Aptitude test for medical studies

EMS logo

The aptitude test for medical studies ( EMS ) is a subject-specific study aptitude test to determine the suitability to study for a degree in medicine , which has been used in Switzerland since 1998 for human medicine , 1999 for veterinary medicine and 2004 also for dentistry as a selection process for admission based on the capacity of the university becomes. It was also used at times in Austria.

The Center for Test Development and Diagnostics (ZTD) at the University of Friborg (Switzerland) is responsible for the test . There has been a long-term collaboration with the developer of the test for medical degree programs (TMS) in Germany, the Institute for Test and Talent Research and its successor ITB Consulting GmbH (Bonn) , of which the EMS is a Swiss adaptation.

commitment

From 1998 to 2006, was and from 2013 for exclusive use in Switzerland is the name " E ignungstest for M edizinstudium in the S witzerland" (EMS) or test d ' a ptitudes pour les études de m édecine s S uisse and Test a ttitudinale per lo studio di m edicina in S vizzera in use. AMS is used as an abbreviation for both of the latter names . At times the simultaneous use in Austria, he was only E ignungstest for the M edical s tudium called.

Use in Switzerland as an admission criterion as part of the Numerus clausus (NC)

The EMS is used in Switzerland as part of university selection procedures as an admission criterion for studying medicine. Since 2001, the number of registrations for medical studies at Swiss universities has been increasing following an almost linear trend. For human medicine (since 1998), veterinary medicine (since 1999) and dentistry (since 2004) there is a numerus clausus (NC) for people who have registered at the universities of Basel, Bern, Freiburg or Zurich. Since 2008, 20 places for chiropractic have been allocated at the University of Zurich. At the universities of Geneva, Lausanne and Neuchâtel there is no numerus clausus for medicine and consequently no test.

In 2017 there were 100 places at ETH Zurich , 80 places each for studies in St. Gallen and Lucerne (start of studies at the University of Zurich, then change) and 15 places at Università della Svizzera italiana (study start in Basel).

Swissuniversities has the governance for the entire selection and admission process, for which the Swiss University Conference has the political responsibility.

The test has been used in Switzerland since 1998 (currently decentralized at nine test locations) and takes place at the beginning of July. It will be carried out if there is a 20 percent capacity overrun for registrations in mid-February and there are no diversion options between the universities. The recommendation to the cantons is made by the Swiss University Conference at the beginning of March each year. The introduction of the NC is then subject to the respective cantonal law and is decided by the government or parliament depending on the legal situation.

For example, in 2019, 3887 people took the test. In human medicine, 37% of 3281 candidates with a valid test result, in veterinary medicine 41% of 435 and in dentistry 54% of 241 were assigned a place. Compared to the number when registering for the course in February 2019 (4095 people), 22% of people in human medicine, 21% in veterinary medicine and 20% in dentistry did not take the test. 74 people took over the test result from the previous year and did not take part again.

Deployment in Austria from 2006 to 2012

From 2006 to 2012 the EMS was also used for approval in Austria (Vienna and Innsbruck). When used there, however, there were specific differences between the results of the sexes: Significantly worse results for women, which also had an impact on the number of admissions and did not occur to this extent in either Switzerland or Germany with TMS. This led to discussions and gave rise to an independent evaluation of the test use in Austria. The MedAT has been used as a test in Austria since 2013 .

Mandatory non-selective deployment in Geneva from 2010 to 2012

From 2010 to 2012, the EMS was used compulsorily but nonselective at the University of Geneva . In other words, you had to take the aptitude test , but the result did not decide on admission. It was more like a self-assessment : The students should receive help in self-assessment of their suitability for studies and, under certain circumstances, draw conclusions from it independently. The ZTD assessed the attempt to compulsory non-selective use as negative: the dissuasive (deterrent) effect in the sense of not applying for a job in the case of relatively poorer test results was not sufficient. The offer of a consultation was hardly taken up either. Over the three-year period, both the absolute test results and the predictive accuracy of the test deteriorated. According to the interpretation of the authors, the test was increasingly perceived as a chore, which was also reflected in the shorter preparation time; a self-assessment with voluntary participation regularly gives better values. According to them, the EMS does not allow exact capacity approval in the case of mandatory non-selective use.

Concept of the test - what does the EMS measure?

