Examination performance of graduate entry medical students compared with mainstream students

A comparison of the academic performance of graduate entry and undergraduate entry pharmacy students at the course exit level

INTRODUCTION

Graduate entry (GE) pharmacy students are trained in a shorter timeframe than undergraduate entry (UE) students. This study compares the academic performance of GE and UE pharmacy students at the course exit point.

METHODS

A retrospective analysis of final exam grades in written and objective structured clinical examination (OSCE) was performed between GE and UE students from three graduating cohorts. Final written examination contained clinical case study questions, whereas OSCE involved role play with simulated patients or doctors. Statistical analyses were performed by t-test and one-way analysis of variance at .05 significance level and Pearson's correlation coefficient.

RESULTS

No significant difference in academic performance was seen between GE and UE groups at course exit (P > .05). There was a trend for GE students performing marginally better in OSCE than UE students. Females showed better performances in verbal communication than males. GE males showed significantly lower empathy scores than all other groups. No significant difference was seen in problem-solving scores amongst all groups. Both UE and GE groups scored significantly better in written examinations compared with OSCE.

CONCLUSIONS

Graduate entry pharmacy students from accelerated learning pathway and UE students performed similarly at the course exit point, providing empirical support for non-traditional graduate entry pathway as a viable option.

Listening to student voice-understanding student and faculty experience at two UK graduate entry programmes

CONTEXT

Shortage of physicians in the UK has been a long-standing issue. Graduate entry medicine (GEM) may offer a second point of entry for potential doctors. However, the challenges of developing and implementing these programmes are still unrecognised. This small-scale study aimed to briefly explore the opportunities and challenges facing students at two UK GEM programmes.

METHODS

Two case studies were conducted at Imperial College and Scotland's GEM (ScotGEM) and used a triangulated qualitative approach via semi-structured and elite interviews. Data analysis, informed by grounded theory, applied thematic and force-field analysis in an empirical approach to generate evidence and instrumental interpretations for Higher Education Institutions.

RESULTS

Although GEM forms an opportunity for graduates to enter medicine, the different drivers of each programme were key in determining entry requirements and challenges experienced by postgraduates. Three key dilemmas seem to influence the experiences of learners in GEM programmes: (a) postgraduate identity and the everchanging sense-of-self; (b)self-directed and self-regulated learning skills, and (c) servicescape, management and marketing concepts.

CONCLUSIONS

Graduate entry programmes may support policy makers and faculty to fill the workforce gap of healthcare professionals. However, their successful implementation requires careful considerations to the needs of graduates to harness their creativity, resilience and professional development as future healthcare workers.

Predicting future performance in medical students. A longitudinal study examining the effects of resilience on low and higher performing students

Introduction: Medical students have high rates of distress and burnout, exacerbated by a high academic workload. Resilience is stated to mitigate such stress, and even allow positive adaptations in the face of such challenges. Despite this, no research has examined the relationship of resilience on the academic performance of medical students. Methods: The goal of our study was to investigate the association between resilience on academic performance. We surveyed all year 2, 3, and 4 medical students (n = 160), and combined this with data on past and future course performance. We conducted an analysis of the internal consistency and validity of the RS-14, suggesting two factors: which we represent as self-assuredness and drive. We then analyzed future course performance using multiple regression. Results: Models utilizing the combined RS-14 score suggested past-performance as the only significant predictor of future course performance. Considering self-assuredness and drive as separate predictors demonstrated self-assuredness to be a predictor of improved performance in lower-than-average students, whilst drive was a predictor of improvement in higher-than-average students. Conclusions: We suggest that the conceptualization of resilience needs greater nuance, and consideration in tandem with broader psychosocial concepts, as it may exert different effects for different students.

Does initial postgraduate career intention and social demographics predict perceived career behaviour? A national cross-sectional survey of UK postgraduate doctors

OBJECTIVE

Studies indicate that initial career intentions and personal characteristics (eg, gender) can influence medical career decision-making. However, little is known about how personal characteristics and intention interact with career decision-making. To address this gap, we examined the link between career intention at the start of the 2-year UK Foundation Programme (FP) and career intentions on its completion.

METHODS

Data came from the 2017 UK National Career Destination Survey, a cross-sectional study completed by all second year foundation doctors. We included respondents' demographics (gender, graduate status on entry to medical school, career intention on starting the FP) and career intention as an outcome measure (eg, specialty (residency) training (UK), NHS non-training posts/further study, career break, working abroad). Multinomial regression was used to assess the independent relationship between background characteristics and career intention.

