Mar 24, 2011

HPAT opens up medicine courses, but is it for the best?

Gavin MacDermott

“I think it is a good concept because it seems to be giving the more medically apt people a chance which is the way it should be in my opinion,” says Patrick Cooper, a medical student in UCD. The ‘Health Professions Admissions Test’ has been used in Ireland since 2009. Before then, most Leaving Certificate students who walked through the door to a life in medicine scored in the high 500s or captured the revered 600. It’s a different ball game now though as the introduction of the HPAT has led to a change in the demographic of medical students who will become the doctors of the future.

The Government at the time, saw fit to ‘improve’ the system of examining prospective medical students by importing the HPAT from Australian Council of Educational Research (ACER) who now moderate the examinations held every February in Ireland. It all sounds quite rosy and the concept is a progressive one, but what does it mean for Irish educational merit when the 600 point winners are not getting their place? Is fairness in education in question regarding the training of our doctors?


The HPAT website states that the test “measures a candidate’s logical reasoning and problem solving skills as well as non-verbal reasoning and the ability to understand the thoughts, behaviour and/or intentions of people” and claims the test is not linked to any particular “academic discipline”. In other words, it believes the HPAT can determine whether a candidate has the personality to be a doctor or not. Full marks on all three sections of the test would be 300, but here’s the rub- its bloody hard and you cannot ‘study’ for it.

“The exam was awful, I just remember not knowing how long was left for each section because I couldn’t see the clock. Also, I remember thinking that I would have to rewrite my CAO application because I was certain that I wouldn’t get in!” explained Aisling Fagan, a first year medical student in Trinity. Aisling managed to prove both herself and the HPAT wrong as she scored very respectably in the 100th percentile of the HPAT overall in 2010. She was also awarded 570 points in the Leaving Cert. The minimum CAO points required for medicine was changed to 480 recently as well to open courses up to Leaving Cert graduates more. Yet, in 2009, the first year of the HPAT in Ireland, most of the people to receive places in medicine still had 520 or more. This has significantly opened the margins for more students but many who place their hopes in the lowered CAO points requirement depend heavily on a top class result in the HPAT. Aisling acknowledges that it benefited her case, as she would not have had enough points to get a place in medicine under the old regime.
Top scores on the HPAT in 2010 were up around the 220 mark but most candidates score between 140 and 170. The Trinity hopeful needs 723 to secure a place in medicine. This is a combination of the HPAT score and CAO points. Candidates, like Aisling and Patrick, who score mainly in the 700’s, usually make the cut. So, the overall process of applying for medicine still favours those with very strong academic inclination. However, there is always the “back door” option for students whereby they undertake a certain course in the health sciences and then transfer to medicine after year one or two.

The test itself has received some criticism in terms of its lay out. Patrick noted that the test could be “weighted inaccurately” with regard to what aspects of a candidate’s personality the HPAT should evaluate. “At the moment Verbal Reasoning has the biggest percentage whereas, I think, Interpersonal Understanding should be the main section.”

Given the importance of the HPAT result under the new regime for qualification, there has been a change in the demographic of medical students. The HPAT has led to further arguments regarding gender. Since the HPAT was introduced the number of successful female candidates has declined and the number of successful males increased. This has some correlation with the fact that traditionally female students do better in the Leaving Cert than males and now it seems that males have a better record in the HPAT. The gas thing about the HPAT is that, according to ACER themselves, it cannot be prepared for! ACER even go as boldly to state that private tuition is unnecessary as there is no way of knowing what will come up on the HPAT, unlike the trusty Leaving Cert. However, there are so many expensive grinds courses being offered in preparation for the HPAT. Aisling paid a substantial €350 for a two-day HPAT course and, even though she found it quite helpful at the time, in hindsight it was not worth the money.
A lot of what we want from a doctor as patients, other than pure medical competence, is the good old-fashioned ‘E.R.’ type bedside manner. The HPAT is supposed to recognise that in candidates today. It is very difficult to quantify intangible things like friendliness, warmth and compassion but perhaps it is a stepping stone. Some Medical academics reckon an interview would be a more plausible method of examining students than a written exam. Patrick argues that, although the HPAT has its limitations, the vast majority of people in medical courses seem to “fit the bill.” Patrick himself received 600 points. He is still, however, of the opinion that the HPAT stops people “cruising into medicine” and that it seems to be giving the more “medically apt a chance”.

Aisling has a contrasting view of the HPAT. “If it was up to me I would get rid of the HPAT,” she states, “I think it’s a ridiculous exam. I’ve always done well in aptitude tests, but I don’t see how this is reflective of being a good doctor.” She is firmly of the belief that 600 points in the Leaving Cert warrants the choice of any course.

So the battle will continue between the existing system of combined HPAT and CAO scores and the previous system of pure academic merit. However the real question today is; will the apparent change in the demographic of medical students signify a postive change in the quality of Ireland’s doctors in the future?

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