To what extent does the Health Professions Admission TestIreland (HPAT) predict performance in early undergraduate tests of communication and clinical skills? – An observational cohort study

CONTEXT Traditionally selection to Irish medical schools was based solely on academic achievement. Following publication of the Fottrell report, the Health Professions Admission Test- Ireland (HPAT) was introduced in 2009. Irish and EU medical school applicants are now selected on a combination of their academic record and HPAT score. The most widely used measure of the efficacy of selection tools is predictive validity (1). This is the first study to report on the predictive validity of the HPAT for undergraduate assessments of communication and clinical skills. STUDY OBJECTIVE To determine the relationship between applicants’ performance on the HPAT and the Leaving Certificate Examination and their subsequent performance in undergraduate tests of communication and clinical skills. METHODS All students enrolled at the medical schools of NUI Galway and UCC in 2009 were followed up for two years. Data collected were gender, HPAT total and subsection scores (Section 1, 2 and 3); LCE, LCE/HPAT combined score, Year 1 OSCE scores (Total score, communication and clinical subtest scores), Year 1 MCQ and Year 2 OSCE (Total score, communication and clinical subtest scores). RESULTS Data were available for 312 students. In Year 1 none of the selection criteria were significantly related to Total OSCE scores, OSCE Communication or OSCE Clinical subsection scores. The LCE and LCE/HPAT scores were modestly associated, with MCQ marks. In Year 2 modest to weak significant correlations were evident between HPAT 2, Total HPAT, and OSCE Communication Z-scores; Total HPAT and LCE/HPAT with OSCE Clinical Z-scores; and HPAT 2, Total HPAT, and LCE/HPAT with Total OSCE Z-scores. However when using multiple regression only the relationship between Total OSCE Score and the Total HPAT score remained significant albeit the predictive power was very weak. DISCUSSION Our study found that none of the entry and selection criteria used to select Irish and EU applicants strongly predict clinical and communication skills performance in the early stages of the course. This finding questions the benefit of the role of the HPAT as an additional selection tool. Follow up is required to establish if this pattern continues during the senior years of the medical course.