RESULTS

There were 6890 participants and 5570 usable responses. 55.9% of respondents were female and 43.1% were male, 77.1% were non-graduates and 22.9% were graduate entrants to medical school. Approximately two-thirds (62.3%, n=2170) of doctors who had an original intention to pursue specialty training after F2, still intended to do so on completion. Most of those who stated at the start of F2 that they did not want to pursue specialty indicated at the end of F2 they would be undertaking other employment opportunities outwith formal training. However, 37.7% of respondents who originally intended to pursue specialty training on FP completion did something different. Graduate entrants to medicine were more likely to immediately progress into specialty training compared with their peers who did medicine as a primary first degree.

CONCLUSION

Original intention is a strong predictor of career intentions at the end of the FP. However, a considerable proportion of doctors changed their mind during the FP. Further research is needed to understand this behaviour.

Relative progress and academic performance of graduate vs undergraduate entrants to an Australian medical school

BACKGROUND

Whether graduate entrants to medical school perform better academically than undergraduate entrants remains controversial. Differences in the discipline backgrounds of graduates may, at least in part, have accounted for differences in the results of comparative studies reported to date. This study aimed to address the dual issues of whether academic performance and progression rates were different between GE and UG students and the extent to which the discipline background of GE students may underpin any differences observed.

METHODS

Relative academic performance as well as indicators of student progression (supplementary examinations, repeat years, leave of absence, withdrawal from the programme) were compared between graduate entrants (GE) (N = 410) and both school leaver entrants (SLE) (N = 865) and non-standard entrants (some prior tertiary education) (NSE) (N = 148) who combined for the final 4 yr. of a 6 yr. MBBS undergraduate programme in 8 consecutive cohorts from 2006 to 2013 in Western Australia.

RESULTS

Examination scores were generally at or very close to a distinction grade or higher across all groups. Higher mean examination scores were seen for GE versus both SLE and NSE in the first 2 years with no significant differences in the final 2 years. GE from biological science / science backgrounds (N = 241) or physical science backgrounds (N = 26) performed the same as SLE and NSE throughout the programme. GE with a health / allied health background (N = 91), however, performed better throughout. They also performed better when compared to their GE counterparts from a humanities (N = 32) or a biological science / science background. GE had increased odds of withdrawing when compared to SLE (OR 2.50, 95% CI 1.30, 4.79, P = 0.006), but not compared to NSE. NSE had increased odds of repeating at least one level when compared to either GE (OR 2.74, 95% CI 1.21, 6.21, P = 0.016) or SLE (OR 4.10, 95% CI 1.93, 8.70, P < 0.001). There were no differences by entry category in the odds of sitting at least one supplementary examination during the programme. There was an increase in the odds of taking at least one leave of absence in both SLE (OR 2.55, 95% CI 1.79, 3.63, P < 0.001) and NSE (OR 2.47, 95% CI 1.50, 4.07, P < 0.001) compared to GE.

CONCLUSIONS

Better academic performance by GE compared to SLE and NSE was predominantly due to higher scores for GE with a health / allied health background. GE were also less likely to have impeded progress during the course.

Impact of accelerated, graduate-entry medicine courses: a comparison of profile, success, and specialty destination between graduate entrants to accelerated or standard medicine courses in UK

BACKGROUND

Little research has compared the profile, success, or specialty destinations of graduates entering UK medical schools via accelerated, 4-yr, standard 5-yr and 6-yr programmes. Four research questions directed this investigation:- What are the success rates for graduates entering graduate-entry vs. undergraduate medicine courses? How does the sociodemographic and educational profile differ between these two groups? Is success - in medical school and foundation training - dependent on prior degree, demographic factors, or aptitude test performance at selection? What specialty do graduate entry medicine students subsequently enter?

METHODS

The data from two cohorts of graduates entering medical school in 2007 and 2008 (n = 2761) in the UKMED (UK Medical Education Database) database were studied: 1445 taking 4-yr and 1150 taking 5-yr medicine courses, with smaller numbers following other programmes.

RESULTS

Completion rates for degree programmes were high at 95%, with no significant difference between programme types. 4-yr entrants were older, less likely to be from Asian communities, had lower HESA (Higher Education Statistics Agency) tariff scores, but higher UKCAT (UK Clinical Aptitude Test) and GAMSAT (Graduate Medical School Admissions Test) scores, than 5-yr entrants. Higher GAMSAT scores, black or minority ethnicity (BME), and younger age were independent predictors of successful completion of medical school. Foundation Programme (FPAS) selection measures (EPM - educational performance measure; SJT - situational judgment test) were positively associated with female sex, but negatively with black or minority ethnicity. Higher aptitude test scores were associated with EPM and SJT, GAMSAT with EPM, UKCAT with SJT. Prior degree subject, class of degree, HESA tariff, and type of medicine programme were not related to success.

