Applications

Title Summary Lead Contact
UKMEDP01
Predicting Fitness to Practise issues from admission profiles in UK medical school entrants

Approved at 15 October 2015 UKMED Advisory Board

Published in BMC Medical Education in April 2018 as "Predictors of fitness to practise declarations in UK medical undergraduates"
The selection of medical students is known to be a complex and ‘evidence light’ area with a wide variety of approaches exercised. Although it is established that cognitive and educational performance tends to predict academic performance, especially in the early years of medical school, less is known about the role of personal attributes and the predictors of later problems that may impair Fitness to Practise (FtP).

In recent years the GMC has required significant FtP concerns to be reported prior to provisional registration of UK graduates and is now over 300 per year are now considered, with rejection an occasional outcome (0-2/year). This is clearly problematic for the few individuals concerned but there is also a suspicion that those allowed to graduate may be ‘at risk’ of future professional behavioural issues arising. This is largely based on case-control studies conducted by Papadakis (2004) in the USA, who found medical school concerns were associated with future misconduct. A more recent paper by Norman (2015) has questioned the feasibility of this approach.

The holy grail of selection is avoiding recruiting ‘problem students’ in the first place but there is no evidence that could be achieved, let alone justified. The advent of the UK Medical Education Database (UKMED) and the possibility of matching a wide range of pre-admissions metrics with outcome markers such as progression through medical school and provisional registration data offers a first opportunity to explore the issue from a modelling perspective and inform selection practice.

Graduate cohorts from 2013 and 2014 offer over 12 000 individuals with matched data and approximately 800 reported FtP concerns recorded by the GMC. Around 8 000 of these should include a range of non-academic measures piloted within the UKCAT test in 2007 offering a unique cohort for study and a sufficient sample to merit exploratory analysis.

It is recognised that these data are highly sensitive and that great care would be required to ensure individuals could not be identified. This may require some blunting of the available data, such as categorising the most severe offences broadly enough to avoid highlighting the 0-5 excluded within these cohorts too clearly. However, it is suggested that, in outline, this can be achieved using the approach described and therefore UKMED has an opportunity and indeed responsibility to conduct pioneering research on such a critical area of selection practice. There is also the opportunity to follow these cohorts on into practice and to pilot methodologies for a prospective cohort study too that may include performance measures such as ARCP progression and FtP events.
Dr Paul Tiffin
paul.tiffin@york.ac.uk
UKMEDP02
What has been the impact of accelerated graduate-entry medicine courses in terms of educational and sociodemographic profile, success at medical school, completion of Foundation training, and specialty entry?

Approved at 15 October 2015 UKMED Advisory Board

Published in BMC Medical Education in November 2018 as "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"
A proportion of each annual intake to medical school already has a first degree in a different subject. Prior to 2000 these graduate entrants studied alongside school leavers in the existing UK five or six year medicine courses. Since then, around 800 graduates annually have entered the fifteen UK graduate-entry 4-year accelerated programmes as well as a smaller number who have continued to join the 5/6 year programmes. The profile of graduate-entrants has also been markedly different from undergraduate programmes in terms of age and subject background: nine of the graduate entry courses admitting students with degrees in non-science subjects.

Older research reported (e.g. James & Chilvers, 2001; Wilkinson et al, 2004) that graduates had a number of advantages in terms of attainment and progress at medical school compared to younger entrants with only secondary educational qualifications. However, it was unclear what exactly might be responsible for these advantages. More recent research (McManus et al, 2013) analysed the year 1 performance of entrants to twelve UK medical schools in terms of potential predictors of their attainment. In summary, that study confirmed the strong relationship between A-level performance and year 1 medical school assessments, but it also demonstrated weaker, but incremental predictive validity for a number of other pre-entry variables: these included GCSE performance, scores on UKCAT, and age>21 (who were most likely graduates). Demographic variables were also influential: in particular, men and students from non-white UK ethnic minority communities performed more poorly.

Several studies of attainment at individual UK medical schools have shown that graduate-entry students have performed comparably (Manning & Garrud, 2009) or better (Price & Wright, 2010) than undergraduate students in common assessments during the shared full-time clinical phase of those programmes. Some studies (e.g. Bodger et al, 2011) have attempted to identify predictors of attainment in graduate-entry programmes, with mixed conclusions, but commonly that prior academic record (e.g. secondary or tertiary educational qualifications) is a reliable predictor.

At present, therefore, there is no evidence about the relative success of graduates who have gone through the graduate-entry vs. the undergraduate medicine courses. There is also very little evidence at a national, pan-individual school level, about markers of success in these different types of course for those students with a prior degree. Two key questions concern the subject of that prior degree and its class or grade. Earlier, secondary educational record may also be an important factor in success. Age, gender, socioeconomic status, and ethnicity may also be relevant factors.