The EMS is a psychometric procedure in the tradition of classical test theory . The task groups are not designed according to the Rasch model (like the American Scholastic Aptitude Test (SAT) or the PISA study ) . H. the subtests are not one-dimensional, but are intended to reflect complex study requirements (“ work samples ”).

The test is designed to measure suitability for study and to optimally predict study success. A place should preferably be given to those people who are best suited for the course: Study suitability as successful completion of the course in an appropriate (short) study period with good results. The available study places will be allocated according to the level of the test result. The relationship between better test performance and higher probability of passing the test, which is necessary to justify this procedure, was evaluated in prognostic studies. Occupational suitability or social skills have not yet been justifiable through a mass test (see below)

Task groups

Since 2016, the EMS has consisted of nine task groups that are to be processed as a one-day assessment from 9 a.m. to 4 p.m. with a one-hour break on the test day. The stress is part of the test concept, because medical studies and work require a high level of resilience.

The nine task groups currently used by EMS are:

Task group	Number of tasks and duration	description
Assign pattern	20 tasks, 18 minutes	Test of visual structuring ability
Basic medical and scientific understanding	20 tasks, 50 minutes	Scientific reasoning test
Hose figures	20 tasks, 12 minutes	mental rotation test of spatial skills
Quantitative and Formal Problems	20 tasks, 50 minutes	Test on math skills in a scientific context
Concentrated and careful work	1600 characters, 8 minutes	Attention Load Test
Break 60 minutes
Learn characters	20 tasks, Learn 4 minutes	Test of figural memory
Learn facts	20 tasks, 6 minutes to learn	Test of verbal memory and associative memory formation
Text comprehension	3 texts 18 tasks, 45 minutes	Reading comprehension test in a scientific context
Reproductive phase	Learn figures: 5 minutes Learning facts 7 minutes
Diagrams and tables	24 tasks, 50 minutes	Test for understanding and interpreting diagrams and tables

After the task group “Concentrated and careful work” there is a one-hour break. Between the learning phases and the reproduction of “learn figures” and “learn facts”, a “basic medical and scientific understanding” is carried out; H. Things have to be kept for at least 50 minutes.

With the help of the factor analysis it was determined which common components can be found in the ten task groups. About 30% of the variance of the test results is explained by a factor “reasoning”, about 15% has “memory” and about 20% “visual skills and concentration”. 35% of the variance is specific to the individual task groups or other proportions.

How does the test work?

Evaluation of the EMS

In contrast to an examination, strictly speaking, you cannot “pass” or “fail” the test, it is a competitive ranking procedure : A certain number of study places is available, the places are given to the best test candidates in the order under the conditions of a numerus clausus of the results awarded. People who could not be admitted are therefore not necessarily unsuitable for the course. Others were better and capacity limited choices.

The test value is also used for the allocation of a place at the desired university or a necessary diversion to less busy universities.

The percentile rank (TP) used for this approval since 2014 is calculated directly from the cumulative frequency distribution of the point values of all people who take part in the EMS test in one year and is an integer. The range is actually 0 to 100, values below 10 are rounded to 10. It shows the percentage of all participants who achieved a worse (or equally good result). The test values are comparable between the years and can be carried over into the following year.

The previously used standardization of the point value on the basis of the mean value and standard deviation of the total number of points in the range from 70 to 130 no longer differentiated sufficiently for a capacity-specific admission due to the increasing number of participants.

If the test value is the same, the people will continue to be considered in the order of the middle ranking of all task groups if the capacity does not allow admission of all people with a test value or differentiation is necessary for diversions. In order to establish a comparison between the years here, too, the rankings are calculated based on 1000 people. This evaluation weights good performance in more difficult task groups higher than the simple point value.

Different language versions

Due to the multilingual nature of Switzerland, the test is developed in German, Italian and French. The tasks are checked with regard to their different effects in the various language and country versions with the help of what is known as differential item functioning (DIF analysis). For questions that are significantly more difficult in the French or Italian version than expected due to the German version, (tenths) bonus points are credited to the participants who may be disadvantaged due to the test.

Limits of the EMS and other influencing factors on the result

In principle, only very specific features can be tested in a suitability test as a large group test (mass test):

Performance characteristics where there are clearly right / wrong solutions, the number of correct solutions stands for suitability. The proof of correctness must be justifiable (e.g. the selectivity is used as parameters);
characteristics that cannot be falsified with regard to the answer (no judgments according to social desirability), which is what all judgment methods of the questionnaire type e.g. B. impossible for personality traits, motivation or social behavior:
economically measurable features, suitability for large group testing, automated evaluability (e.g. no realistic video presentations);
poor trainability (not to be confused with the need for preparation) - the recommended self-preparation must remain comparable to commercial training courses.

