Irish Medical Organisation

Entry to Medical School – the Gender Question. What has Happened? - Irish Medical Journal - September 2013

Irish Medical Journal Press Release
September 2013 ■ Volume 106 ■ Number 8
Official Journal of the Irish Medical Organisation
Entry to Medical School – the Gender Question. What has Happened?

The recent revised selection processes to medical schools in Ireland, introduced in 2009 following the Fottrell report, appear to have unintentionally marginally reduced the proportion of female entrants to medical school provoking a media debate and concerns that the process favours male applicants over female. An analysis of the gender profile and scores of all applicants from HPAT - Ireland and Leaving Certificate scores from 2009 -2011 is presented in this study by authors Flynn, Mills and Fitzgerald in the September edition of the Irish Medical Journal.

Since 2009, entry and selection to medical school in Ireland is determined by scoring performance in six subjects in a single sitting of the state run school exit examination the Leaving Certificate (or equivalent), wherein matriculation requirements have been met and the score achieved in an adjunct admission test the Health Professions Admission Test or HPAT-Ireland. To be eligible to apply to medicine candidates must score above 480 points

The study shows that small gender differences favouring males are evident in total HPAT-Ireland scores and subsection scores less than 7 and 4 points respectively with a total selection score impact of approximately 0.8%. In relation to Leaving Certificate performance, since 2009, eligible male applicants to medicine have tended to outperform females with less than 3 points mean difference which has an impact close to 0.7% as selection is still weighted in favour of this test. The gender profile of applicants securing a place has varied annually. Reforms may have inadvertently altered the gender distribution in medical school but there is no evidence that this is entirely attributable to the HPAT-Ireland test.

Equity of access to medical school is not simply a gender question. There is concern regarding the access of minority groups and perhaps socio-economically disadvantaged candidates to a place in medical school when traditional tests are used.

Gender performance in the Leaving Certificate varies from year to year however since 2009 the data collated in this study reveal that eligible male applicants to medical school have tended to slightly outperform females. There is a slight gender difference in HPAT-Ireland performance favouring males most evident in 2009 but less apparent in 2010 or 2011.

The authors note that there are persistent subtle gender patterns at the level of HPAT-Ireland subsections with males consistently outperforming females in Section 1 of the exam - Logical Reasoning and Problem Solving and in Section 3 - Non-Verbal Reasoning, whilst females consistently outperform males in Section 2 - Interpersonal Understanding. This was perhaps most evident in 2009 but is overall less evident thereafter. The subtle differences observed in gender performance at the level of HPAT-Ireland subsections would appear to partially compensate for each other. Furthermore recent proposed changes to the scoring of HPAT-Ireland , which will reduce the weighting applied to Section 3 may reduce the gender differential observed in total HPAT-Ireland scores

Females predominate in the total applicant pool, and in the eligible applicant pool however the gender representation of successful applicants i.e. those who secure a place in medical school has varied annually with near equal gender distribution in 2009, female dominance in 2010 and male dominance in 2011.

The authors analysis of medical school applicants in 2009-2011 inclusive suggests that male applicants outperform female applicants in the Leaving Certificate and, although overall the differences are small, as the entry and selection process is still weighted in favour of the Leaving Certificate any gender differences in such test scores theoretically has approximately twice the effect of a similar difference in gender performance in HPAT-Ireland. The authors state that “This finding surprised us it is known that females generally outperform males in such tests and previous female dominance in medical school was secondary to superior Leaving Certificate performance.”

The authors note that “The historic relative over-representation of females in medical school is a sensitive and emotive issue. All agree that selection to the profession should focus on selecting the best potential doctors but the debate as to the precise mechanism to be employed continues. Proxy measures such as knowledge based tests and adjunct admission tests are, and will continue to be, widely used in a merit based system”.

“The gender debate may have gained attention however policy makers are more concerned about socio-demographic equity. Concerns regarding access to commercial HPAT preparatory courses and repeat effects have already led to recommendations being considered by all medical schools.”

The data analysis carried out in this study to date does not support any evidence of a definite gender bias associated with the introduction of the adjunct admission test HPAT- Ireland. Data will continue to be analysed on an on-going basis.

All references and author names are contained in the full article in this month’s IMJ, p.230
Title: Entry to Medical School – the Gender Question.
What has Happened?


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