Background: The United Kingdom Clinical Aptitude Test (UKCAT) is used by 23 UK medical schools. Research to date has focused on validity and utility but it is also critical to examine selection processes from the applicant's perspective. Methods: This was a mixed-methods study using a paper-based survey and focus groups with first year medical students in Scotland in 2009-2010. Questionnaire data were analysed using SPSS, focus group data using framework analysis. Results: The survey return rate was 88% (883/1005). More than 99% of respondents had sat the UKCAT. Only 20% of respondents agreed the UKCAT was useful in the selection procedure. Nineteen students then took part in three focus groups held in three medical schools. These identified four themes related to views of the UKCAT: lack of face validity, concerns about fairness and cost, and the use of data by medical schools and influence of preparation. Conclusion: The UKCAT was viewed unfavourably by first year medical students completing it pre-admission. These negative views seem due to concern as to the use of UKCAT data, and the fairness of the test. More evidence as to validity and fairness of the UKCAT and how it is used in practice is required.