Why do medical school applicants apply to particular schools?

Medical school origins of award-winning physicians; analysis of a complete national dataset

BACKGROUND

Educators and medical students share the same objective of achieving success in medical practice. Both groups consider doctors' successes to include optimum patient care outcomes and positive career progressions. Accordingly, identifying common educational features of such high-achieving doctors facilitates the generation of excellence amongst future medical trainees. In this study we use data from the British clinical merit award schemes as outcome measures in order to identify medical school origins of doctors who have achieved national or international prominence.

METHODS

Britain has Clinical Excellence Awards/Distinction Awards schemes that financially reward all National Health Service doctors in England, Scotland and Wales who are classified as high achievers. We used these outcome measures in a quantitative observational analysis of the 2019-20 dataset of all 901 national award-winning doctors. Where appropriate, Pearson's Chi-Square test was applied.

RESULTS

The top five medical schools (London university medical schools, Glasgow, Edinburgh, Oxford and Cambridge) were responsible for 51.2% of the physician merit award-winners in the 2019-20 round, despite the dataset representing 85 medical schools. 91.4% of the physician merit award-winners were from European medical schools. The lowest national award-winners (tier 3) originated from 61 medical schools representing six continents. International medical graduates comprised 11.4% of all award-winners.

CONCLUSIONS

The majority of physicians who were national merit award-winners originated from only five, apparently overrepresented, UK university medical schools. In contrast, there was a greater diversity in medical school origin among the lower grade national merit awards; the largest number of international medical graduates were in these tier 3 awards (13.3%). As well as ranking educationally successful university medical schools, this study assists UK and international students, by providing a roadmap for rational decision making when selecting physician and non-physician medical education pathways that are more likely to fulfil their career ambitions.

Medical school origins of award-winning psychiatrists; analysis of a complete national dataset

BACKGROUND

Britain attracts doctors from all over the world to work in the National Health Service. Elucidating the educational backgrounds of award-winning doctors working in the country is potentially an important medical education issue and a merit award audit. Using the British clinical merit award schemes as outcome measures, we identify medical school origins of award-winning doctors who have been identified as having achieved national or international prominence.

METHODS

The Clinical Excellence Awards/Distinction Awards schemes select doctors in Britain who are classified as high achievers, with categories for national prominence and above. We used this outcome measure in a quantitative observational analysis of the 2019-20 dataset of all 901 award-winning doctors. Pearson's Chi-Square test was used where appropriate.

RESULTS

Five university medical schools (London university medical schools, Glasgow, Edinburgh, Aberdeen and Cambridge) accounted for 59.1% of the psychiatrist award-winning doctors in the 2019 round, despite the dataset representing 85 medical schools. 84.1% of the psychiatrist award-winners were from European medical schools, compared to 92.1% of the non-psychiatrist award-winners. International medical graduates accounted for 22.7% of the award-winning psychiatrists. Psychiatrists with the lower grade national awards came from a more diverse educational background of 17 medical schools. IMGs represented diverse medical schools from five continents and were most represented in the lowest grade of national merit awards at 24.2%.

CONCLUSIONS

The majority of the award-winning psychiatrists originated from only five medical schools. A greater diversity of medical school origin existed for the lowest grade national psychiatrist award-winners. International medical graduates contributed substantially to these award-winners; psychiatrist award-winners were more likely to be international medical graduates (22.7%) than non-psychiatrist award-winners (10.8%). This study not only indicates educational centres associated with the production of award-winners but also provides students with a roadmap for rational decision making when selecting medical schools.

Medical school origins of award-winning surgeons; analysis of a complete national dataset

BACKGROUND

Britain attracts doctors from all over the world to work in the National Health Service. Elucidating the educational backgrounds of award-winning doctors working in the country is potentially an important medical education issue and merit award audit. Using the British clinical merit award schemes as outcome measures, we identify medical school origins of award-winning doctors who have been identified as having achieved national or international prominence.

METHODS

The Clinical Excellence Awards/Distinction Awards schemes select doctors in Britain who are classified as high achievers, with categories for national prominence and above. We used this outcome measure in a quantitative observational analysis of the 2019 dataset of all 901 award-winning doctors. Pearson's Chi-Square test was used where appropriate.

RESULTS

Seven medical schools (London university medical schools, Glasgow, Edinburgh, Aberdeen, Oxford, Cambridge and Manchester) accounted for 52.7% of the surgical award-winning doctors in the 2019 round, despite the dataset representing 85 medical schools. Surgeons with the lower grade national awards came from a more diverse educational background of 43 medical schools. International medical graduates accounted for 16.1% of the award-winning surgeons and 9.8% of the award-winning non-surgeons. 87.1% of the surgical award-winners were from European medical schools, whereas 93.2% of the non-surgical award-winners were from European medical schools.

