Back in the 1980s, some on the left used to call for university admission to be conducted by lottery. Anyone who applied for a course would be selected at random. The left thought it would make it easier for working-class people, who do relatively poorly in admissions systems based on academic merit, to go to university.
At the time, I thought lottery selection of university students was a crazy idea. But now I am not so sure, and nor is the University of Sydney medical school, which is considering using a ballot to choose its students.
The University of Sydney’s problem is that the different admissions tests used for medical schools don’t seem better than each other in predicting future academic performance (here is one study, pdf). This is not an isolated issue. Other published studies, based on larger groups of students, have found correlations usually of around .3 or .4 between school and university academic results. That’s a lot more than 0, but also a lot less than 1. Several researchers have found that, for a given Year 12 score, students from standard government schools do better in their first year of university studies than students from private schools and selective government schools.
So if getting the best students is the goal, our admissions systems are only modestly good mechanisms for achieving it. Effectively, there are so many unobserved factors affecting results that, as a means of selecting the best students, our current methods already contain a random element.
But there is an even larger problem. It’s not clear that we should always be so worried about only selecting students whose academic peformance is likely to be the best. Other qualities are just as relevant, if not more so, out in the workforce (though medicine has tried to take this into account). Being very bright can actually be a disadvantage, given the drudgery involved in most occupations.
I wouldn’t favour a completely random process, but if universities set a minimum threshold below which a student was likely to struggle, choosing among those above it by lottery would not necessarily be any worse than the current semi-random system based on a spurious ranking. It might ultimately be better, if it lets in to some highly-competitive courses people who have done something more in their teens than studied very hard. And it could be fairer, going back to the left’s original rationale, if it spreads the rewards of high-prestige courses more broadly than the current system, which benefits most those who, with their high intelligence and often affluent parents, have already won life’s lottery.
Andrew Norton 
I think they have a lottery system for some university courses in Germany, in that they first select the bulk of the student intake on the basis of academic achievement in the matriculation, after which students who don’t get into their course of choice can apply to the lottery to allocate the relatively small number of remaining positions.
LikeLike
Clearly, we are in the realm of third-best solutions here! One disadvantage with a lottery approach is that it could blunt the already-limited incentives operating in the secondary education market. The TER is the one quantified and objective (though imperfect) measure of secondary school academic performance. Publication of Year 12 results combined with a university entrance focus on TERs has probably driven substantial improvements in the quality of secondary schooling and a lottery system may reduce some of the responsible incentives.
LikeLike
Presumably in the case of prospective medical students the lottery pool will consist only of qualified students. that is those that have already have passed some academic hurdles. You don’t want dumb people becoming doctors. Imaginr if say, Brendan Nelson, had become a doctor instead of a politician.
A lottery sounds fairer than an interview system, where people can be subconsciously accepted/rejected because of the way they comb their hair etc.
LikeLike
Interesting post Andrew, however don’t you feel concerned that resorting to a lottery is both a cop-out for a university (avoiding potential law suits from disgruntled rejected med students with a dandruff problem at an interview perhaps?) and misses one of the big issues which is important to patients – getting doctors who can actually relate to patients and deliver a sense of confidence?
A lottery is definitely not going to get doctors with people skills nor a curious, probing mind…just statistically lucky individuals.
LikeLike
C’mon Matt, you’re not suggesting that the current process delivers on that score. Are you?
I think selecting at random from a pool of qualified candidates is probably a good idea. An even better idea would be accepting all qualified candidates. But if the government won’t pay and forbids the students (or their parents) from paying then this is better than any of the other corrupt techniques that might otherwise be adopted.
LikeLike
“An even better idea would be accepting all qualified candidates.”
That’s not very practical. Thousands of people apply for the hundreds of places in medical schools. Medical students don’t just sit in lecture theatres. They sit at the feet of doctors in teaching hospitals. Who is going to pay for all the new hospitals needed just to teach all the students? And where are the patients going to come from? Hospital waiting lists aren’t that big.
Think, Sinclair, think.
LikeLike
I know precisely how medical students are trained. Mrs D mark I is a medical doctor.
Spiros, we live in a society, not an economy. In any event, I doubt you’d find that we were swamped with doctors. I suspect further that if more students did medicine and found they couldn’t earn a living in the burbs that they’d move to rural areas, or even migrate to those parts of the world where there is a shortage of doctors. So I’m not sure what the problem is.
LikeLike
The problem is that to train doctors you need teaching hospitals which are very expensive. That is why you can’t have as many medical students as there are applicants to medical schools.
Who by the way says that there is an oversupply of doctors in the burbs? If that were true we wouldn’t be importing them from India?
LikeLike
By the way is the first Mrs D (I suppose that should be Dr D unless she is a surgeon) in this great country of ours? South Efrican doctors are very high quality in my observation.
LikeLike
There isn’t an over-supply now – but if medical schools expanded their activities there might be.
We’ve got teaching hospitals now, and I’m not convinced they’re at full capacity.
There is another alternative as you indicate. Close all Austalian medical schools and import all our doctors. Or at least privatise them and import any shortfall (if any).
LikeLike
Mrs D mark I is Dr G. She kept her ‘maiden’ name for professional purposes. Yes, she is here (graduated third in her class). When we came to Australia the authorities were not allowing foreign doctors in so she came as a spouse and not a doctor. (Luckily we came when we did because the next year they closed that loophole and started subtracting immigration points for doctors). It took years for her to get registered here. A total disgrace.
LikeLike
Matt – You could still apply basic selection criteria, such as minimum school and UMAT/GAMSAT results. Unmet demand for medical school is so huge that I am sure there are hundreds if not thousands of people who would be perfectly good doctors who are missing out now.