Possible other factors that influence the test result:

Quality of school education as training of ability to study (probably);
Motivational factors related to medical studies / medical profession and test motivation (sure);
Proficiency, preparation (sure);
Resilience (the test takes almost six hours - this requirement is, however, part of the test concept, because the medical profession usually also requires high resilience), (very likely);
Test anxiety (likely).

Evaluations and political discussions on the future of the selection process

Prediction of exam passing year 1, cohort 1998 (source see picture information)

Possible further development of the approval process (source see picture information)

A meta-analysis of subject - specific study aptitude tests published in German-speaking countries in 2007 showed that, particularly in the field of human medicine, a high level of predictability of academic success comparable to school grades is achieved. All other criteria examined (aptitude interviews, general tests, etc.) were inferior to the school grades and the study aptitude tests in their prediction of academic success. For the medical-specific tests, individual studies on TMS and EMS were included in the meta-analysis, including individual studies by the ZTD on test participants in 1998 and 1999. Grades achieved in the course were used as success criteria, in the case of the EMS grades in the first and sometimes also in the second Preliminary examination (after one or two years of study). In addition, the test ensures a high degree of comparability of the conditions (different assessment criteria, different grade severity or individual advantages / disadvantages are practically not possible).

An evaluation report from the Swiss Science and Innovation Council from 2016 confirms that the EMS is a valid test for predicting academic success, especially in human medicine, with limitations in veterinary medicine. However, this applies above all to the first year of study; there is no corresponding information for the continuation of studies. The Science Council recommends further investigations for the later course of studies at all medical faculties.

In the run-up to the evaluation, several variants were suggested and discussed as alternatives or additions to the approval process or tests. The Swiss University Conference came to the conclusion that the selection process should continue in its previous form after 2019 and that it will continue to work together with the Center for Test Development on the basis of a new contract. Thus the additions in the room through questions about school knowledge were initially rejected. The two-stage aptitude test proposed by the Association of Swiss Doctors , which introduces situational judgment tests, multiple mini-interviews or internships in addition to the EMS, was not taken up either.

Differences to the German TMS

The EMS is based on the concept of the test for medical degree programs (TMS). The differences are:

a modified concentration test (which is now also included in the new TMS);
From 2005 to 2015 a new task group planning and organizing , which was included on the basis of a new requirements analysis for medical studies and is intended to record planning competence. It had to be saved in favor of the annual usability of new tasks for cost reasons.
a waiver of litter tasks; This means that the number of tasks is reduced by four in most task groups compared to the TMS, and the EMS is roughly the same length despite the additional task group;
The averaged ranking over the task groups as a decision criterion for admission with the same test value;
equivalent test forms in the (national) languages of Switzerland: German, French and Italian.
From 2014, the use of the test percentile rank (TP) for approval, which is derived directly from the distribution of the points achieved. This replaces the previous test value and ensures greater differentiation (see above).
The EMS can be repeated annually (the last result counts) or the test result can be carried over to the following year.

Study suitability, professional suitability and social competence

The admission test was deliberately limited to study suitability because before the introduction of the NC 50-60% of the people failed exams and dropped out. Medicine is and will remain a demanding course of study in terms of the required mathematical and scientific competencies. If the weight of the test is shifted too much to social skills (which are less relevant to the exam), there is a risk that admission will no longer be based on the prospect of success and that the drop-out rates will rise again. If the admission was limited, the training capacity would then no longer be used optimally, especially in the specialist course.

The aptitude to study as "ability to study" (effectively acquiring new knowledge) is, however, also seen as a core competence of professional suitability, especially with regard to models of the increasingly required continuous lifelong further education and training in medicine.

With regard to social competence, the search for a falsification-proof paradigm with suitability for the admission test has continued (and unsuccessfully): The “Situational Judgment Tests” (SJT) did not fulfill hopes. A presentation on paper in Belgium did not allow sufficient predictions for cognitive or social study success criteria; a presentation by video would be more promising, but is not realistic due to the effort and the technical requirements. Due to a detailed workshop in Vienna, a pilot study with a paper version was dispensed with. Other paradigms based on self-assessment are at best suitable for self-assessment - but not for an admission test as characterized above (also because of the falsifiability and trainability).

