Why Medical School Admissions Should be Changed to a Lottery

I think medical schools should be using a lottery to select their students for admission. Not a weighted lottery (i.e. better grades/MCAT scores give you a higher chance of being selected), but a pure, unadulterated, Lotto 6/49 type lottery. To get your ticket, all you need is to meet the academic requirements of the medical school you're applying to. This is not a popular view. I have been called an idiot – and worse – for believing this. But I'm not an idiot, let me tell you why.

The most common reaction I get to mentioning the lottery is that there is no way, absolutely no way, that a lottery could be as good as an interview. What they are really saying is that they have tremendous faith in the ability of an interviewer, or interviewers, to recognize and appropriately weight qualities that would make a good colleague in a 20-30 minute encounter. Some people put it another way: it is the interviewers job to identify people who would be disastrous to work with, like a sociopath. Whichever way you think of it, we are woefully incapable of fulfilling our role as an interviewer in these encounters. In my mind, there are two glaring reasons why this is: (1) the applicant pool is so large and so strong, and (2) there are too many personalities in medicine to adequately standardize the interview in any meaningful manner. 

Let's think about the applicant pool first (it's more important anyway). There are more students applying now than at any other time in the history of the profession. This has resulted in the academic admissions criteria becoming increasingly difficult. It is no longer acceptable to write the MCAT on a whim, the scores needed to gain entry to medical school are too competitive. Likewise, with undergraduate or graduate school marks just to be in consideration for a spot in medical school are astronomically high. So if 3000 students apply, and the school interviews 500, those students will have higher scores than if you did the same thing even 10 years ago. With so many elite level students applying, certainly they would, at a minimum, be able to deal with the academic component of medicine.

But that really isn't the point of the interview, is it? We feel like meeting the candidates face to face is the only way to measure the character of the people we are letting in to medical school. Yet our measures of how successful the interview process is, is based on test scores. There are snippets of data showing that the Multiple Mini Interviews (MMI) might correlate to a higher score on MCCQE parts I and II (Eva et. al 2012 JAMA). Is performance on those two exams what interviewers have in mind when selecting applicants? Certainly not. Let's not forget that the MCCQEs are pass/fail exams, and the MMI does not influence the overall pass/fail rate of the test. So the actual implications of the MMI have no influence on graduating doctors. We can't measure the character of people we graduate because it’s too hard – it's too subjective.

So really, looking at the evidence for our current interview process (MMI), combined with the ever increasing academic strength of incoming students, the interview process has become superfluous. I am willing to have my mind changed, but as it stands right now, I can't imagine anyone raising an argument that is strong enough to warrant the immense time, energy, and money it takes to interview these candidates. Let's use our academic cutoffs, and then have a lottery.

Anonymous, Queen's University