The issue of patient confidence is an interesting one, but what protects patients has never been the university admissions system, but the extraordinary number of hurdles would-be doctors have to jump before they become fully qualified.
The major argument against change is essentially a conservative one – there is relatively low attrition from medical courses and the medical profession, so the current system looks to be a fairly efficient one. Plus I take Rajat’s point that we don’t want to alter the incentives in the school system, though it think there would still be a fair amount of pressure to reach the threshold entry requirements.
LikeLike
So many GP’s spend their time treating ailments that once my mother handled effectively, if brutally.
I have thought for years of a needed split between doctor and good first aid, health worker. Most third world countries are treated by”witch doctors” not all ineffectively. Penicillin was derived from them?
As it is now if a doctor is less than sure of his diagnosis ,one finishes up with a specialist. Why not split the qualification to treat the common cold, odd stitching and worried mother?
Failed doctors once became dentists, which was a great improvement on having teeth attended to by the blacksmith.
A better solution than dumbing down our universities.
fluff4
LikeLike
Andrew (re post 12, your response to Matt): you seem to be implying that UMAT/GAMSAT are not doing the job of both identifying useful potential medical students, and making it clear to aspirants what’s involved in a medical education/career. Therefore, doesn’t this cast doubt over UMAT/GAMSAT as useful tools?
–
Why has there been no investigation of probably Australia’s best medical entrance program, that run by the Uni of Newcastle?
–
Surely the selection criteria requires recalibration, rather than the vicissitudes of the lottery. There may be an opening in the market for a preliminary course that puts one through mentally and physically stressful conditions that one faces in the medical workforce, much like the basic training conducted by the armed forces before inductees (i.e. those who aren’t excluded, or don’t drop out) are formally admitted to a particular service and trained in specific tasks.
LikeLike
Andrew E – Given the relatively low attrition I also note in comment 12, it is hard to say that any of the admissions systems are failures on the basic admit/don’t admit question, even if they fail to predict which students will do the best academically. My basic point in the post is that given all the tests do a reasonable job of screening out those who will fail or drop out, perhaps we should not place so much emphasis on enrolling people based on their rank according to an admissions test.
I’m not sure whether there is research on Newcastle; I don’t recall it. But there is surprisingly little research anywhere on the outcomes of higher education – one of the many respects in which higher education is not yet a modern, professional service industry.
LikeLike
I was thinking about the medical profession more broadly rather than the education-based component of that.
–
For the first few years post-graduation, medicine graduates tend to be employed by a hospital/area health service, or admitted to general practice where Medicare represents most, if not all, of his/her income. The founders of Medicare were acutely sensitive to the whole ‘socialised medicine’ issue, especially as this policy was introduced in the face of sweeping deregulation and privatisation in almost every other area of the economy/society. Yet, the fact is that less-experienced medical graduates practicing medicine are all but public-sector employees, whose working conditions are as inextricable to the maintenance of effective government as those of the military.
–
Another trend in medical education is the formalisation of postgraduate specialty training (i.e. the greater control by formalised education over this), and the degree to which this training should be the preserve of industry groups comprised of existing practitioners with an interest in maintaining tight restrictions on numbers to maintain high incomes.
–
I’m also reading Paul Ham’s (excellent) Vietnam: the Australian war, thus the musings on conscription lotteries and emergency forms of medicine.
LikeLike
I think lotteries are a good idea for all of the reasons Andrew states and also because they make a very clear, public point about both the spuriousness of current “meritocratic” entrance conditions generally and the heavy handed restrictions of the feds over student places more specifically.
–
Rajat’s point is somewhat important if medical training is only conducted at the undergraduate level but not near as important if entry is at the postgraduate level. One of the neat features of postgraduate training is that aspirants have more opportunities to apply for entry. If an aspirant doesn’t make it in the first round, it really is no big deal if they apply in subsequent years. In fact, for young people who have only just completed their bachelor’s it’s probably a very good thing to be forced to go ourt and do something else for a few years.
LikeLike
One effect, and probably a purpose, of interview systems for admission to medical schools was to reduce the number of Asian, particularly Chinese students.
This was justified on the ground that their communication skills are not adequate. What the real agenda was, we can only guess at.
It would be interesting to look at the changed output of graduates from, for example UNSW, since it adopted interviews.
I don’t think anyone knows what skills and personal characteristics will make a good doctor. Certainly, interviews have not done a good job of sorting out.
Maybe a lottery, among those having a basic level of academic ability, would work best.
LikeLike
“This was justified on the ground that their communication skills are not adequate”
I never heard that — I thought it was done so that it was possible to discriminate against minority groups.
LikeLike
I assume this post is tongue in cheek? The logic is completely spurious. On this argument, we should also argue as follows: Elections often perform poorly at selecting good politicians. Therefore we should select our MPs using a lottery.
Or: Job interviews often perform poorly at selecting the best candidate for a position. Therefore we should draw the next editor of Policy magazine out of a hat.
LikeLike
Hans – If there is no job candidate who is clearly the best choosing one is a semi-random process, or one that brings in strictly irrelevant factors (such as liking some aspect of their CV that does not relate to the job). A lottery would be just as ‘fair’.
Lotteries can be used in a wide range of circumstances in which rationing is required but there are no clear criteria for making a choice.
LikeLike
Education should be given to everyone who wishes to be trained or attain a degree. But I agree that there should be admission fair systems for applicants. Not just pick them by random.
LikeLike
Quite an interesting read
Another trend in medical education is the formalisation of postgraduate specialty training (i.e. the greater control by formalised education over this), and the degree to which this training should be the preserve of industry groups comprised of existing practitioners with an interest in maintaining tight restrictions on numbers to maintain high incomes.
LikeLike