CONCLUSIONS

The type of medicine programme has little effect on graduate entrant completion, or EPM or SJT scores, despite differences in student profile. Aptitude test score has some predictive validity, as do sex, age and BME, but not prior degree subject or class. Further research is needed to disentangle the influences of BME.

Are efforts to attract graduate applicants to UK medical schools effective in increasing the participation of under-represented socioeconomic groups? A national cohort study

INTRODUCTION

Attracting graduates was recommended as a means of diversifying the UK medical student population. Graduates now make up nearly a quarter of the total medical student population. Research to date has focused on comparing the sociodemographic characteristics of applicants to and/or students on traditional and graduate entry programmes (GEMs), yet GEMs account for only 40% of the graduate medical student population. Thus, we aimed to compare the sociodemographic characteristic and outcomes of graduates and non-graduate applicants across a range of programmes.

METHODS

This was an observational study of 117 214 applicants to medicine who took the UK Clinical Aptitude Test (UKCAT) from 2006 to 2014 and who applied to medical school through Universities and Colleges Admissions Service (UCAS). We included applicant demographics, UKCAT total score and offers in our analysis. Applicants were assigned as graduates or non-graduates on the basis of their highest qualification. Multiple logistic regression was used to predict the odds of receiving an offer, after adjusting for confounders.

RESULTS

Irrespective of graduate or non-graduate status, most applicants were from the highest socioeconomic groups and were from a white ethnic background. Receiving an offer was related to gender and ethnicity in both graduates and non-graduates. After adjusting for UKCAT score, the OR of an offer for graduates versus non-graduates was approximately 0.5 (OR=0.48, 95% CI 0.46 to 0.49).

DISCUSSION

Our findings indicate that the aim of diversifying the medical student population on socioeconomic grounds by attracting graduates has been only marginally successful. Graduate applicants from widening access backgrounds are less likely than others to be offered a place at medical school. Different approaches must be considered if medicine is to attract and select more socially diverse applicants.

Comparison of graduate-entry and direct school leaver student performance on an applied dental knowledge test

AIMS

To compare the academic performance of graduate-entry and direct school leavers in an undergraduate dental programme.

METHODS

This study examined the results of students in applied dental knowledge (ADK) progress tests conducted during two academic years. A mixed model analysis of variance (ANOVA) was conducted to compare the performance of graduate-entry and direct school leavers. ADK was treated as a repeated measures variable, and the outcome variable of interest was percentage score on the ADK.

RESULTS

The results show statistically significant main effects for ADK [F (1,113) = 61.58, P < 0.001, η²_p = 0.35], Cohort [F (1,113) = 88.57, P < 0.001, η²_p = 0.44] and Entry [F (1,113) = 11.31, P = 0.001, η²_p = 0.09]. That is, students do better on each subsequent test (main effect of ADK), students in later years of the programme perform better than those in earlier years (main effect of cohort), and graduate-entry students outperform direct school leavers.

CONCLUSIONS

This is the first study to explore the differences in the academic performance of graduate-entry and direct school leavers in an undergraduate dental programme. The results show that the academic performance of graduate students was better than the direct school leavers in years 2 and 3. Further research is required to compare the performance of students longitudinally across the entire duration of undergraduate dental programmes and evaluate whether this difference persists throughout.

Predicting medical students who will have difficulty during their clinical training

BACKGROUND

We aimed to classify the difficulties students had passing their clinical attachments, and explore factors which might predict these problems.

METHODS

We analysed data from regular student progress meetings 2008-2012. Problem categories were: medical knowledge, professional behaviour and clinical skills. For each category we then undertook a predictive risk analysis.

RESULTS

Out of 561 students, 203 were found to have one or more problem category and so were defined as having difficulties. Prevalences of the categories were: clinical skills (67%), knowledge (59%) and professional behaviour (29%). A higher risk for all categories was associated with: male gender, international entry and failure in the first half of the course, but not with any of the minority ethnic groups. Professional and clinical skills problems were associated with lower marks in the Undergraduate Medical Admissions Test paper 2. Clinical skills problems were less likely in graduate students.

CONCLUSIONS

In our students, difficulty with clinical skills was just as prevalent as medical knowledge deficit. International entry students were at highest risk for clinical skills problems probably because they were not selected by our usual criteria and had shorter time to become acculturated.

High school versus graduate entry in a Saudi medical school - is there any difference in academic performance and professionalism lapses?

