A national investigation on the impact of rurality on standardised clinical aptitude test performance

Article

Biki, S.M., Fox, J., Whitcombe, D., Bliss, E., Partanen, R., Whiteside, E., Saluja, S. and McGrail, M.. 2026. "A national investigation on the impact of rurality on standardised clinical aptitude test performance ." Medical Teacher. https://doi.org/10.1080/0142159X.2026.2628083
Article Title

A national investigation on the impact of rurality on standardised clinical aptitude test performance

ERA Journal ID13709
Article CategoryArticle
AuthorsBiki, S.M., Fox, J., Whitcombe, D., Bliss, E., Partanen, R., Whiteside, E., Saluja, S. and McGrail, M.
Journal TitleMedical Teacher
Number of Pages1-12
Year2026
PublisherTaylor & Francis
ISSN0142-159X
1466-187X
Digital Object Identifier (DOI)https://doi.org/10.1080/0142159X.2026.2628083
Abstract

Purpose
Rural applicants to medical school are known to be disadvantaged, given their observed poorer performance on most selection measures. This study aims to examine performance differences of rural and metropolitan applicants on all UCAT-ANZ (University Clinical Aptitude Test in Australia and New Zealand) subtests and overall, as well as explore whether increasing rurality is associated with poorer performance.

Methods
Retrospective repeated cross-sectional study of all UCAT-ANZ applicants between 2019 and 2023, stratified by rurality according to the Modified Monash Model. Six performance scores of the UCAT-ANZ were assessed: verbal reasoning, abstract reasoning, decision making, quantitative reasoning, situational judgement and aggregate cognitive score.

Results
Rural origin applicants consistently achieved lower scores compared with the metropolitan origin applicants across all five years and most test components, with quantitative reasoning and abstract reasoning having the largest differences. Most test scores consistently decreased with each rurality level, even after accounting for key socio-economic and demographic differences. Additionally, the gap between metropolitan and rural applicants increased for decision making, quantitative reasoning, abstract reasoning and overall. The largest decrease in scores between rurality categories occurred for metropolitan and large regional centre applicants, with scores generally decreasing with each subsequent rurality category.

Conclusions
There remains a substantial disadvantage for rural applicants completing standardised tests for selection into medical school, and this worsens with increasing rurality. The performance gap between rural and metropolitan applicants has somewhat widened in the last five years, emphasising the need for immediate action to help address rural disadvantage within medical school selection. Failure to address this risks selection not aligning with social justice principles. Key actions include increased efforts from an earlier age to better support rural applicants, decreased reliance on these tests for selection decisions, or decreased direct competition between rural and metropolitan applicants through the use of quotas or separate tiers.

KeywordsMedical School, Selection, Rurality, Aptitude Test, Rural Disadvantage
Article Publishing Charge (APC) FundingProject Funding
Contains Sensitive ContentDoes not contain sensitive content
ANZSRC Field of Research 2020320299. Clinical sciences not elsewhere classified
390110. Medicine, nursing and health curriculum and pedagogy
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Seib, Charrlotte, Whiteside, Eliza, Lee, Kathryn, Humphreys, Janice, Dao Tran, Tiet Hanh, Chopin, Lisa and Anderson, Debra. 2014. "Stress, lifestyle, and quality of life in midlife and older Australian women: results from the stress and the health of women study." Women's Health Issues. 24 (1), pp. e43-e52. https://doi.org/10.1016/j.whi.2013.11.004
A longitudinal study of the impact of chronic psychological stress on health-related quality of life and clinical biomarkers: protocol for the Australian Healthy Aging of Women Study
Seib, Charrlotte, Whiteside, Eliza J., Humphreys, Janice, Lee, Kathryn, Thomas, Patrick, Chopin, Lisa, Crisp, Gabrielle, O'Keeffe, Angela, Kimlin, Michael, Stacey, Andrew and Anderson, Debra. 2014. "A longitudinal study of the impact of chronic psychological stress on health-related quality of life and clinical biomarkers: protocol for the Australian Healthy Aging of Women Study." BMC Public Health. 14 (1), pp. 1-8. https://doi.org/10.1186/1471-2458-14-9
You don't know what you don't know: ethics and participant consent issues for eResearch users
Ostini, Jenny, Gacenga, Francis, Pocock, Celmara and Whiteside, Eliza. 2014. "You don't know what you don't know: ethics and participant consent issues for eResearch users." eResearch Australasia 2014 Conference: Towards Unified Global Research. Melbourne, Australia 27 - 31 Oct 2014 Sydney, Australia.
Multi-species sequence comparison reveals conservation of ghrelin gene-derived splice variants encoding a truncated ghrelin peptide
Seim, Inge, Jeffrey, Penny L., Thomas, Patrick B., Walpole, Carina M., Maugham, Michelle, Fung, Jenny N. T., Yap, Pei-Yi, O'Keeffe, Angela, Lai, John, Whiteside, Eliza J., Herington, Adrian C. and Chopin, Lisa K.. 2016. "Multi-species sequence comparison reveals conservation of ghrelin gene-derived splice variants encoding a truncated ghrelin peptide." Endocrine. 52 (3), pp. 609-617. https://doi.org/10.1007/s12020-015-0848-7
Cloning of a novel insulin-regulated ghrelin transcript in prostate cancer
Seim, Inge, Lubik, Amy A., Lehman, Melanie L., Tomlinson, Nadine, Whiteside, Eliza J., Herington, Adrian C., Nelson, Colleen C. and Chopin, Lisa K.. 2013. "Cloning of a novel insulin-regulated ghrelin transcript in prostate cancer." Journal of Molecular Endocrinology. 50 (2), pp. 179-191. https://doi.org/10.1530/JME-12-0150
Identification of a long non-coding RNA gene, growth hormone secretagogue receptor opposite strand, which stimulates cell migration in non-small cell lung cancer cell lines
Whiteside, Eliza J., Seim, Inge, Pauli, Jana P., O'Keefe, Angela J., Thomas, Patrick B., Carter, Shea L., Walpole, Carina M., Fung, Jenny N. T., Josh, Peter, Herington, Adrian C. and Chopin, Lisa K.. 2013. "Identification of a long non-coding RNA gene, growth hormone secretagogue receptor opposite strand, which stimulates cell migration in non-small cell lung cancer cell lines." International Journal of Oncology. 43 (2), pp. 566-574. https://doi.org/10.3892/ijo.2013.1969
Necessity breeds innovation: GPs help prevent an emergency department closure
Partanen, Riitta L., O'Brien, Maxine L. and Eley, Diann S.. 2009. "Necessity breeds innovation: GPs help prevent an emergency department closure." Australian Health Review. 33 (3), pp. 467-471. https://doi.org/10.1071/AH090467
Functional growth hormone (GH) receptors and GH are expressed by preimplantation mouse embryos: a role for GH in early embryogenesis?
Pantaleon, M., Whiteside, E. J., Harvey, M.B., Barnard, R.T., Waters, M.J. and Kaye, P.L.. 1997. "Functional growth hormone (GH) receptors and GH are expressed by preimplantation mouse embryos: a role for GH in early embryogenesis?" University of Adelaide. 94 (10), pp. 5125-5130. https://doi.org/10.1073/pnas.94.10.5125