Selection into medical school: from tools to domains

BACKGROUND: Most research into the validity of admissions tools focuses on the isolated correlations of individual tools with later outcomes. Instead, looking at how domains of attributes, rather than tools, predict later success is likely to be more generalizable. We aim to produce a blueprint for an admissions scheme that is broadly relevant across institutions. METHODS: We broke down all measures used for admissions at one medical school into the smallest possible component scores. We grouped these into domains on the basis of a multicollinearity analysis, and conducted a regression analysis to determine the independent validity of each domain to predict outcomes of interest. RESULTS: We identified four broad domains: logical reasoning and problem solving, understanding people, communication skills, and biomedical science. Each was independently and significantly associated with performance in final medical school examinations. CONCLUSIONS: We identified two potential errors in the design of admissions schema that can undermine their validity: focusing on tools rather than outcomes, and including a wide range of measures without objectively evaluating the independent contribution of each. Both could be avoided by following a process of programmatic assessment for selection.