References

  1. James, D, Chilvers, C. Academic and non‐academic predictors of success on the Nottingham undergraduate medical course 1970–1995."Medical education 35.11 (2001): 1056-1064.
  2. McManus, I. C., et al. "The UKCAT-12 study: educational attainment, aptitude test performance, demographic and socio-economic contextual factors as predictors of first year outcome in a cross-sectional collaborative study of 12 UK medical schools." BMC medicine 11.1 (2013): 244.
  3. Manning, G, Garrud, P. Comparative attainment of 5-year undergraduate and 4-year graduate entry medical students moving into foundation training. BMC medical education 9.1 (2009): 76.
  4. Price, R. Wright, SR. Comparisons of examination performance between 'conventional' and Graduate Entry Programme students; the Newcastle experience. Medical teacher 32.1 (2010): 80-82.
  5. Wilkinson, TJ., et al. Are differences between graduates and undergraduates in a medical course due to age or prior degree? Medical education 38.11 (2004): 1141-1146.

Paul Garrud
Paul.Garrud@nottingham.ac.uk
UKMEDP03
Do the Educational Performance Measure decile score and SJT predict successful completion of the foundation programme?

Approved at 15 October 2015 UKMED Advisory Board

Published in BMJ Open in July 2018 as "Evaluating the validity of the selection measures used for the UK’s foundation medical training programme: a national cohort study"
Work Psychology Group published a report in February 2015 on the Validation of the F1 Selection Tools . The study was limited to 391 F1s and therefore did not have data on which trainees successfully completed the foundation programme. Their sample specifically targeted F1 doctors who had received particularly high or particularly low SJT scores. They make the following recommendation: “that further studies are undertaken to explore the relationship between performance at application and performance outcomes beyond F1 (for example at the end of F2 and into specialty training) and that application scores (particularly SJT scores) spanning the full range of scores are targeted. If the relationship between application scores and ARCP outcomes is to be examined further, a large population (ideally all schools) should be targeted, as incidences of unsatisfactory ARCP outcomes appear to be very rare (1.1% in the present sample).”

We will seek to measure the predictive validity of the Educational Performance Measure (EPM) decile score (note in 2012 the EPM score was in quartiles) and the Situation Judgement Test (SJT) , collected as part of medical students’ applications to the foundation programme captured on the Foundation Programme Application System (FPAS) using ARCPs from the two-year foundation programme as an outcome measure. The EPM deciles are a medical school performance score calculated by the applicant’s medical school based on performance in a number of assessments and divided into 10 equal groups (deciles) within the given medical school and not UK-wide. Each UK medical school has agreed with its students which assessments will be included in this measure.

We will also seek to understand the relationship between the EPM decile score and SJT scores and specialty recruitment (applications to specialty training made by F2 doctors) . Specifically we will investigate: whether the EPM decile score and SJT relate to which specialties F2 doctors apply to and whether offers of a place on the training programme are made.

References

  1. Patterson, F., Kerrin ,M., Edwards, H, Ashworth, V and Baron, H. (February 2015). Validation of the F1 Selection Tools.
  2. www.isfp.org.uk/EPM/Pages/EPM.aspx
  3. FP 2015 sjt technical report
  4. Medical Schools Council and Work Psychology Group (2013) Situational Judgement Tests: A guide for applicants to the UK Foundation Programme.

Daniel Smith
DSmith@gmc-uk.org
UKMEDP20
The role of academic attainment in understanding sex differences in specialty choice and fitness to practise.

Approved as part of the pilot phase of UKMED, May 2016
The proportions of men and women in different medical specialties varies greatly [1]. Understanding how and why is important for effective workforce planning and the provision of future healthcare, and to reduce sex segregation in some specialties. It may also help us understand other areas of stark sex differences, such as disciplinary action, where male doctors have nearly 2.5 times the odds of facing medico-legal action [2], and doctors from certain specialties are at higher risk of receiving sanctions [3].

Sex differences in specialty choice are partly explained by features such as how plannable, technical, and intellectual a specialty is [1]; but success in obtaining a training place depends on competition ratios, selection methods, and candidates’ previous academic attainment – also potentially associated with sex. Academic performance is also important to help us understand how sanctions relate to sex and specialty, because past academic performance predicts future academic performance [4], and poor academic performance is associated with increased odds of sanctions [5].

