Cleland Jennifer, Blitz Julia, Amaral Eliana, You You, Alexander Kirsty
Lee Kong Chian School of Medicine, Nanyang Technological University Singapore and National Healthcare Group Singapore, Singapore.
Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.
Med Educ. 2025 Jan;59(1):46-55. doi: 10.1111/medu.15492. Epub 2024 Aug 9.
The medical school selection literature comes mostly from a few countries in the Global North and offers little opportunity to consider different ways of thinking and doing. Our aim, therefore, was to critically consider selection practices and their sociohistorical influences in our respective countries (Brazil, China, Singapore, South Africa and the UK), including how any perceived inequalities are addressed.
This paper summarises many constructive dialogues grounded in the idea of he er butong () (harmony with diversity), learning about and from each other.
Some practices were similar across the five countries, but there were differences in precise practices, attitudes and sociohistorical influences thereon. For example, in Brazil, South Africa and the UK, there is public and political acknowledgement that attainment is linked to systemic and social factors such as socio-economic status and/or race. Selecting for medical school solely on prior attainment is recognised as unfair to less privileged societal groups. Conversely, selection via examination performance is seen as fair and promoting equality in China and Singapore, although the historical context underpinning this value differs across the two countries. The five countries differ in respect of their actions towards addressing inequality. Quotas are used to ensure the representation of certain groups in Brazil and regional representation in China. Quotas are illegal in the UK, and South Africa does not impose them, leading to the use of various, compensatory 'workarounds' to address inequality. Singapore does not take action to address inequality because all people are considered equal constitutionally.
In conclusion, medical school selection practices are firmly embedded in history, values, societal expectations and stakeholder beliefs, which vary by context. More comparisons, working from the position of acknowledging and respecting differences, would extend knowledge further and enable consideration of what permits and hinders change in different contexts.
医学院校选拔相关文献大多来自全球北方的少数几个国家，几乎没有机会去思考不同的思维方式和做法。因此，我们的目标是批判性地审视我们各自国家（巴西、中国、新加坡、南非和英国）的选拔做法及其社会历史影响，包括如何处理任何被察觉到的不平等问题。
本文总结了许多基于“和而不同”理念展开的建设性对话，相互学习并借鉴彼此的经验。
五个国家的一些做法存在相似之处，但在具体做法、态度以及社会历史影响方面存在差异。例如，在巴西、南非和英国，公众和政治层面都承认学业成就与社会经济地位和/或种族等系统和社会因素相关。仅依据先前的学业成就来选拔医学院校学生被认为对社会中较弱势的群体不公平。相反，在中国和新加坡，通过考试成绩进行选拔被视为公平且能促进平等，尽管支撑这一价值观的历史背景在两国有所不同。五个国家在应对不平等问题的行动方面存在差异。巴西使用配额来确保特定群体的代表性，中国则用于确保地区代表性。配额在英国是非法的，南非不实行配额制，而是采用各种补偿性的“变通方法”来解决不平等问题。新加坡不采取行动解决不平等问题，因为从宪法角度看所有人都是平等的。
总之，医学院校选拔做法深深植根于历史、价值观、社会期望和利益相关者的信念之中，这些因具体情况而异。从承认和尊重差异的立场出发进行更多比较，将进一步拓展知识，并有助于思考在不同情况下促成和阻碍变革的因素。