BACKGROUND

King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) was the first university in the Kingdom of Saudi Arabia offering both high school entry and graduate entry (GE) students into medical school. We compared the academic performance and professionalism lapses of high school entry and GE students who undertook the same curriculum and examinations in the College of Medicine, Riyadh, KSAU-HS.

METHODS

Examination scores of 196 high school graduates and 54 GE students over a 4-year period (2010-2014) were used as a measure of academic achievement. For assessment of professionalism lapses, we compared the number of warning letters in both streams of students.

RESULTS

In some pre-clinical courses, high school entry students performed significantly better than GE students. There was no significant difference in academic performance of high school entry and GE students in clinical rotations. GE students had a significantly greater number of warning letters per student as compared to high school entry students.

DISCUSSION

This is the first Saudi study to compare the performance of high school entry and GE students in a medical school. Overall, both streams of students performed equally well with high school entry students performing better than GE students in a few pre-clinical courses. We compared professionalism lapses and found an increase in number of warning letters for GE students. More studies are needed to evaluate if there are differences in other assessments of professionalism between these two streams of students.

The impact of clinical maturity on competency in evidence-based medicine: a mixed-methods study

OBJECTIVE

To identify whether the clinical maturity of medical trainees impacts upon the level of trainee competency in evidence-based medicine (EBM).

MATERIALS AND METHODS

Undergraduate and graduate-entry medical trainees entering their first year of training in the clinical environment were recruited for this study. Competency in EBM was measured using a psychometrically validated instrument. EBM competency scores were analysed using Student's t tests, in order to differentiate between undergraduate and graduate-entry trainee performance. Ten focus group discussions were conducted with undergraduate and graduate-entry trainees. Audio transcripts were thematically analysed.

RESULTS

Data on a total of 885 medical trainees were collected over a 5-year period. Undergraduate trainees had significantly higher EBM competency scores during years in which the programme was presented in a didactic format (mean difference (MD)=1.24 (95% CI)CI 0.21 to 2.26; 1.78 (0.39 to 3.17); 2.13 (1.16 to 3.09)). Graduate trainee EBM competency scores increased when a blended learning approach to EBM was adopted, demonstrating no significant difference in EBM competency scores between undergraduate and graduate cohorts (-0.27 (-1.38 to 0.85); -0.39 (-1.57 to 0.79). Qualitative findings indicated that differences in learning and teaching preference among undergraduate and graduate-entry trainees influenced the level of competency obtained in EBM.

CONCLUSIONS

Clinical maturity is the only one factor that may influence medical trainees' competency in EBM. Other predictors of EBM competency may include previous training and exposure to epidemiology, biostatistics and information literacy. While graduate-entry medical students may have more 'life' experience, or maturity, it does not necessarily translate into clinical maturity and integration into the clinical environment.

Graduate-entry medical students: older and wiser but not less distressed

OBJECTIVES

Australia has a growing number of graduate-entry medical courses. It is known that undergraduate medical students have high levels of psychological distress; however, little is known about graduate-entry medical students. We examined whether graduate-entry medical students had higher levels of psychological distress than the same-age general population.

METHOD

Psychological distress was assessed in 122 graduate-entry medical students in an Australian graduate-entry medical school using the 21-item Depression Anxiety and Stress Scale. Mean scores and the proportion of students with scores in the highly distressed range were compared with non-clinical population norms. Scores were also compared across demographic characteristics.

RESULTS

Medical students reported higher mean depression, anxiety and stress scores than the general population and were more likely to score in the moderate to extremely high range for anxiety (45% vs. 13%; p<0.001) and stress (17% vs. 13%; p=0.003). Anxiety and stress were higher in students aged ≥30 years than in younger students.

CONCLUSIONS

Despite their maturity, graduate-entry students experienced high psychological distress. Anxiety and stress were higher, not lower, with increasing age. Our results suggest that graduate-entry medical students warrant the same level of concern as their school-leaving counterparts. Further interventions to support these students during medical school are warranted.

Self-reported extracurricular activity, academic success, and quality of life in UK medical students

OBJECTIVES

To explore the relationship between academic performance, extracurricular activity, and quality of life at medical school in the UK to aid our understanding of students' work-life balance.

METHODS

A cross-sectional study, using an electronic questionnaire distributed to UK final year medical students across 20 medical schools (4478 students). Participants reported the hours of self-regulated learning and extracurricular activities undertaken each year at medical school; along with their academic decile (1 = highest, 10 = lowest). Self-reported quality of life (QoL) was assessed using an established screening tool (7 = highest, 1 = lowest).