References

  1. Elston MA. Women and medicine: the future. London: Royal College of Physicians, 2009.
  2. Unwin E, Woolf K, Wadlow C, et al. Sex differences in medico-legal action against doctors: a systematic review and meta-analysis. BMC Medicine 2015; 13:172.
  3. Unwin E, Woolf K, Wadlow C, et al. Disciplined doctors: does the sex of a doctors matter? A cross-sectional study examining the association between a doctor’s sex and receiving sanctions against their medical registration. BMJ Open 2014; 4:8.
  4. McManus IC, Woolf K, Dacre J, et al. The Academic Backbone: longitudinal continuities in educational achievement from secondary school and medical school to MRCP(UK) and the specialist register in UK medical students and doctors. BMC Medicine 2013; 11:242.
  5. Papadakis MA, Arnold GK, Blank LL, Holmboe ES, Lipner RS. Performance during Internal Medicine Residency Training and Subsequent Disciplinary Action by State Licensing Boards. Ann Intern Med 2008; 148(11):869-876

Dr Katherine Woolf
k.woolf@ucl.ac.uk
UKMEDP22
Recruitment to specialty training posts by demographic and socio-economic characteristics.

Approved as part of the pilot phase of UKMED, May 2016
Becoming a medical practitioner is a competitive and complex process and its outcome determines the composition of the medical profession. There is a growing concern that the profession should reflect both the appropriate skills and a balance of social, economic, gender and ethnicity (GMC 2010) The distribution of these characteristics is highly unequal across medical specialties (Goldacre, Laxton et al. 2010 and Rodríguez Santana,& Chalkley 2015). There is a persistent gender gap in certain specialties (men in surgery, women in general practice), and underrepresentation of those from deprived socioeconomic backgrounds (Arumpalam, Naylor et al. 2005) in highly competitive specialties.

We propose to analyse the outcome of the specialty allocation, recognising that it is a sequential process. Junior doctors’ preferences over the different training posts and their personal characteristics, qualifications and environment influence their applications; these are then assessed to determine the suitability of applicants to each training post and finally doctors’ decide which of the offers they have received to accept.

Our principle objective is to understand how demographic and socio-economic characteristics impact on each stage of this process; how do an individual’s characteristics correspond to their decision to apply, to their subsequent assessment and to their decisions to accept offers. Such an understanding is vital for the formulation effective strategies to ensure greater representativeness across specialities. Central to our approach is controlling for other factors, such as previous educational experience and attainment to establish the effect of demographic and socio-economic characteristics "other things equal".

References

  1. General Medical Council. Generic standards for specialty including GP training. 2010.
    This report highlights the importance of ensuring the equality, diversity and opportunity in the specialty and GP recruitment process. One of the GMC’s main goals is to widen access and participation and to ensure that the selection process for entry specialty and GP recruitment are fair, transparent and effective.
  2. Goldacre MJ, Laxton L, Lambert T. Medical graduates’ early career choices of specialty and their eventual specialty destinations: UK prospective cohort studies. BMJ: British Medical Journal. 2010;341
    This study compares the specialty choices of graduates over time finding that some specialties consistently attract women (e.g. general practice, paediatrics) or men (e.g. surgical). Moreover it shows clear mismatches between early career choices and eventual destinations, pointing out the importance of medical school, undergraduate and foundation training in the eventual choices.
  3. Rodríguez Santana, I., & Chalkley, M. J. (2015). The socioeconomic and demographic characteristics of United Kingdom junior doctors in training across specialities.(pp. 1-15). (CHE Research Paper; No. 119). York, UK: Centre for Health Economics, University of York.
    This paper analyses the distribution of socio-economic and demographic characteristics for the doctors in training in the year 2013. The authors find systematic differences between specialties in terms of gender, ethnicity, age, origin and socio-economic background.
  4. Arulampalam W, Naylor R, Smith J. Doctor Who? Who gets admission offers in UK medical schools. IZA Discussion Paper No. 1775. 2005
    This study shows that individuals from disadvantaged socioeconomic backgrounds, mature students and ethnic minorities have a lower probability of receiving an offer from medical schools in the United Kingdom. A similar analysis in the specialty allocation process would test if non-majority candidates are prejudiced.
  5. Fang, H. and A. Moro (2010). Theories of statistical discrimination and affirmative action: A survey, National Bureau of Economic Research.
    This paper summarize several statistical discrimination theories (as opposite to tasted-based theories of discrimination) that derive group inequality without assuming racial, gender or socioeconomic animus, or preference bias, against a target group. These theories can be used to explain some of observed differences in the specialty recruitment outcomes. For instance, certain groups of doctors might perceive themselves as less qualified or non-suitable and apply in a smaller ratio to the specialties with the greatest competition ratios. Alternatively, the lack of role models may act as a disincentive to apply to certain specialties (e.g. women in surgical specialties).

