Putting the HPat system to the test

MEDICAL MATTERS:Study points out flaws in medical school exam

IN ABOUT three weeks’ time, the results of the 2010 Leaving Certificate will be published. It’s a tense time for students, especially those who don’t secure enough points for their chosen course. Should they accept an offer of a lower choice or go back and repeat the exam next year?

For aspiring medical students, there is the added complexity of the Health Professions Admission Test (HPat), an aptitude test whose score is combined with Leaving Cert points to determine who is offered a place in medical schools in the Republic.

Since its introduction last year, the HPat has been the source of no little controversy. This column was contacted by a number of 600-point Leaving Cert candidates who were not offered medical school places because of relatively poor HPat scores. Determined to become doctors, they sat the HPat again this year. In the case of one woman – who incidentally was offered places in two UK medical schools last year – her HPat score went from the 50th to the 97th percentile. The difference was that this year she enrolled in a dedicated HPat preparation course. I am aware of a number of similar cases, where students, contrary to the advice of the Department of Education and the Australian administrators of the HPat scheme, undertook specific preparatory work for the test, achieved better scores and who will now secure places denied to them last year.

The HPat purports to test a candidate’s ability to reason, think logically and understand the thought process, emotions and intentions of other people. These are skills which most people acquire over time. In theory, experienced doctors should outperform potential medical students on HPat testing if the examination is a true measure of problem- solving skills and the ability to understand human behaviour.

This was the hypothesis put forward by the authors of an insightful paper in the current issue of the Irish Medical Journal. Led by professor of surgery at the RCSI, Arnie Hill, they administered a HPat test to 222 candidates: medical students, junior doctors training to be surgeons and consultant surgeons. Medical students included those sitting the traditional five-year undergraduate programme as well as graduate entry students who follow a four-year programme. Of note, the graduate entry students had already sat an aptitude test to gain entry to medical school.

The results are fascinating. The junior doctors had the lowest average HPat scores. The consultants scored marginally better than the undergraduate medical students. But top performers were those who entered medical school as mature students, having first obtained a degree in another discipline.

Commenting on the outcome of their research, the authors said they were somewhat surprised at the scores of consultants. “We would have expected that consultants with years of experience accrued in the clinical, research and academic fields would have out-

performed students. The ability to interpret data along with the more intuitive ‘wait and see’ decisions, combined with the ability to make a decision based on suboptimal knowledge and change as the situation evolves, are critical determinants in the performance of a doctor. These are skills gained with time and experience, and would be akin to the traits purported to be tested by the aptitude tests. If a true measure of these skills, consultants should clearly have scored higher.”

And they are concerned that just like in any other exam, HPat candidates can improve their score with practice.

“The introduction of the HPat is a positive step; however, it is not without its flaws. We wish to emphasise that undergraduate medicine is a broad basic qualification. The traits that are required to be a pathologist, surgeon or paediatrician are as varied as the traits required for any other profession, and we would caution that the HPat, as it stands, does not allow for this diversity,” the authors conclude.

Both reliable anecdote and objective research suggest the decision to introduce HPat needs to be revisited. In the meantime, budding medical students would be well advised to spend as much time preparing for the aptitude test as they do for the Leaving Cert.