The selection procedures used in Auckland have been reviewed, and the characteristics of those admitted over 25 years analysed. Students are admitted either as school-leavers, mature entrants, or through an affirmative action scheme. A further small number are admitted as part of overseas development assistance. School-leavers are invited for interview on the basis of their academic achievement. Mature students and the affirmative group must have a minimum acceptable academic standard, with the interview playing a dominant role. Two thousand four hundred and forty-eight students have been admitted. The mean age was 18.6 years, and 39.7% were women. Over one half of the students had a parent who had attended university and 13% had a medical parent. One in ten students failed to complete the course, academic failure and withdrawal being of equal importance. The high loss seen in the affirmative group was due to academic failure and has led to the introduction of extra tuition and support for these students. The emphasis on academic achievement by school-leavers has excluded many applicants with outstanding personal qualities. The academic staff has therefore decided to modify the selection procedure, the final rank order of these applicants being based on their personal attributes and life experiences.

The major focus in the selection of entrants for medical school has traditionally been on academic achievement in school-leaving examinations in which certain science subjects are a requirement. A longitudinal study of 413 successful applicants was undertaken to determine the relationship of these admission criteria to subsequent performance. The findings support a correlation between overall marks in the school-leaving examination and the annual Grade Point Averages. Those students in the top quartile for marks showed a significant advantage in terms of achievement but only in the preclinical years. Despite the significant correlations no predictions could be made on the basis of overall marks. No correlation was found with levels of clinical competence during the ward clerkships or with the interdisciplinary objective structured clinical examination (OSCE) in the final examination. Marks in individual school-leaving examination subjects correlated with performance during different parts of the course but only those entrants in the top quartile for marks in physics and biology showed an advantage through to the clinical years. English marks were the least correlated and failed to confer an advantage in any year of the course. None of the correlations between school-leaving marks and grades in medical school exceeded 0.4. The predictive value of school-leaving examination marks therefore accounted for only 16% of the variance in subsequent examinations. Selection of medical students on the basis of academic criteria alone is inadequate and should be accompanied by assessment of personal qualities. This School no longer uses school-leaving marks as the primary selection instrument.(ABSTRACT TRUNCATED AT 250 WORDS)

SUMMARY An affirmative‐action programme was introduced in Auckland in 1972 to increase the proportion and absolute number of entrants to medical school from the indigenous or Maori population and those of Pacific Island ancestry. One hundred and forty‐seven students have entered the course through this programme, the percentage of females being higher than that of the non‐affirmative category. Seventy‐five have graduated – a graduation rate of 78%. Twenty‐seven (18%) have been lost from the course mainly through academic failure, This loss is much higher than the 8% found for the remaining medical student population. The subsequent careers of those lost from the course has been satisfactory, some graduating from other faculties and some from polytechnics. Although such a programme remains controversial it has enabled a large number of persons to enter medical school who would not have been able to do so through the standard admitting process.

Major changes in health care delivery and the increased number of clerkship sites used for teaching by many medical schools has resulted in significant implications for medical education. Methods have become necessary to achieve and maintain a comparable clinical experience and a uniform assessment process at each teaching site. Following a review of existing practices, a new core curriculum, a problem-based approach and the Objective Structured Clinical Examination (OSCE) were introduced into this department. Over 1200 students have passed through this revised surgical clerkship over the past 8 years. The introduction of the OSCE has helped to direct student learning, provide an objective assessment to complement the ward grade, and enabled an audit of teaching and learning to be carried out. In one group of 103 students no significant correlation was found between the OSCE and ward grades. Performance at different hospitals was similar and those carrying out their clerkship later in the academic year benefited from their previous other attachments. The OSCE has enabled immediate feedback to be given to learners as well as providing teachers with an opportunity to see for themselves the outcome of their tuition. A clinical performance record card has now been introduced to improve the monitoring of students' clinical experience.

Limitations of the traditional final medical examination for the assessment of clinical competence led to such developments as simulated patients and the Objective Structured Clinical Examination (OSCE). An interdisciplinary OSCE incorporating simulated patients and involving nine disciplines was introduced into the final examination in the Auckland School of Medicine to supplement the written papers and the long case. Six-hundred and eight students were assessed over a 6-year period. Each of the three examination modes provided good discriminatory power. Significant correlations were found between the tests, but this does not mean one or more is redundant. Principal component analysis showed that a single significant factor accounted for over half the variance in the final assessment. This factor was equally weighted to the three examinations. A variety of evaluative methods are necessary to assess a student's competence and greater emphasis should be placed on those methods which encourage the learning of clinical skills and concurrently provide an appropriate mechanism for assessing them. The changes introduced have been supported by students and teachers and have fostered the learning of important clinical skills. Efforts to standardize the single long case have not overcome the criticisms surrounding its use, particularly in summative assessment.