Professor Martin Chalkley
martin.chalkley@york.ac.uk
UKMEDP26
“Getting on” in medicine: a programme of study of careers trajectories and decisions of doctors.

Approved as part of the pilot phase of UKMED, May 2016

Published at BMJ Open in September 2017 as "The relationship between school type and academic performance at medical school: a national, multi-cohort study"

Published in BMJ Open in June 2018 as "Relationship between sociodemographic factors and selection into UK postgraduate medical training programmes: a national cohort study"
Millburn's "Fair Access to Professional Careers" highlighted that the increasing diversity of the UK medical student body in terms of age, ethnicity and gender is not reflected in terms of student socio-economic (SEC) background. Cleland et al's (2012) subsequent work identified that research is lacking on how widening access (WA) students and doctors progress in medicine. Only one recent UK study does so. Dowell et al. (2015), in a survey of 2050 Scottish GPs, found that those whose parents had semi-routine or routine occupations were more likely to be working in a deprived practice than those from professional families. While this suggests that SEC on entry to medical school may be associated with differences in career pathway, the study looked only at a sub-sample of doctors who were established in their career choice. In contrast, we are interested in "tomorrow's doctors", the generation who are currently deciding what (specialty) and where (location) they wish to work - or, indeed, when or if they wish to work as a doctor after the Foundation Programme.

Are their careers decisions influenced by demographic factors such as SEC only or is there a complex relationship between these and other factors (e.g., medical school) given the medical training pathway is competitive (see MacKenzie et al. in press)? We must understand these relationships to identify how to address barriers to progression within medicine and to inform policy decisions about workforce planning. WA students are few and only UKMED provides sufficient data to address these questions appropriately.

References

  1. Cleland JA, Dowell J, McLaughlin J, Nicholson S, Patterson F. (2012) Identifying best practice in the selection of medical students. http://www.gmc-uk.org/about/research/25036.asp.
    This GMC-commissionned literature review collated data on WA activities directed at preparing potential applicants, the application process, support once at medical school, and what happens to WA medical students when they become doctors. The relevance to this study is that they identified that data is lacking in terms of understanding the career pathways of students from WA background.
  2. Cleland JA, Johnston P, Watson V, Krucien N, Skatun D. (due for publication in Medical Education Feb 2016 issue).
    What do UK doctors-in-training value in a post? A discrete choice experiment. This study, which used a novel methodology to progress medical careers decision making from information-seeking survey, to identify the relative strength, or value, of careers preferences, found that trainees placed most value on good working conditions, good opportunities for their partner and desirable geographical location when making careers-related decisions. (See below for relevance).
  3. Dowell J, Norbury M, Steven K, Guthrie B. (2015) Widening access to medicine may improve general practitioner recruitment in deprived and rural communities: survey of GP origins and current place of work. BMC Medical Education 2015, 15:165 doi:10.1186/s12909-015-0445-8.
    Relevance: the first study to indicate that the careers pathways of WA and traditional doctors may differ, and hence reinforce the need for a large-scale study in this area.
  4. MacKenzie RK, Cleland JA, Ayansina D, Nicholson S. (In submission). Does the UKCAT predict performance on exit from medical school? A national cohort study.
    This project, funded by the UKCAT, was the first to link the UKCAT and UKFPO databases, to examine predictors of performance during, and on exit from, medical school. They found that those from lower IMD groups perform less well on the UKFPO selection processes. Relevance: disadvantage may continue given the competitiveness of medical education and the UK medical training pathway. There is a need to explore the relationship between SEC, other demographics, performance and careers decisions/trajectory.
  5. Svirko E, Goldacre MJ, Lambert T. Career choices of the United Kingdom medical graduates of 2005, 2008 and 2009: Questionnaire surveys. Medical Teacher. 2015; 355, 365-375.
    This study indicated that specialty preferences expressed by newly qualified doctors, notably the shortfall in numbers choosing general practice, remain inconsistent with future service needs.
    Relevance: The findings of the Svirko et al. and Cleland et al. papers are supported by training recruitment and retention figures over recent years and the crisis in workforce planning is increasing (e.g., 50%+ of this year's FY2 cohort stating that they have not applied to go directly into core/specialty/GP training). It is critical to understand the factors influencing careers decision making to plan ways to anticipate, and address, likely mismatches between the careers preferences of newly qualified doctors and healthcare delivery requirements (the right people with the right skills, in the right place, at the right time).

Professor Jennifer Cleland
jen.cleland@abdn.ac.uk
UKMEDP30
What demographic and educational factors predict doctors' decisions to apply for training programmes in particular medical specialties?

