School leaver selection to medicine in Ireland: a qualitative study of stakeholder perspectives

Selection of medical students is high stakes. From a widening participation and social accountability perspective understanding the views of stakeholders is critically important. However, the voices of certain stakeholder groups, including parents, teachers and members of the public, are poorly represented in the extant literature. This study aims to explore the perspectives of a broad group of stakeholders on the national selection system for entry to medical programmes in Ireland that utilises the national school exit examination (Leaving Certificate Examination, LCE) and a specific admissions test for health professions (Health Professions Admission Test, HPAT-Ireland). This qualitative study was designed and reported according to the SRQR guidelines. The conceptual framework is underpinned by organisational justice theory. Recruitment was guided by a sampling framework, using key informants and snowballing, to engage participants. Semi-structured qualitative interviews were conducted remotely by telephone, using a topic guide. Sample size was guided by the data saturation principle. Thematic data analysis was conducted iteratively and inductively. Twenty-five participants included medical school staff, regulatory bodies, schoolteachers, parents, medical students and members of the public. Three themes were generated, each with 2–4 subthemes. Theme 1 describes attributes identified as essential to being a good doctor and to patient trust. These included empathy, compassion, good communication skills, strong cognitive skills and resilience. Theme 2 captures participants’ understanding of what selection tools measure, how these measures relate to being a good doctor and the information sources participants used to inform their opinions. Theme 3 portrays participants’ views on the fairness of the current and alternative selection tools and perceptions of equality of opportunity. It was the overwhelming and strongly held view across all participant groups that financial, social and cultural circumstances impacted unfairly on applicant performance on both the LCE and HPAT-Ireland. Our research found pervasive concerns about equity of opportunity in terms of both student performance on selection tests and self-efficacy of students from less affluent and under-represented backgrounds. Removing these barriers has the potential to have a multiplier effect on participation in medicine from under-represented groups and is likely to be a move welcomed by stakeholders.