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In 2014, the random selection (or lottery) admission process was replaced by a decentralised selection procedure for all medical schools in the Netherlands. The argument behind this change is that it should lead to a better match between candidate and study. Also, at introduction some reasoned that this new procedure would be fairer. However, several recent studies show no evidence that a decentralised selection procedure outperforms the replaced lottery system when motivation and study results are considered. Furthermore, medical schools use their own, wide varying selection criteria, whilst having the same goal: selecting the best future doctors. Next to this, future students can only apply for one medical school each year. Medical schools show significant difference in the number of applications, which therefore leads to different odds of a student being admitted (e.g. 27 vs. 62% admission rate at most and least popular medical schools). To make the selection procedure for admission to medical school fairer, central selection for all medical schools or the option to apply at multiple medical schools each year should be considered - particularly since these are well-known aspects of the selection procedures in other countries.

In the Netherlands, most universities use a lottery system, weighted by average examination grades, to admit students to medical school. However, the political climate for pre-entry selection procedures is changing rapidly. A study by the University Medical Center Rotterdam revealed that pre-entry selection reduces the medical school drop-out rate during the first years of medical training. This is an important observation. It is plausible that students selected by pre-entry selection are more motivated than students selected by a lottery system. However, it is unknown whether these students will also display better professional behaviour and skills in their future careers. Further research is required to determine which of the cognitive and non-cognitive characteristics relevant for predicting students' success in their future careers should be included in the assessment to optimize the selection procedure.

Admittance to a medical school in the Netherlands has for decades been based on a grade point average weighted lottery system of secondary school leavers. Since 2000, the Dutch Higher Education and Scientific Research Act has given medical schools the option of selecting candidates. In 2000, two of the eight Dutch medical schools started selection experiments for 10 percent of their places. Leiden University Medical Center invited school leavers who had studied a more varied range of extra subjects to attend a 10-day summer school. All 54 candidates were ranked on the basis of assessments and tests; 24 of them were admitted. Utrecht University invited students with a higher education degree to a selection day. An application form, a structured interview and a questionnaire determined the ranking of 53 candidates; 24 of them were admitted. Both schools were satisfied with the manner in which the selection procedure worked. However, it is not yet possible to draw any definite conclusions about the effectiveness of the selection procedure.