Approved as part of the pilot phase of UKMED, February 2016

Published in BMC Medicine in December 2017 as "Factors associated with junior doctors’ decisions to apply for general practice training programmes in the UK: secondary analysis of data from the UKMED project"
Decisions to apply for postgraduate training programmes in particular medical specialties are shaped by a multitude of factors. These include the doctor's family background, schooling, undergraduate (medical school) training, early postgraduate professional experience, and the perceived likelihood of a successful application. Much survey-based research has been done into factors that are associated with the self-reported (intended) career preferences of both medical students and early-career doctors [1-5]. Intentions to follow a particular career pathway however are subject to change [4,5] and may not, at the ultimate decision point, materialise as actual applications to particular specialty training programmes.

The UKMED database provides a unique and valuable opportunity to add to the literature on career choice by permitting analysis, for a large cohort of doctors and a range of nationally-recruited UK specialty training programmes, of some of the important factors that are associated with the decision to apply for a place on those programmes.

Research in this area has particular importance for workforce planning. The most recent data on application ratios suggests that certain specialties are experiencing recruitment difficulties; from 2013 to 2015 General Practice, Paediatrics and Psychiatry consistently ranked within the five least competitive specialisms (http://specialtytraining.hee.nhs.uk/specialty-recruitment/competition-ratios/). This proposed research may therefore influence changes to policy and practice in areas such as the provision of specialty training programmes, the design of undergraduate medical school courses, methods of recruitment and selection to medical school and the widening participation agenda, in order to encourage a better match between graduate career choice and service need.

References

  1. Querido SJ, Vergouw D, Wigersma L, Batenburg RS, De Rond MEJ & Ten Cate OTJ (2016) Dynamics of career choice among students in undergraduate medical courses. A BEME systematic review: BEME guide no. 33. Medical Teacher 38(1), 18-29.
    As a systematic review this paper identifies studies relevant to the field, assesses their methodological strength, identifies a wide range of factors associated with career choice, classifies these into in five main categories, highlights the gaps in the literature and in particular points to the prevalence of studies that analyse expressed student preferences (collected through questionnaires) rather than actual specialty applications.
  2. Svirko E, Goldacre MJ & Lambert T (2013) Career choices of the United Kingdom medical graduates of 2005, 2008 and 2009: Questionnaire surveys. Medical Teacher 35(5), 365-375.
    By comparing the expressed preferences of three different cohorts of graduates over a four-year period, this paper uncovers the direction of changes in student preferences and highlights an increasing trend towards uncertainty of achieving a post in students’ preferred specialty as a major factor in career choice as well as pointing to the inconsistency between career preference and service need.
  3. Wiener-Ogilvie S, Begg D & Dixon G (2015) Foundation doctors career choice and factors influencing career choice. Education for Primary Care 26(6), 395-403.
    This study in Scotland uncovers some of the reasons given by medical students for career choices, highlighting, for example, the importance of the medical schools themselves in influencing career decisions.
  4. Lambert TW, Davidson JM, Evans J & Goldacre MJ (2003) Doctors' reasons for rejecting initial choices of specialties as long-term careers. Medical Education 37(4), 312-318.
    Recognising as a starting point that initial expressed preferences for particular specialties frequently do not match ultimate career paths, this study uses questionnaires to uncover some of the reasons given for rejecting initial choices (e.g. quality of life issues) and examines the relative importance of not considering a particular specialty in the first place versus subsequent rejection of a specialty choice as explanations for application shortfalls in certain specialties.
  5. Cleland JA, Johnston PW, Anthony M, Khan N & Scott NW (2014) A survey of factors influencing career preference in new-entrant and exiting medical students from four UK medical schools. BMC Medical Education 14(1): 151.
    This study investigates career preferences of entry and exit cohorts at four Scottish medical schools, identifying demographic, socioeconomic, job-related and learning environment factors that predict career preference and underlining the importance, already recognised in the non-medical educational effectiveness literature, of considering a complexity of variables in career preference research.

Dr. Tom Gale
thomas.gale@plymouth.ac.uk
UKMEDP32
What factors predict doctors' successful completion of core training in medicine and anaesthetics and their subsequent decisions to pursue higher specialty training?

