Selecting the most suitable candidate to be a medical student who will later perform as the best physician constitutes a great challenge and is discussed in many medical schools worldwide. In the past, it was common to rely only on cognitive abilities and previous academic success. Cognitive skills and academic grades were shown to predict success in medical school and in measures of career success. However, this association between academic performance and success beyond medical school is relatively week. Some studies [3, 4] provide clear evidence that candidates selected on the basis of high academic performance alone are much more likely to drop out from medical school than candidates selected through a complex admission process. Moreover, relying only on cognitive tools introduces a significant socio-economic class bias [5, 6]. Therefore, in recent years there is increasing agreement that the admission process to medical school that is aimed at selection of candidates with the highest propensity of becoming the best physicians includes the evaluation of two principal domains, 1-basic intelligence and cognitive aptitude and 2- personality, including candidates’ emotional ability, conscientiousness and self-esteem. Various methods have been developed to examine these personal characteristics including: personal interviews, biographical questionnaires, Situational Judgement Tests, Multiple Mini Interview and others. The process varies between medical schools between countries and within Israel, reflecting the diversity in vision and mission of each one of them. Since it is complicated to define the best physician, it is an unresolved and ongoing debates which admission process predicts which candidate will be the best physician.
Since its establishment 47 years ago, the six years Goldman medical school at Ben-Gurion University (BGU) advocates for personality traits been of highest importance, and therefore deliberately emphasizing the personality evaluation to the first domain, once the basic (although very high) intelligence criterion has been met [8–10]. The admission process is open for all high school graduates and includes a three-staged process (Fig. 1). The first stage includes a score a.k.a. "Sekhem" that represents a weighted average between the Israeli national matriculation exams and the grade of the psychometric test administered by the Israeli National Institute for testing and evaluation. This combined mark ("Sechem") is a prerequisite for eligibility for initiating an admission process in all medical schools in Israel. In the BGU school, Sekhem has been historically set lower relative to other schools following an understanding that the highest combined mark does not necessarily predict the best medical student and physician . Additionally, a slightly lower cut off ensures a socioeconomic diversity of the candidates. Once passed the Sekhem cut off, the candidates are eligible for the second stage. It is comprised of a computerized questionnaire, based on the "Big Five" - testing for different variables of personality including conscientiousness, extraversion, agreeableness, openness to experience and emotional stability. This computerized test enables widen the funnel so all candidates with the basic cognitive abilities are given a chance. The candidates with the highest scores on the computerized test are invited for an interview by two trained interviewers in a session that may take up to one hour. One interviewer is a physician and the other is a community representative (stage 3).
The interview is based on a pre-written structured resumes and the questions are directed to specific abilities including thinking ability, emotional ability, social skills, social awareness and social involvement, as well as the ability to stand under pressure.
The scores for the interview are standardized separately for each interviewer by calculating a t-score relative to his/her history of grading. Thus the t-score of the grade indicates the extent to which a candidate scored high or low relative to other evaluations of the same interviewer. An average t-score for both interviewers represent the final interview score. The scores are back-transformed into grades 0–10 for the final comparison. Over the last decades the admission process varied in terms of the interview structure, while often times it included 2 consecutive interviews (by overall 4 interviewers), while the second interview was administered within candidates passing a threshold score in the first. The "2-interview" structure was always preferred over the "1-interview" and depended entirely on the capacity of the admission committee on a certain year. The 120 candidates with the highest score out of approximately 1600–1800 candidates passing the first stage are the ones accepted to medical school, with an acceptance rate around 7%.
Over the years, the graduates of the Goldman medical school at BGU are known for their excellence and high human-factor quality. Friedberg & Glick from BGU analyzed evaluations made by department heads in hospitals throughout the country comparing BGU graduates to their counterparts trained in other medical schools in Israel. Seventy-four (74) % thought that BGU graduates were better in physician-patient relations and 49% felt they excelled in physician-team relations.
Despite these findings, the admission process at BGU and its association with the students' performance has never been assessed.
In this study, we focused on the students’ performance at the internal medicine rotation – which is practically sub-internship in their last (6th ) year of medical school. The sixth-year internal medicine clinical rotation lasting for 6 weeks is designed to prepare students for their role as house officers. During the rotation the student should function as a first-year resident under the supervision of the senior medical staff. The student will assume primary responsibility for the patients he/she admits to the service. Students are evaluated by their skills to accurately and efficiently assess, diagnose, and treat general medical conditions requiring hospitalization and provide an immediate care. Additionally, at this point students are assessed for their problem-solving skills needed to facilitate future medical care/compliance in a patient population frequently without prior medical care. During this rotation students are expected to effectively care for patients during their hospitalization and provide for a safe transition at discharge. As well as foster effective communication with patients, families, colleagues, consultants, primary care physicians, and allied health professionals.
In our opinion, the medical student sixth year internal medicine rotation performance may potentially serve as a close proxy to their future performance as physicians.