Progress of medical students after open admission or admission based on knowledge tests.

Context: Although admission to university in Austria is generally open for applicants who have successfully completed secondary school, in some areas of study, including human medicine and dentistry, the selection of students by additional criteria has become legally possible as a result of a decision by the European Court in 2005. We studied the impact of this important change on the temporal pattern of medical students' progress through the study programme.

Methods: All 2532 regular students admitted to the diploma programme in human medicine at the Medical University of Graz during the academic years 2002/03-2007/08 were included in the analysis. Non-parametric and semi-parametric survival analysis techniques were employed to compare the time required to complete the first two study semesters (first part of the curriculum) before and after the implementation of admission tests. Temporal patterns of dropout before this goal was achieved were also investigated. Sex, age and nationality of students were assessed as potential confounding variables.

Results: The cumulative probability of study success was dramatically better in selected students versus those who were admitted openly (P < 0.0001). Whereas only 20.1-26.4% of openly admitted students completed the first two study semesters within the scheduled time of 1 year, this percentage rose to 75.6-91.9% for those selected by admission tests. Similarly, the cumulative probability for dropping out of study was also significantly lower in selected students (P < 0.0001). By univariate as well as multivariate techniques, student nationality, age and sex were also identified as partly significant, albeit weak, predictors.

Discussion: The analysis convincingly demonstrates that, by contrast with open admission, performance-based selection of medical students significantly raises the probability of successful study progress. Additionally, the proportion of dropouts is significantly reduced. Thus, admission tests save considerable costs, in terms of both student time and public resources.