Approved at 27 March 2017 UKMED Advisory Board
Core training programmes for medicine and anaesthesia have high fill rates for CT1 entry compared to other specialties. However, these specialties suffer from below optimal conversion rates between core and higher specialty training posts.[1] As a result, there are many unfilled posts at entry to higher specialty training in medicine and anaesthetics. The CfWI has identified an urgent need to increase the number of ST3 posts, and to model the way in which the output from core training posts and ACCS flows into higher specialty training.[2,3]
Research is required to understand the extent of attrition between core training and specialty training posts in these specialties, and factors that predict successful appointment to higher specialty training. The main aim of our study is to identify factors, which predict doctors' successful completion of core training in medicine and anaesthesia, and their subsequent decisions to pursue higher specialty training. Previous work has investigated trainees’ perceptions regarding the weighting of individual and job-related factors influencing choice and selection to specialty training posts, but there is limited longitudinal research investigating factors which predict successful completion of training.[4]
A large longitudinal prospective study, identified that previous academic attainment predicts undergraduate attainment in pre-clinical and clinical years of a medical degree, but socio-demographic factors are also important predictors of future clinical performance.[5] The UKMED database provides a unique opportunity to investigate the contribution of a number of factors that predict successful completion of core training in medicine and anaesthesia, and successful progression to higher specialty training.

References

  1. Royal College of Anaesthetists (2016). Workforce data pack. Accessed online, 29th Jan 2017, available at: http://www.rcoa.ac.uk/system/files/TRG-WorkforceDataPack2016.pdf Provides accurate and up to date anaesthetic workforce data collated from College Census 2015, the Centre for Workforce Intelligence’s review of anaesthetics and intensive care medicine, and National Recruitment Office data.
  2. Centre for Workforce Intelligence (2015). In depth review of the acute medical care workforce. Accessed online, 29th Jan 2017, available at: http://www.cfwi.org.uk/publications/in-depth-review-of-the-acute-medical-care-workforce Comprehensive review of all fully trained physicians who contribute to acute medical care including, acute medicine specialists, geriatricians, and physicians from a number of other specialties, with projected analyses of the balance between patient/service demand and supply of CCT holders until 2033.
  3. Centre for Workforce Intelligence (2015). In depth review of the anaesthetics and intensive care medicine workforce. Accessed online, 29th Jan 2017, available at: http://www.cfwi.org.uk/publications/in-depth-review-of-the-anaesthetics-and-intensive-care-medicine-workforce Comprehensive review of all fully trained physicians who contribute to anaesthetics and intensive care medicine, with projected analyses between patient/service demand and supply of CCT holders until 2033.
  4. Patterson F, Knight A, Dowell J, Nicholson S, Cousans F, Cleland J. (2016) How effective are selection methods in medical education? A systematic review. Medical Education 50(1):36-60. Large systematic review assessing effectiveness and fairness of different selection methodologies for medical training, and highlighting lack of predictive validity studies investigating successful completion of training programmes and progression.
  5. Stegers-Jager KM, Themmen APN, Cohen-Schotanus J and Steyerberg EW. (2015) Predicting performance: relative importance of students’ background and past performance. Medical Education 49(9): 933–45. Large longitudinal prospective study, where multivariate logistic regression analysis identified that previous academic attainment predicts undergraduate attainment in pre-clinical and clinical years of a medical degree, but socio-demographic factors are also important predictors of future clinical performance.

Dr. Tom Gale
thomas.gale@plymouth.ac.uk
UKMEDP38 How do the professional outcomes of medical graduates from gateway courses compare to graduates from standard entry medicine courses?

Approved at 27 March 2017 UKMED Advisory Board
The postgraduate outcomes of those on 6-year medicine with a gateway courses will be compared to those on the 5 year standard entry courses after accounting for attainment and aptitude measured on entry and the students’ performance relative to their year within the school on exit, used to rank applicants to the foundation programme. UKMED Data are available for three schools that offered both types of course. Outcomes will be measured in terms of: progression through training as captured by ARCPs, performance in royal college medical exams and the specialty training programmes applied to and offered at CT1/ST1.
Daniel Smith
daniel.smith@gmc-uk.org
UKMEDP39
What factors lead to success in obtaining an ophthalmology specialty training (OST) post and completing postgraduate ophthalmology examinations?

Approved at 27 March 2017 UKMED Advisory Board
Run-through surgical specialty training posts lead directly to a certificate of completion of training, making them attractive, but competitive career choices among doctors [1]. Ophthalmology specialty training (OST) is a highly subscribed run-through post with competition ratios higher than the overall average for all specialty-training posts [2]. We aim to explore which factors lead to successful applications to ophthalmology training on the first attempt. We also aim to understand what influences success in ophthalmology postgraduate examinations on the first attempt. The Royal College of Ophthalmologists’ (RCOphth) endorses this study.
The RCOphth oversees a rigorous recruitment process but has little evidence to guide them on the predictive validity of their recruitment measures (personal communication). Understanding what makes their candidates successful in gaining a training post is a research priority. We aim to ascertain whether interview and shortlisting scores predict exam performance and recruitment into ophthalmology specialist training on the first attempt.
Our study explores a range of demographic, socioeconomic [3] and academic variables, which are hypothesised to influence success in attaining an Ophthalmology training post, as well as success in passing post-graduate exams on the first attempt. Previous studies have demonstrated the predictive validity of prior educational attainment (PEA) and UKCAT scores in predicting success in medicine [4]. Our project aims are twofold; 1) To enable RCOphth and other postgraduate colleges to operate an evidence-based recruitment process and 2) To guide applicants of the factors that may influence success in ophthalmology so that they are able to make realistic career choices.