RESULTS

Seven hundred responses were obtained, across 20 participating medical schools, response rate 16% (700/4478). Factors associated with higher academic achievement were: graduate entry course students (2 deciles higher, p < 0.0001), more hours academic study during term and revision periods (rho=-0.1, p < 0.01), and involvement in teaching or research. Increased hours of study was associated with lower QoL (rho = -0.13, p < 0.01).

CONCLUSIONS

Study skills may be more important than duration spent studying, for academic achievement and QoL. Graduate-entry students attain higher decile scores despite similar self-reported duration of study.

Peer assisted learning in the clinical setting: an activity systems analysis

Peer assisted learning (PAL) is a common feature of medical education. Understanding of PAL has been based on processes and outcomes in controlled settings, such as clinical skills labs. PAL in the clinical setting, a complex learning environment, requires fresh evaluation. Socio-cultural theory is proposed as a means to understand educational interventions in ways that are practical and meaningful. We describe the evaluation of a PAL intervention, introduced to support students' transition into full time clinical attachments, using activity theory and activity systems analysis (ASA). Our research question was How does PAL transfer to the clinical environment? Junior students on their first clinical attachments undertook a weekly same-level, reciprocal PAL activity. Qualitative data was collected after each session, and focus groups (n = 3) were held on completion. Data was analysed using ASA. ASA revealed two competing activity systems on clinical attachment; Learning from Experts, which students saw as the primary function of the attachment and Learning with Peers, the PAL intervention. The latter took time from the first and was in tension with it. Tensions arose from student beliefs about how learning takes place in clinical settings, and the importance of social relationships, leading to variable engagement with PAL. Differing perspectives within the group were opportunities for expansive learning. PAL in the clinical environment presents challenges specific to that context. Using ASA helped to describe student activity on clinical attachment and to highlight tensions and contradictions relating PAL in that setting. Planning learning opportunities on clinical placements, must take account of how students learn in workplaces, and the complexity of the multiple competing activity systems related to learning and social activities.

Exam Success at Undergraduate and Graduate-Entry Medical Schools: Is Learning Style or Learning Approach More Important? A Critical Review Exploring Links Between Academic Success, Learning Styles, and Learning Approaches Among School-Leaver Entry ("Traditional") and Graduate-Entry ("Nontraditional") Medical Students

PHENOMENON: The literature on learning styles over many years has been replete with debate and disagreement. Researchers have yet to elucidate exactly which underlying constructs are measured by the many learning styles questionnaires available. Some academics question whether learning styles exist at all. When it comes to establishing the value of learning styles for medical students, a further issue emerges. The demographics of medical students in the United Kingdom have changed in recent years, so past studies may not be applicable to students today. We wanted to answer a very simple, practical question: what can the literature on learning styles tell us that we can use to help today's medical students succeed academically at medical school?

APPROACH

We conducted a literature review to synthesise the available evidence on how two different aspects of learning-the way in which students like to receive information in a learning environment (termed learning "styles") and the motivations that drive their learning (termed learning "approaches")-can impact on medical students' academic achievement.

FINDINGS

Our review confirms that although learning "styles" do not correlate with exam performance, learning "approaches" do: those with "strategic" and "deep" approaches to learning (i.e., motivated to do well and motivated to learn deeply respectively) perform consistently better in medical school examinations. Changes in medical school entrant demographics in the past decade have not altered these correlations. Optimistically, our review reveals that students' learning approaches can change and more adaptive approaches may be learned. Insights: For educators wishing to help medical students succeed academically, current evidence demonstrates that helping students develop their own positive learning approach using "growth mind-set" is a more effective (and more feasible) than attempting to alter students' learning styles. This conclusion holds true for both "traditional" and graduate-entry medical students.

Comparison of performance in a four year graduate entry medical programme and a traditional five/six year programme

BACKGROUND

In 2006 the Royal College of Surgeons in Ireland, (RCSI), introduced the first four year Graduate Entry Programme (GEP) in medicine in Ireland in line with national policy to broaden access to medical education. One concern considered at the time, was whether the GEP students could be trained to the same standard as their undergraduate Direct Entry Programme (DEP, five/six year duration) counterparts in the shorter time frame. Since students from both cohorts undertake the same examinations in the final two years, it is possible to directly compare GEP vs DEP outcomes. The primary aim of the current study was to analyse the comparative performance of GEP and DEP students undergoing these examinations between 2008 and 2013.

METHODS

Scores from five assessments performed during the final two years were transformed to z scores for each student and 4 scores for the penultimate year were summed to create a unit weighted composite score. The resultant scores for each of the two years were used to assess the comparative performance of GEP vs DEP cohorts and to perform sub-cohort analyses of GEP outcomes.

