Medical student selection: Effects of different admissions processes

This thesis describes several studies on selection outcomes in the multi-process medical school admissions system in the Netherlands. After a long tradition of lottery-based admissions, we have transferred to a system of selection-based admissions. The main research question in this thesis is whether selection-based admissions should indeed be preferred over lottery-based admissions. The period in which the Netherlands transitioned from the lottery-based to the selection-based admissions system provided us with the unique opportunity to compare study outcomes of students who were admitted based on either a top pre-university GPA, selection-acceptance, weighted lottery after selection-rejection, or weighted lottery without participation in selection.
We conclude that there is not enough evidence to support the preference for selection-based medical school admissions over lottery-based admissions. Performance differences between groups of students who were admitted based on the four admissions processes were small, though in some cases statistically significant. Considering the biases that are inherent to most selection processes and the fact that the validity and reliability of most selection instruments that are currently used are not warranted, implementing selection instead of lottery does not improve the admissions system as much as one might have hoped.
Curriculum sample selection, possibly combined with lottery, seems most promising for future admissions decisions. In addition to academic and possibly non-academic aptitude, admissions decisions should reflect future societal needs. It is recommended that the focus of medicals school selection be expanded from applicant characteristics to societal change, in order to admit and train professionals that will be needed in the society of the future.