References

  1. Carr A, Marvell J, Collins J., (2013) Applying to specialty training: considering the competition. BMJ Careers. [Accessed 29/01/2017] Available from: http://careers.bmj.com/careers/advice/Applying_to_specialty_training%3A_considering_the_competition The authors of this paper examine the competition data for all UK specialty training posts in 2013. The purpose was to inform applicants of the relative numbers of posts available in each specialty so that candidates are able to make realistic career choices.
  2. Kennedy C., (2015) Specialty training applications for entry in 2016: competition ratios and the application process. BMJ Careers. [Accessed 29/01/2017] Available from: http://careers.bmj.com/careers/advice/Specialty_training_applications_for_entry_in_2016%3A_competition_ratios_and_the_application_process This paper examines the overall competition ratios for entry into specialist training programmes over a one-year period, with the aim of facilitating the application process for candidates.
  3. Rodriguez-Santana I, Chalkley MJ., (2015) The socioeconomic and demographic characteristics or United Kingdom junior doctors in training across specialities. CHE Research Paper; Mo 119. York, UK: Centre for Health Economics, University of York. [Accessed 29/01/2017] Available from: https://www.york.ac.uk/media/che/documents/papers/researchpapers/CHERP_119_junior_doctors_training_specialities.pdf This paper draws upon the National Training Survey data to analyse the differences in socioeconomic and demographic characteristics of doctors in all postgraduate specialties in 2013.
  4. I. C. McManus, C. Dewberry, S. Nicholson, and J. Dowell (2013) The UKCAT-12 study: Educational attainment, aptitude test performance, demographic and socio-economic contextual factors as predictors of first year outcome in a collaborative study of twelve UK medical schools. BMC medicine 11.1: 244 The authors of this study present their findings from a prospective study of over 5000 medical students in twelve UK medical schools. The study examines the predictive validity of multiple academic variables including prior educational attainment (PEA) and UKCAT scores in predicting medical school performance.

Dr. Aditi Das
Aditi.Das@moorfields.nhs.uk
UKMEDP41
Development of a UKMED multidimensional measure of widening access status.

Approved at 25 September 2017 UKMED Advisory Board
Contextual admissions data are increasingly employed in selection to the study of medicine in the UK, albeit with little knowledge about the quality of the indicators or the implications of their use on both widening access (WA) and student achievement. [1,2,3] Moreover, there is concern about the validity of contextualised admissions decision making because; contextual data have been shown to produce conflicting information on WA status, doubtful veracity of self-reported information and the extent of missing data values on contextual indicators generally [4] [5] Furthermore, little is known about the association between students’ contextual background characteristics and performance in medical school.[6, 7, 8]
Triangulation of contextual indicators to identify those most likely to be disadvantaged is recommended to reduce numbers of false positive WA status identification but, may also serve to increase the number of false negative and introduce new injustices. Contextual data comprise disparate measures of disadvantage which each capture an aspect of the underlying concept WA status. It is therefore important to know about the strengths and limitations of the most commonly used contextual indicators, singly and in combination.
It is also desirable to efficiently combine the most reliable contextual indicators into a single multidimensional measure of WA status which UK medical schools can confidently use in their selection processes. The UK Medical Education Database (UKMED) includes a range of contextual admissions indicators commonly used in selection to the study of medicine and provides a unique opportunity to achieve this study’s aims, the outcome of which has the potential to make WA to medicine fair, transparent and above all, evidence-based.