RESULTS

In all cohorts/years examined, evidence demonstrated significantly better assessment outcomes for the GEP group for the final two years' examinations as compared with the DEP group. In all but one cohort examined, this advantage was retained when nationality factors were excluded. Further analyses showed no difference in outcomes between GEP students having science vs. non-science backgrounds and/or between those from EU vs non-EU backgrounds. Finally, data suggested weak correlations between total composite scores and entry scores in American (r = 0.15) and Australian (r = 0.08) medical school admissions tests.

CONCLUSIONS

We have shown for the first time in Ireland, that graduate-entry students perform at least as well, or even better, than a corresponding undergraduate-entry group. Moreover, having a scientific background on entry to the GEP confers no advantage in final assessments. These data provide evidence of the viability of the graduate entry route into medical education in Ireland.

Enhanced research assessment performance in graduate vs. undergraduate-entry medical students: implications for recruitment into academic medicine

BACKGROUND

Studies investigating variance between the academic performance of direct-entry (DEM) versus graduate-entry (GEM) medical students have yielded conflicting results, but their performance in undergraduate research-based assessments has not been compared to-date.

AIM

We aimed to compare the results of DEM and GEM students with respect to their senior research dissertation module.

METHODS

This retrospective study examined the final year results between 2011-2012 in DEM, (n = 219) and GEM (n = 84) students. Between-group comparisons of dissertation module marks were conducted using independent t-tests. Correlations between marks in dissertation module and in other disciplines assessed during the final year were attained using Pearson's correlation. Multiple regression analysis was employed to adjust for potential confounding factors such as student age and gender.

RESULTS

No apparent difference was apparent between the DEM and GEM students with respect to results achieved across the clinical disciplines examined. However, GEM students performed significantly better than DEMs in their senior research dissertation assessment (Mean = 66.81% vs. 65.00%, fully adjusted p = 0.048). The variable which remained influential in regression analysis was nationality, where North American and Asian students were demonstrated to score lower than their Irish counterparts in the dissertation module (B coefficient = -1.90, SE = 0.94, P = 0.045 and B coefficient = -4.88, SE = 1.00, P < 0.001 respectively).

CONCLUSIONS

Performance in the research-based module was significantly better in GEM relative to their DEM colleagues. This finding may have implications for future recruitment into academic medicine, as aptitude and interest in research at undergraduate level has been shown to be associated with increased likelihood of an academic career in medicine.

Predictive validity of the UK clinical aptitude test in the final years of medical school: a prospective cohort study

BACKGROUND

The UK Clinical Aptitude Test (UKCAT) was designed to address issues identified with traditional methods of selection. This study aims to examine the predictive validity of the UKCAT and compare this to traditional selection methods in the senior years of medical school. This was a follow-up study of two cohorts of students from two medical schools who had previously taken part in a study examining the predictive validity of the UKCAT in first year.

METHODS

The sample consisted of 4th and 5th Year students who commenced their studies at the University of Aberdeen or University of Dundee medical schools in 2007. Data collected were: demographics (gender and age group), UKCAT scores; Universities and Colleges Admissions Service (UCAS) form scores; admission interview scores; Year 4 and 5 degree examination scores. Pearson's correlations were used to examine the relationships between admissions variables, examination scores, gender and age group, and to select variables for multiple linear regression analysis to predict examination scores.

RESULTS

Ninety-nine and 89 students at Aberdeen medical school from Years 4 and 5 respectively, and 51 Year 4 students in Dundee, were included in the analysis. Neither UCAS form nor interview scores were statistically significant predictors of examination performance. Conversely, the UKCAT yielded statistically significant validity coefficients between .24 and .36 in four of five assessments investigated. Multiple regression analysis showed the UKCAT made a statistically significant unique contribution to variance in examination performance in the senior years.

CONCLUSIONS

Results suggest the UKCAT appears to predict performance better in the later years of medical school compared to earlier years and provides modest supportive evidence for the UKCAT's role in student selection within these institutions. Further research is needed to assess the predictive validity of the UKCAT against professional and behavioural outcomes as the cohort commences working life.

Studying medicine - a cross-sectional questionnaire-based analysis of the motivational factors which influence graduate and undergraduate entrants in Ireland

Objectives

The number of places available in Ireland for graduate entry to medical school has steadily increased since 2006. Few studies have, however, characterized the motivational factors underlying decision to study medicine via this route. We compared the factors motivating graduate entrants versus undergraduate entry (UGE) students to choose medicine as a course of study.

Design

The present study was a quantitative cross-sectional questionnaire-based investigation.

