mojac). The qualities identified by the PQA were not influenced by educational background, although some minor differences with deprivation category were noted: those from areas of greater deprivation produced higher ECAN scores, indica- ting that they were more involved (empathic and confident) and less detached (narcissistic and aloof) than those from areas of lesser deprivation.

13 Personal Qualities Assessment (PQA). http://www. pqa.net.au

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Med Educ. 2005 Mar;39(3):258-65.

Assessment of personal qualities in relation to admission to medical school.

Lumsden MA1, Bore M, Millar K, Jack R, Powis D.

Author information

• 1Division of Developmental Medicine, Glasgow Royal Infirmary, Glasgow, UK. M.A.Lumsden@clinmed.gla.ac.uk

Abstract

BACKGROUND:

Recently there has been much scrutiny of the medical school admissions process by universities, the General Medical Council and the public. Improved objectivity, fairness and effectiveness of selection procedures are desirable. The ultimate outcome sought is the graduation of competent doctors who reflect the values of and are in tune with the communities they serve.

METHODS:

Applicants to the Scottish medical schools sat a battery of psychometric tests to measure cognitive ability, personality traits and moral/ethical reasoning (Personal Qualities Assessment, PQA). Analysis determined the potential impact of the latter variables, and those of educational background and socioeconomic class (assessed by residential 'deprivation category'), upon success in gaining a place to study medicine.

RESULTS:

Cognitive ability did not vary significantly as a function of gender or educational background, although there was a trend for it to be lower in individuals from more deprived backgrounds. Women as a group were more empathic, with a greater communitarian orientation, than men. There was no significant difference between individuals attending independent and state-funded schools in respect of any of the qualities measured by the PQA. Applicants from deprived backgrounds and those attending state-funded schools would not be disadvantaged by an admissions process based on the PQA.

CONCLUSION:

The incorporation of an assessment tool such as the PQA may have positive implications for widening access and the objective selection of suitable medical students, resulting in the training of doctors who are more representative of the community at large. A longterm follow-up of the professional careers of those medical students who completed the PQA will be undertaken.

Comment in

• How to choose tomorrow's doctors. [Med Educ. 2005]

PMID:

 

15733161

 

[PubMed - indexed for MEDLINE]