In 2014, the Spanish Ministry of Education, Culture and Sport published a Royal Decree (RD 412/2014, dated 6 June) which established the basic regulations governing the procedures on admission to official university degree courses. Among other points, this decree empowered Spanish public universities to establish the evaluation criteria, the rules to be applied to determine the order of preference for admission and, if applicable, the admission procedures to be applied .

Accordingly, universities could decide on admission to official university degree courses using only the criterion of the final mark obtained in the Spanish Baccalaureate (roughly equivalent to A levels / High School Diploma), as has been the case up until now, or set specific admission procedures. These procedures, which are stipulated in the RD, allow for the possibility of taking into account the modality and the subjects related to the chosen degree course taken in previous studies equivalent to the Baccalaureate, the grades obtained in particular subjects in the Baccalaureate, complementary vocational or academic training, previous higher education studies and also, exceptionally, establishing specific assessments of knowledge or competencies. This RD should have come into force as of the academic year 2017-2018 .

Therefore, the aforementioned decree opened up the possibility of universities and, more specifically, Faculties of Medicine being able to establish their own admission procedures. In some contexts, this has brought to the fore the need and advisability of implementing specific complementary exams to be able to access medical studies .

The system currently used to select candidates who will be admitted to to a public Faculty of Medicine in Spain, based on the results obtained in the so-called ‘university entrance exams', which consist of a series of tests on general knowledge from the Baccalaureate syllabi, on the one hand, and on the student's grade on the academic transcript, on the other, is characterised by its transparency and equality for all the candidates and releases the centre from any kind of responsibility, since they limit themselves to accepting the candidates that have been allocated to them. This system, together with the existence of a numerus clausus, ensures that students who are admitted to Spanish Faculties of Medicine have very high marks and very good previous academic transcripts. Yet, with this system it is not possible to ensure that those who have the most suitable characteristics for practising medicine in the future will be the ones who are admitted .

Medical practice requires the highest standards of professional and personal conduct. Those responsible for admission to Faculties of Medicine should be aware that doctors are trained in a very wide range of competencies in which knowledge and technical skills are complemented by humanistic competencies and other personal qualities such as communication, compassion and commitment to service, which can already be observed in many students but not in others. In this sense, the personal qualities and attributes of the future physician are as important as his or her academic grades. In order to assess whether tomorrow's doctors possess these personal qualities and attributes, it would seem logical for medical schools to establish processes for the selection of candidates that go beyond the mere evaluation of scientific and specific knowledge. By so doing, it would become possible to identify candidates who raise reasonable doubts about their behaviour or integrity so that they are simply not admitted, instead of them having to abandon their studies or profession, with the consequent frustration and wastage of time at this crucial stage of young people's lives .

For all these reasons, it seems clear that there is a need to establish some kind of test or evaluation that takes into account the aforementioned aspects. The question is how to do so. Nevertheless, in any case, the procedure should be valid and reliable from a psychometric point of view, and above all fair and transparent, legal and ethical, known to all those concerned and lead to a consensus among all the stakeholders .

To ensure validity and reliability, no single instrument but instead a combination of instruments should be employed. The scientific literature on medical education indicates that there are different types of tools that have been and are being successfully used in different countries, ranging from more specific and appropriate knowledge tests for medical studies to instruments that evaluate personal, non-academic qualities [ ¹ ]. These include personality and performance tests such as the UK Clinical Aptitude, Situational Judgement Test and Personal Qualities Assessment. All these tools explore and evaluate important attributes of health professionals and how they respond to different situations, taking into account a number of personal qualities considered important for the study and practice of medicine, such as mental agility, interpersonal values and social responsibility. Another method currently being widely used is multiple mini-interviews, which involve observation of the candidate in action. They consist in a series of interviews or meetings, similar to structured objective clinical evaluations, each lasting about 8-10 minutes, in which the candidates face different situations or stations while being observed by a rater. These interviews assess communication, critical thinking, ethical aspects, resilience, empathy, moral reasoning and capacity for initiative, among other things .

Despite what has been said, we must be aware that implementing such an admission system is is by no means easy. It calls for determination and abandoning the current comfort zone. It also requires the involvement of all the Faculties of Medicine around the country, the availability of experts – since this is not a task for amateurs – and steps must be taken to ensure that the procedures that are finally adopted are cost-effective, acceptable and satisfactory to all those concerned. Nevertheless, despite all the difficulties, it can be achieved .

I am even going to be as bold as to urge our public Faculties of Medicine to discuss the admission of students, as international experience shows that specific tests for the selection of candidates for medical schools are advisable, and that reliable and valid instruments designed for this purpose that result in selected candidates with more appropriate characteristics already exist.