In addition, there are no sufficiently differentiated requirement analyzes to actually describe professional suitability for the various medical professions and subsequently to record it with an admission test. The individual specialist areas (e.g. surgery vs. psychiatry) and work locations (e.g. laboratory vs. practice) differ considerably. None of the characteristics has the quality that it could be used in practice as a "hard" criterion for admission (assessors may be necessary for interviews who can have different standards, desired behavior can be trained to a great extent and some characteristics only develop during the course of study out or are training goals themselves).

Supplementary self-assessment for soft skills

In addition to the EMS, an online self-assessment has been used since 2010 to record personality traits relevant to the study, interests in studying medicine and occupation, as well as knowledge and expectations with regard to studying medicine / a medical profession since 2010, in order to also include soft skills in the decision-making process for admission of applicants . This is anonymous and voluntary, and therefore less prone to responses based on social desirability.

Trainability of the EMS

The trainability of the EMS is an important issue for many applicants, as they want to prepare well for the test, which is why there is also a flourishing training market in this area. The test developers urgently recommend preparation for the test. The test, however, is not a knowledge test where you can prepare by memorizing a given catalog of contents.

In principle, the so-called testing-the-limits paradigm applies to the EMS. This means that the test gains its ability to differentiate itself with increasing practice and practice and that the values level off at a more stable level (the individual performance asymptote) from test to test, as initial advantages, which may be due to differences in prior knowledge or better school education, between the Applicants are balanced. This means that the reliability of the measuring instrument increases from test to test, as has been confirmed in various studies. The same goes for training. The better the training intervention, the faster someone will reach their individual performance asymptote. Practice and training are therefore a necessity for applicants, which is why original versions of the test are publicly available and it is best to take them in real-time conditions.

As part of the EMS evaluations, the effects of various types of preparation were also examined. Overall, an optimum could be found statistically with an independent preparation time of 30 to 35 hours. In addition, there seems to be a positive effect of joint preparation in groups. Carrying out a test under real-time conditions also has a positive effect on preparation. Regarding the success of additional test training, no significant advantages of participants could be determined. Independent preparation also seems to have more effect than taking part in courses, as it has been shown that those course participants who only attended a short course (duration <8 h) and were intensively self-employed performed better than those who took part in a longer course (Course> 8 h) ".

As part of a large-scale study in 1982, Bernhard Deter showed that not even differences could be found between participants in a course and those who only received a test brochure, which led to the introduction of the test information brochure at the time. The combination of the test brochure and original versions today and the data from the evaluations suggest that no restrictions on test fairness due to training courses are to be expected.

There is an interesting connection with the question of which EMS subtests can be trained particularly well and which are particularly difficult to train. In this regard, a connection with the factor structure of the test could be found when these data are combined with the large-scale training study by Deter (1982). The higher the load of the subtest on the “reasoning” factor, the lower the training gains to be expected. However, the higher the load on the “visual skills” factor, the higher the expected profit. In connection with the factor “retention” there is no connection with the trainability of the subtests. This results in a sequence of the subtests with regard to their trainability, which can also be taken into account when preparing for priorities:

Assign pattern
Learn characters
Learn facts
Hose figures
Diagrams and tables
Basic medical and scientific understanding
Quantitative and formal problems
Text comprehension.

Gender differences and gender fairness

Sex Differences in EMS were the subject of repeated discussions since test fairness an equal opportunity requires. Equal opportunities means that the same results can be achieved with the same suitability (here study suitability, see above). Equal opportunities should not be confused with equal results (if, for example, the same mean values are compulsorily expected for all groups), since objectively existing aptitude differences must also be reflected in the result. In addition, the cohorts of men and women who apply for a medical degree are not representative of the respective age groups and also not necessarily comparable with each other, because the choice of degree can be motivated differently. They are also not the same percentage.

This discussion was of particular importance during the deployment in Austria (see gender differences in the results in Austria ).

In Switzerland and also with the test for medical degree programs (TMS) in Germany, based on the empirical results, gender equality can be assumed (see the annual chapter on gender differences in the reports of the ZTD with various mean value comparisons).

