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Background: A two-step selection procedure, consisting of a non-academic and an academic step, was recently shown to select students with a 2.6 times lower risk of early dropout and a higher clerkship Grade Point Average (GPA) than lottery-admitted controls. Aim: To determine the relative contribution of the non-academic and academic steps to differences found in student performance. Method: Lottery-admitted students (n=653) and three groups of selection procedure participants were compared on early dropout rate and clerkship GPA: (1) all participants (n = 1676), (2) participants who passed step 1, and (3) participants who passed step 2. Results: Selection procedure participation resulted in a 4.4% lower dropout rate than lottery admission and this difference increased to 5.2% after step 1 and to 8.7% after step 2. Clerkship GPA was significantly higher for participants who passed step 1 than for their lottery-admitted controls. This difference remained significant after the rejection of students on academic criteria in step 2. Conclusion: The lower dropout rate of selected students is related to both self-selection of participants before the start of the selection procedure and the academic part of the selection procedure. The higher clerkship GPA of selected students is almost exclusively related to the non-academic selection criteria. [ABSTRACT FROM AUTHOR]

Medical Education 2011: 45: 1032-1040 Objectives A recent controlled study by our group showed that the dropout rate in the first 2 years of study of medical students selected for entry by the assessment of a combination of non-cognitive and cognitive abilities was 2.6 times lower than that of a control group of students admitted by lottery. The aim of the present study was to compare the performance of these two groups in the clinical phase. Methods A prospective cohort study was performed to compare the performance of 389 medical students admitted by selection with that of 938 students admitted by weighted lottery between 2001 and 2004. Follow-up of these cohorts lasted 5.5-8.5 years. The main outcome measures were the mean grade obtained on the first five discipline-specific clerkships by all cohorts and the mean grade achieved on all 10 clerkships by the cohorts of 2001 and 2002. Results Selected students obtained a significantly higher mean grade during their first five clerkships than lottery-admitted students (mean ± standard error [SE] 7.95 ± 0.03, 95% confidence interval [CI] 7.90-8.00 versus mean ± SE 7.84 ± 0.02, 95% CI 7.81-7.87; p < 0.001). This difference reflected the fact that selected students achieved a grade of ≥ 8.0 1.5 times more often than lottery-admitted students. An analysis of all mean grades awarded on 10 clerkships revealed the same results. Moreover, the longer follow-up period over the clerkships showed that the relative risk for dropout was twice as low in the selected student group as in the lottery-admitted student group. Conclusions The selected group received significantly higher mean grades on their first five clerkships, which could not be attributed to factors other than the selection procedure. Although the risk for dropout before the clinical phase increased somewhat in both groups, the actual dropout rate proved to be twice as low in the selected group. [ABSTRACT FROM AUTHOR]