Setting

The study was conducted in University College Cork and University of Limerick, Ireland.

Participants

It involved 185 graduate entry (GE) and 120 UGE students.

Outcome measures

Questionnaires were distributed to students addressing the following areas: demographic/academic characteristics; factors influencing the selection of academic institution and motivation to study medicine; and the role of career guidance in choice of study.

Results

When asked to list reasons for selecting medicine, both groups listed a wish to help and work with people, and a desire to prevent and cure disease. UGE students were significantly more motivated by intellectual satisfaction, encouragement by family/friends, financial reasons, and professional independence. Approximately half of GE students selected their first degree with a view to potentially studying medicine in the future. GE and UGE students differed significantly with respect to sources consulted for career guidance and source of study information.

Conclusions

This study is the first systematic examination of study and career motivation in GE medical students since the programme was offered by Irish universities and provides insight into the reasons why graduate entrants in Ireland choose to study medicine via this route.

Selection of student-selected component [SSCs] modules across the medical undergraduate curriculum: relationship with motivational factors

Student-selected components (SSCs) encourage the following within the undergraduate medical curriculum: greater exploration of core curriculum topics; exploration of non-core subjects/experiences; research and self-directed learning; and personal and professional development opportunities. This study examined the motivational factors which influence SSC choice to assess (a) SSC selection patterns across each year of the curriculum (direct and graduate entry) and (b) motivation underlying SSC selection across the curriculum. During SSC registration at University College Cork, all medical undergraduates (years 1-3, graduate-entry medicine) were required to select an SSC and provide a written justification for their selection. Five primary motivational factors were identified: correction of perceived deficits; genuine interest in subject and wish to study in more depth; career strategy; exam strategy; and taking a chance. A complex pattern of relationships emerged in relation to matching of motivational factors with SSC categories, e.g. selection of research skills SSCs was strongly associated with the 'career strategy' motivation. Significant differences were observed across curriculum years, as well as between direct-entry versus graduate-entry undergraduates, with respect to SSC selections and underlying motivation. This study provides insight into changing patterns of SSC selection in medicine, as well as accompanying motivational factors, across the undergraduate years.

The use of specially designed tasks to enhance student interest in the cadaver dissection laboratory

Cadaver dissection is a key component of anatomy education. Unfortunately, students sometimes regard the process of dissection as uninteresting or stressful. To make laboratory time more interesting and to encourage discussion and collaborative learning among medical students, specially designed tasks were assigned to students throughout dissection. Student response and the effects of the tasks on examination scores were analyzed. The subjects of this study were 154 medical students who attended the dissection laboratory in 2009. Four tasks were given to teams of seven to eight students over the course of 2 weeks of lower limb dissection. The tasks were designed such that the answers could not be obtained by referencing books or searching the Internet, but rather through careful observation of the cadavers and discussion among team members. Questionnaires were administered. The majority of students agreed that the tasks were interesting (68.0%), encouraged team discussion (76.8%), and facilitated their understanding of anatomy (72.8%). However, they did not prefer that additional tasks be assigned during the other laboratory sessions. When examination scores of those who responded positively were compared with those who responded neutrally or negatively, no statistically significant differences could be found. In conclusion, the specially designed tasks assigned to students in the cadaver dissection laboratory encouraged team discussion and collaborative learning, and thereby generated interest in laboratory work. However, knowledge acquisition was not improved.

The multiple mini-interview in the U.K. context: 3 years of experience at Dundee

BACKGROUND

The multiple mini-interview (MMI) is a new interview process that Dundee Medical School has recently adopted to assess entrants into its undergraduate medicine course. This involves an 'objective structured clinical examination' like rotational approach in which candidates are assessed on specific attributes at a number of stations.

AIMS

 To present methodological, questionnaire and psychometric data on the transitional process from traditional interviews to MMIs over a 3-year period and discuss the implications for those considering making this transition.

METHODS

 To facilitate the transition, a four-station MMI was piloted in 2007. Success encouraged consideration of desirable attributes which were used to develop a full 10-station process which was implemented in 2009 with assessors being recruited from staff, students and simulated patients. A questionnaire was administered to all assessors and candidates who participated in the 2009 MMIs. Cronbach's alpha and Pearson's r and analysis of variances were used to determine the MMI's psychometric properties. Multi-faceted Rasch modelling (MFRM) was modelled to control for assessor leniency/stringency and the impact of using 'fair scores' determined. Analysis was conducted using SPSS 17 and FACETS 3.65.0.