More political discussions

The other political discussions shape v. a. following topics:

Problems of increasing demand for doctors, a current shortage of doctors and, in Switzerland, the high proportion of foreign doctors among doctors could be solved by abolishing the NC. Admission to medical studies is restricted by the training capacities, especially in specialist studies, where appropriate clinical capacities must be available (beds or patients, technology, care) - medical studies are also vocational training with practical components. This expansion is expensive, and the cantons, as sponsors of the universities, can only raise additional funds to a limited extent. The number of people who took the aptitude test for medical studies (EMS) in Switzerland grew from 670 in 2000 to 2363 in 2012. In order to meet the demand and to be able to maintain the same quality of studies as in 2000 without the NC, 11 universities such as Basel or 6 such as Zurich would have been required. Demand for university places and sensible capacity expansion, which is expensive, have become two different questions.
The sensibility of admission restrictions is questioned, and free university access is required. This is therefore also a political decision that has nothing to do with the test itself.
The justification for using an aptitude test is questioned. Not least for this reason, the ability to predict the success of the exam is continuously evaluated. However, the test also has advantages in comparison with other admission criteria (high school graduation grade, admission interviews, social internships, intra-university selection after the first year).

Web links

Notifications from the Swiss University Conference (with all resolutions on medicine, admission and the EMS)
Official homepage for registration, testing and admission to swissuniversities
Official homepage of the EMS from the ZTD
Three original German versions published by Hogrefe Verlag Göttingen (also 3 each in French and 3 in Italian are available)
Overview of reports and publications on EMS

Individual evidence

↑ ^a ^b ^c EMS expansion from 2016 on unifr.ch

↑ Registration page for medical studies at swissuniversities

↑ Annual report 2016 from swissuniversities p. 7 ff.

↑ It is usually the first Friday - if it is too early because of the Matura exams, you will switch to the second Friday.

↑ The legal basis for NC and aptitude tests can be found on the Swissuniversities website .

↑ Aptitude test for medical studies (EMS): Statistical report of the 2019 session on swissuniversities.ch

↑ Mallinger, R. et al.: EMS aptitude test for medical studies in Austria 2006 report page 33 ff.

↑ On one page of the Austrian Federal Ministry for Science and Research you can find the evaluation study by Christiane Spiel and others on the subject as well as statements from the Swiss Rectors' Conference and the ZTD.

↑ Report on the test deployment in Geneva (PDF; 184 kB)

↑ e.g. K.-D. Hänsgen and B. Spicher (2001): EMS • Aptitude test for medical studies in Switzerland Prediction of exam success Figure 7, p. 19.

↑ Report 13 of the ZTD, p. 84 (PDF file; 1.2 MB)

↑ Explanation of the earlier evaluation by EMS, from Report 19 of the ZTD (PDF; 113 kB)

↑ Structure of EMS from 2016 , ZTD materials (evaluation since 2014 and current structure)

↑ Benedikt Hell, Sabrina Trapmann, Heinz Schuler: A meta-analysis of the validity of subject-specific study aptitude tests in German-speaking countries . In: Empirische Pädagogik , Vol. 21 (2007), Heft 3, pp. 251–270, online . The primary studies included by the ZTD can be found in Hänsgen / Spicher (2001): Report on implementation and results 2001 = Report 7 (2001), from p. 40 ( online ).

↑ Swiss Science and Innovation Council (SWIR): Admission procedure for medical studies at universities with numerus clausus. Report to the Swiss University Conference . Bern, January 21, 2016. PDF , pp. 3 and 20.

↑ De Haller J. Medical Offspring: Do we want graduates or doctors? Schweiz Ärztezeitung. 2014; 95 (4): 129–32.

↑ Klaus-D. Hänsgen: Do we want graduates or doctors? Wouldn't we rather have qualified doctors? Are professional and social skills opposites? Swiss Medical Journal 2014; 95: 6

↑ Klaus-D. Hänsgen: Admission procedure for studying medicine in Switzerland Options for an “evolutionary further development” Schweizerische Ärztezeitung 2015; 96 (48): 1776–1779

↑ Annual report 2017 of the Swiss University Conference p. 10 ff

↑ Yvonne Gill: In front of the numerus clausus there is the career aspiration Swiss Medical Journal 2017; 98 (44): 1439 of October 31, 2017

↑ News in EMS 2016 from ZTD

↑ FAQ on swissuniversites.ch

↑ ^a ^b FAQ on EMS and NC on unifr.ch

^ Statement of the ZTD on the Situational Judgment Test for a possible pilot study 2008 for the approval for medical use

^ Project page Self Assessment Medicine , accessed on July 2, 2016.