CONCLUSIONS

The majority of the award-winning surgeons originated from only seven, overrepresented, medical schools. A greater diversity of medical school origin existed for the lowest grade national merit awards. These comprised 43 medical schools and indicated greater globalization effects in this category. International medical graduates contributed substantially to these award holders; surgical award-winners were more likely to be international medical graduates (16.1%) than non-surgical award-winners (9.8%). This study not only indicates educational centres associated with the production of award-winners but also provides students with a roadmap for rational decision making when selecting medical schools.

A national analysis of the medical schools of training for merit award-winning laboratory medical doctors working in Britain

AIMS

To inform the discussion regarding the origins of Laboratory Medical Consultant clinical merit award holders (LMC) whether the awards came from the Clinical Excellence Awards (CEA) or Distinction Awards (DA) schemes.

METHODS

Setting - CEA is a scheme to financially reward senior doctors in England and Wales who are assessed to be working over and above the standard expected of their role. The DA scheme is the parallel and equivalent scheme in Scotland. Participants - All of the merit award holders in the 2019 round. Design - This involved a secondary analysis of the complete 2019 published dataset of award winners. Statistical analyses were performed with Chi-square tests set at p < 0.05 level for statistical significance.

RESULTS

The top five medical schools (London University, Glasgow, Edinburgh, Aberdeen and Oxford) were responsible for 68.4% of the LMC merit award holders in the 2019 round. 97.9% of the LMC merit award holders were from European medical schools, whereas 90.9% of the non-LMC award holders were from European medical schools. The LMCs with A plus or platinum awards came from only six medical schools: Aberdeen, Edinburgh, London University, Oxford, Sheffield and Southampton. In contrast, the B or silver/bronze LMC award holders came from a more diverse background of 13 medical schools.

CONCLUSIONS

The majority of LMC merit award holders originated from only five university medical schools. All the LMCs with A plus or platinum awards came from only six university medical schools. There is an apparent overrepresentation of a small number of medical schools of origin amongst those LMCs that hold national merit awards.

'I'd have to fight for my life there': a multicentre qualitative interview study of how socioeconomic background influences medical school choice

Students from lower socio-economic backgrounds who were educated in state funded schools are underrepresented in medicine in the UK. Widening access to medical students from these backgrounds has become a key political and research priority. It is known that medical schools vary in the number of applicants attracted and accepted from non-traditional backgrounds but the reasons for this are poorly understood. This study aims to explore what applicants value when choosing medical schools to apply to and how this relates to their socioeconomic background. We conducted a multicentre qualitative interview study, purposively sampling applicants and recent entrants based on socioeconomic background, stage of application and medical school of application. We recruited participants from eight UK medical schools. Participants attended semi-structured interviews. We performed a framework analysis, identifying codes inductively from the data. Sixty-six individuals participated: 35 applicants and 31 first year medical students. Seven main themes were identified; course style, proximity to home, prestige, medical school culture, geographical area, university resources, and fitting in. These were prioritised differently depending on participants' background. Participants from lower socioeconomic backgrounds described proximity to home as a higher priority. This was typically as they intended to be living at home for at least part of the course. Those from higher socioeconomic backgrounds were more concerned with the perceived prestige of medical schools. Since medicine is a highly selective course, only offered at a minority of UK higher education institutions, these differences in priorities may help explain observed differential patterns of medical school applications and success rates by applicant social background.

A Student Survey: Influence of Emergency Medical Technician Training on Student's Application, Matriculation, and Transition into Medical School

PURPOSE

Medical education seeks to develop active methods of learning in addition to skills for patient interaction. With this in mind, the University of South Carolina (UofSC) School of Medicine Greenville developed a curriculum with an integrated emergency medical technician (EMT) certification course designed to provide a meaningful clinical experience for students; however, no data exists on whether this type of course influences a student's decision to apply to or attend a medical school and how such a course affects the transition to the medical school environment. The purpose of this study was to determine if an EMT course, as part of the medical school curriculum, influences students' decision to apply and attend a particular medical school and if this course influences students' transition to medical school while providing awareness of patients' lives and circumstances.

METHODS

A voluntary anonymous survey was distributed in Spring 2019 to first-, second-, third-, and fourth- year medical students at the UofSC School of Medicine Greenville. Response rates were 68.5%, 66.3%, 55.2%, and 56.9%, respectively.

RESULTS

Forty-three percent of students agreed/strongly agreed that the EMT course at UofSC School of Medicine Greenville factored into their decision to apply while 52% of students agreed/strongly agreed that it factored into their decision to attend. Students agreed/strongly agreed (82%) that the program helped with medical school transition. Ninety-one percent of students reported that EMT experiences increased awareness of patients' lives and circumstances.