RESULTS

 The questionnaire confirmed that the process was acceptable to all parties. Cronbach's alpha reliability was satisfactory and consistent. Graduates/mature candidates outperformed U.K. school-leavers and overseas candidates. Using MFRM fair scores would change the selection outcome of 6.2% and 9.6% of candidates in 2009 and 2010, respectively. Students were less lenient, made more use of the full range of the rating scales and were just as reliable as staff.

CONCLUSIONS

 The strategy of generating institutional support through staged introduction proved effective. The MMI in Dundee was shown to be feasible and displayed sound psychometric properties. Student assessors appeared to perform at least as well as staff. Despite a considerable intellectual and logistical challenge MMIs were successfully introduced and deemed worthwhile.

Clinical assessment performance of graduate- and undergraduate-entry medical students

BACKGROUND

Recent evidence suggests that graduate-entry medical students may have a marginal academic performance advantage over undergraduate entrants in a pre-clinical curriculum in both bioscience knowledge and clinical skills assessments. It is unclear whether this advantage is maintained in the clinical phase of medical training.

AIM

The study aimed to compare graduate and undergraduate entrants undertaking an identical clinical curriculum on assessments undertaken during clinical training in the medical course.

METHODS

Clinical assessment results for four cohorts of medical students (n = 713) were compared at the beginning and at the end of clinical training for graduate and undergraduate entrants.

RESULTS

Results showed that graduate- and undergraduate-entry medical students performed similarly on clinical assessments. Female students performed consistently better than male students.

CONCLUSION

The findings of this study suggest that any academic performance advantage held by graduate-entry medical students is limited to the early years of the medical course, and is not evident during clinical training in the later years of the course.

Predicting success in graduate entry medical students undertaking a graduate entry medical program

BACKGROUND

Success in undergraduate medical courses in the UK can be predicted by school exit examination (A level) grades. There are no documented predictors of success in UK graduate entry medicine (GEM) courses. This study looks at the examination performance of GEM students to identify factors which may predict success; of particular interest was A level score.

METHODS

Data was collected for students graduating in 2004, 2005 and 2006, including demographic details (age and gender), details of previous academic achievement (A level total score and prior degree) and examination results at several points during the degree course.

RESULTS

Study group comprised 285 students. Statistical analyses identified no significant variables when looking at clinical examinations. Analysis of pass/fail data for written examinations showed no relationship with A level score. However, both percentage data for the final written examination and the analysis of the award of honours showed A level scores of AAB or higher were associated with better performance (p<0.001).

DISCUSSION

A prime objective of introducing GEM programs was to diversify admissions to medical school. In trying to achieve this, medical schools have changed selection criteria. The findings in this study justify this by proving that A level score was not associated with success in either clinical examinations or passing written examinations. Despite this, very high achievements at A level do predict high achievement during medical school.

CONCLUSIONS

This study shows that selecting graduate medical students with the basic requirement of an upper-second class honours degree is justifiable and does not disadvantage students who may not have achieved high scores in school leaver examinations.

Ethnicity and academic performance in UK trained doctors and medical students: systematic review and meta-analysis

OBJECTIVE

To determine whether the ethnicity of UK trained doctors and medical students is related to their academic performance.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Online databases PubMed, Scopus, and ERIC; Google and Google Scholar; personal knowledge; backwards and forwards citations; specific searches of medical education journals and medical education conference abstracts.

STUDY SELECTION

The included quantitative reports measured the performance of medical students or UK trained doctors from different ethnic groups in undergraduate or postgraduate assessments. Exclusions were non-UK assessments, only non-UK trained candidates, only self reported assessment data, only dropouts or another non-academic variable, obvious sampling bias, or insufficient details of ethnicity or outcomes. Results 23 reports comparing the academic performance of medical students and doctors from different ethnic groups were included. Meta-analyses of effects from 22 reports (n = 23,742) indicated candidates of "non-white" ethnicity underperformed compared with white candidates (Cohen's d = -0.42, 95% confidence interval -0.50 to -0.34; P<0.001). Effects in the same direction and of similar magnitude were found in meta-analyses of undergraduate assessments only, postgraduate assessments only, machine marked written assessments only, practical clinical assessments only, assessments with pass/fail outcomes only, assessments with continuous outcomes only, and in a meta-analysis of white v Asian candidates only. Heterogeneity was present in all meta-analyses.

CONCLUSION

Ethnic differences in academic performance are widespread across different medical schools, different types of exam, and in undergraduates and postgraduates. They have persisted for many years and cannot be dismissed as atypical or local problems. We need to recognise this as an issue that probably affects all of UK medical and higher education. More detailed information to track the problem as well as further research into its causes is required. Such actions are necessary to ensure a fair and just method of training and of assessing current and future doctors.