# A Qualitative Study of a New Generation of Irish-Trained Doctors’ Views on Selection for Medicine

## TL;DR

This study explores how a new generation of Irish doctors views the selection process for medical school, focusing on fairness and effectiveness.

## Contribution

The paper provides novel insights from recent Irish-trained doctors on the validity and equity of medical student selection criteria.

## Key findings

- Participants emphasized academic thresholds and motivation as essential for selection.
- HPAT-Ireland was criticized for socioeconomic inequity and limited scope.
- Doctors suggested a two-stage selection system to improve fairness and authenticity.

## Abstract

Student selection for Medicine degree programmes is a complex and high-stakes process. In Ireland, students entering from secondary school are selected based on combined scores achieved in the state school exit examination (Leaving Certificate) and the Health Professions Aptitude Test (HPAT-Ireland), introduced in 2009 to broaden entry assessment beyond academic achievement alone. Questions remain about the validity, fairness, and alignment with the skills required for medical practice of this approach. This study explored the views of the “HPAT generation” (doctors admitted via HPAT-Ireland) on ideals and processes of medical student selection, including the relevance and equity of the Irish system.

An interpretivist qualitative study using semi-structured interviews was conducted and analysed using reflexive thematic analysis.

Twelve Irish-trained doctors admitted post-2009 were interviewed. Four themes were identified. Participants identified
Threshold criteria as foundations of selection (Theme 1) highlighting academic ability and motivation as essential, with the Leaving Certificate viewed as an appropriate threshold measure. They also identified
Further criteria as top-level differentiators (Theme 2) including problem-solving, critical thinking, and communication skills. Interviews, multiple mini-interviews, and selection centres were seen as authentic assessments albeit limited by bias and nepotism. HPAT-Ireland was criticised for limited scope, artificial format, and socioeconomic inequity. Under
Personal diversity and potential for development (Theme 3) participants emphasised varied personalities, and recognition that desirable qualities can be cultivated during training. Under
Equity, access, and exploitation (Theme 4) participants expressed concerns that any selection method may be prone to financial inequity and exploitative score inflation without systems-level change.

Findings highlight tensions between academic thresholds, authentic assessment of differentiators, and equitable access. Doctors of the HPAT-Ireland generation support a two-stage selection system but are sceptical of HPAT-Ireland’s ability to fulfil its intended role. Policy reforms must address these tensions to ensure fair and sustainable medical student selection.