CONCLUSION

Students felt an EMT certification course at the beginning of the first year helped with the transition to medical school and increased awareness of patients' lives and circumstances.

Does performance at the intercollegiate Membership of the Royal Colleges of Surgeons (MRCS) examination vary according to UK medical school and course type? A retrospective cohort study

OBJECTIVES

The knowledge, skills and behaviours required of new UK medical graduates are the same but how these are achieved differs given medical schools vary in their mission, curricula and pedagogy. Medical school differences seem to influence performance on postgraduate assessments. To date, the relationship between medical schools, course types and performance at the Membership of the Royal Colleges of Surgeons examination (MRCS) has not been investigated. Understanding this relationship is vital to achieving alignment across undergraduate and postgraduate training, learning and assessment values.

DESIGN AND PARTICIPANTS

A retrospective longitudinal cohort study of UK medical graduates who attempted MRCS Part A (n=9730) and MRCS Part B (n=4645) between 2007 and 2017, using individual-level linked sociodemographic and prior academic attainment data from the UK Medical Education Database.

METHODS

We studied MRCS performance across all UK medical schools and examined relationships between potential predictors and MRCS performance using χ2 analysis. Multivariate logistic regression models identified independent predictors of MRCS success at first attempt.

RESULTS

MRCS pass rates differed significantly between individual medical schools (p<0.001) but not after adjusting for prior A-Level performance. Candidates from courses other than those described as problem-based learning (PBL) were 53% more likely to pass MRCS Part A (OR 1.53 (95% CI 1.25 to 1.87) and 54% more likely to pass Part B (OR 1.54 (1.05 to 2.25)) at first attempt after adjusting for prior academic performance. Attending a Standard-Entry 5-year medicine programme, having no prior degree and attending a Russell Group university were independent predictors of MRCS success in regression models (p<0.05).

CONCLUSIONS

There are significant differences in MRCS performance between medical schools. However, this variation is largely due to individual factors such as academic ability, rather than medical school factors. This study also highlights group level attainment differences that warrant further investigation to ensure equity within medical training.

Exploring UK medical school differences: the MedDifs study of selection, teaching, student and F1 perceptions, postgraduate outcomes and fitness to practise

BACKGROUND

Medical schools differ, particularly in their teaching, but it is unclear whether such differences matter, although influential claims are often made. The Medical School Differences (MedDifs) study brings together a wide range of measures of UK medical schools, including postgraduate performance, fitness to practise issues, specialty choice, preparedness, satisfaction, teaching styles, entry criteria and institutional factors.

METHOD

Aggregated data were collected for 50 measures across 29 UK medical schools. Data include institutional history (e.g. rate of production of hospital and GP specialists in the past), curricular influences (e.g. PBL schools, spend per student, staff-student ratio), selection measures (e.g. entry grades), teaching and assessment (e.g. traditional vs PBL, specialty teaching, self-regulated learning), student satisfaction, Foundation selection scores, Foundation satisfaction, postgraduate examination performance and fitness to practise (postgraduate progression, GMC sanctions). Six specialties (General Practice, Psychiatry, Anaesthetics, Obstetrics and Gynaecology, Internal Medicine, Surgery) were examined in more detail.

RESULTS

Medical school differences are stable across time (median alpha = 0.835). The 50 measures were highly correlated, 395 (32.2%) of 1225 correlations being significant with p < 0.05, and 201 (16.4%) reached a Tukey-adjusted criterion of p < 0.0025. Problem-based learning (PBL) schools differ on many measures, including lower performance on postgraduate assessments. While these are in part explained by lower entry grades, a surprising finding is that schools such as PBL schools which reported greater student satisfaction with feedback also showed lower performance at postgraduate examinations. More medical school teaching of psychiatry, surgery and anaesthetics did not result in more specialist trainees. Schools that taught more general practice did have more graduates entering GP training, but those graduates performed less well in MRCGP examinations, the negative correlation resulting from numbers of GP trainees and exam outcomes being affected both by non-traditional teaching and by greater historical production of GPs. Postgraduate exam outcomes were also higher in schools with more self-regulated learning, but lower in larger medical schools. A path model for 29 measures found a complex causal nexus, most measures causing or being caused by other measures. Postgraduate exam performance was influenced by earlier attainment, at entry to Foundation and entry to medical school (the so-called academic backbone), and by self-regulated learning. Foundation measures of satisfaction, including preparedness, had no subsequent influence on outcomes. Fitness to practise issues were more frequent in schools producing more male graduates and more GPs.

CONCLUSIONS

Medical schools differ in large numbers of ways that are causally interconnected. Differences between schools in postgraduate examination performance, training problems and GMC sanctions have important implications for the quality of patient care and patient safety.

Students' approaches to medical school choice: relationship with students' characteristics and motivation

OBJECTIVES

The aim was to examine main reasons for students' medical school choice and their relationship with students' characteristics and motivation during the students' medical study.

METHODS

In this multisite cross-sectional study, all Year-1 and Year-4 students who had participated in a selection procedure in one of the three Dutch medical schools included in the study were invited to complete an online survey comprising personal data, their main reason for medical school choice and standard, validated questionnaires to measure their strength of motivation (Strength of Motivation for Medical School-Revised) and autonomous and controlled type of motivation (Academic Self-regulation Questionnaire). Four hundred seventy-eight students participated. We performed frequency analyses on the reasons for medical school choice and regression analyses and ANCOVAs to study their associations with students' characteristics and motivation during their medical study.

RESULTS

Students indicated 'city' (Year-1: 24.7%, n=75 and Year-4: 36.0%, n=52) and 'selection procedure' (Year-1: 56.9%, n=173 and Year-4: 46.9%, n=68) as the main reasons for their medical school choice. The main reasons were associated with gender, age, being a first-generation university student, ethnic background and medical school, and no significant associations were found between the main reasons and the strength and type of motivation during the students' medical study.

CONCLUSIONS

Most students had based their medical school choice on the selection procedure. If medical schools desire to achieve a good student-curriculum fit and attract a diverse student population aligning the selection procedure with the curriculum and taking into account various students' different approaches is important.

Medical school choice: what influences applicants?

BACKGROUND

Little is known about factors influencing applicants' choice of medical school, yet it is important that both the academic and non-academic needs of medical students are satisfied, and that medical schools attract students suited to the courses provided. Relevant evidence suggests that there are five main factors influencing choice: curriculum; reputation of the school; personal contact; location; and facilities. Aberdeen has the particular challenge of being the most northern medical school in the UK.

METHOD

To address this challenge, and learning from the literature, a medical school open day was developed to showcase the medical school, the wider university and the city of Aberdeen.

RESULTS

The main messages from this small study were that interactive events were more popular than static displays, and that applicants preferred to interact with student representatives rather than just hear about student life, suggesting that the opportunity to ask questions and hear the 'uncensored' version of what being a student is like are important.

DISCUSSION

There are some generalisable messages about what prospective students want from an open day, which along with the prospectus and the website can contribute to informing choice. Further work is needed to identify what is critical in terms of first point of contact, and how much this influences the choice of medical school.

Size matters: what influences medical students' choice of study site?

BACKGROUND

The University of British Columbia, Canada doubled its class intake in 2004, creating, in addition to its main metropolitan campus, 2 distributed campuses, one in a medium sized island city, and the other in a small geographically isolated northern city. Our admission process attempts to identify students more suitable for education in our northern, rural site. Students also indicate their preferred site. Little is known about what influences student choice when they have more than one campus to choose from at a single medical school.

AIM

To understand what influences students' preference of study site in a single medical school with 3 separate campuses, one with a rural mission.

METHODS

We used qualitative methodology to examine what influenced student choice of study site. Semi-structured interviews were conducted with students at all three sites (n = 37). Iterative and independent coding and analysis took place to corroborate research findings.

RESULTS

The primary theme was size of class and community. Some students viewed a larger class size and larger study and practice community as advantages, others viewed a smaller class size and smaller study and practice community as important. Additional themes were perceptions of quality of education, relationships, and lifestyle. These were related to the larger theme of class and community size and overlapped. Students articulated advantages and disadvantages of each site, and dynamic tensions in their choice of sites. Close relationships and educational experiences were emphasized at the smaller regional sites. Greater access to medical and educational specialists and the diversity offered by a larger, more anonymous class, patient case-mix, and community were emphasized at the originating and largest site. Partner and family--trumps--could overrule preferred site choices.

CONCLUSION

Early and comprehensive descriptions of the differences between sites for students and their partners is needed to help truly informed choices.

A qualitative study of medical school choice in the UK

BACKGROUND

Examining the factors that make a medical school attractive (or otherwise) to potential students is particularly important but there is little empirical evidence that explores this issue.

METHODS

Semi-structured interviews were undertaken with 24 prospective medical students at six schools and colleges in England. The interviews aimed to elicit detailed information on the why and how of medical school choice, in students' application and acceptance decisions.

RESULTS

Three categories of medical school attributes stood out as positive determinants of choice: academic factors (with reputation considered the most important), location factors (specifically preferences for particular cities) and intangibles (gut feelings and personal contacts and recommendations). Most of students' decision-making activity was undertaken during the admissions stage of the application process.

CONCLUSIONS

The results are important in explaining why the students in the sample did not rate the new medical schools highly and also suggest that few of the important attributes can be manipulated by the schools themselves.