References

  1. Medical Schools Council. Entry requirements for UK medical schools - 2017 entry. MSC 2016.
  2. Garrud P. Help and hindrance in widening participation - commissioned research report. Medical Schools Council - Selecting for Excellence, 2015.
  3. Boliver V., Gorard S., Siddiqui N., Will the use of Contextual Indicators Make UK Higher Education Admissions Fairer? Educational Sciences. 2015; 5(4):306-22.
  4. Steven K., Dowell J., Jackson C., Guthrie B. Fair access to medicine? Retrospective analysis of UK medical schools application data 2009-2012 using three measures of socioeconomic status. BMC Med Educ. 2016;16(1):11.
  5. Tiffin P., McLachlan J., Webster L., Nicholson S. Comparison of the sensitivity of the UKCAT and A Levels to sociodemographic characteristics - a national study. BMC Med Educ[Internet].2014;14(7). http://bmcmededuc.biomedcentral.com/articles/10.1186/1472-6920-14-7.
  6. Cleland J., Dowell J., McLachlan J., Nicholson S., Patterson F. Identifying best practice in the selection of medical students (literature review and interview survey). 2012.
  7. Thiele T., Pope D., Singleton A., Stanistreet D. Role of students' context in predicting academic performance at a medical school: a retrospective cohort study. Brit Med J. 2016;6(3):e010169.
  8. McManus I., Dewberry C., Nicholson S., Dowell J. The UKCAT-12 study: educational attainment, aptitude test performance, demographic and socio-economic contextual factors as predictors of first year outcomes in a cross-sectional collaborative study of 12 UK medical schools. BMC Medicine 2013, 11:244

Dr Paul Lambe
paul.lambe@plymouth.ac.uk
UKMEDP42
Understanding variation in BME medical exam performance across the UK.

Approved at 25 September 2017 UKMED Advisory Board
The landscape of exam result differential performance for Black, Asian and Minority Ethnic (BAME) individuals in the medical education system is complex. Performance data from undergraduate and postgraduate settings demonstrate lower success rates in doctors of BAME background. The recent “Fair Training for All” report by the General Medical Council used a qualitative approach to understand the barriers and facilitators to success in BAME doctors. One of the key findings of the report was the negative impact of poor performance in exams: poorer performance in exams adversely affected autonomy in job choice, increased likelihood of being separated from family and support networks, and increased chance of mental health problems.
Failing exams can lower confidence, and resits can be felt to interfere with workplace learning. There is relatively little published evidence on the BAME attainment gap, especially when considering local variation. Learning from the NHS clinical arena, identifying regional and local variation in performance is valuable as it (1) highlights exemplars of best practice and (2) helps allocate effort and resource to areas with poorer clinical outcomes. Measuring and publishing unit level NHS performance data is the central tenet of the Health Care Quality Commission.
Our planned analysis will use the NHS approach, and aim to identify medical school variation in BAME exam success, identifying where the attainment gap becomes more pronounced and may warrant further explanatory investigation. Central to this project will be to implement appropriate statistical methods to ensure accurate definition of medical school variation. In particular, the concept of ‘case-mix’ from clinical practice is relevant; understanding the characteristics of individuals within each medical school cohort prior to commencing study (e.g. prior academic attainment, socio-demographic background) is essential to interpreting any inter-school variance in attainment gap.
Dr James Galloway
james.galloway@kcl.ac.uk
UKMEDP43
Does medical school entry performance and medical school performance predict success on the Intercollegiate Membership of The Royal College of Surgeons (MRCS) exam?

Approved at 25 September 2017 UKMED Advisory Board
In 2008, McManus and colleagues published an article in BMC Medicine highlighting the substantial difference in performance on the MRCP across medical schools and encouraged other groups to investigate whether similar patterns exist in other postgraduate UK examinations. This study reported data from those medical graduates taking PACES between 1989 and 2005. These cohorts entered medical school in the years before school examination grade inflation and before the widespread implementation of multi-method selection into medical school (e.g., the use of selection tests such as UKCAT, BMAT or GAMSAT). Moreover, the McManus study was also prior to changes in assessment during medical school, notably the introduction of ranking using the educational performance measurement (EPM), which is then used in selection into the next stage of medical training, the UK Foundation Programme.
To the best of our knowledge, no previous studies have looked at the relationship between performance on medical school entry tests and performance on postgraduate examinations although UKCAT has been shown to be predictive of medical school final outcome (EPM). Nor has there been prior research looking at performance at medical school and performance on postgraduate examinations. The development of the UKMED database enables such studies.
Our specific interest is surgical selection and training. The Intercollegiate Membership of The Royal College of Surgeons (MRCS) is a mandatory postgraduate exam for all aspiring UK surgeons wishing to apply for higher surgical training (ST3 selection). It is attempted by upwards of 6000 UK and overseas doctors annually. We wish to investigate whether medical school, medical school entry performance and medical school performance predict MRCS success.
Professor Jennifer Cleland
jen.cleland@abdn.ac.uk
UKMEDP44
From family-home to education and from education to training: the spatial patterns of future doctors.

Approved at 25 September 2017 UKMED Advisory Board
This project aims to discover and analyse the spatial patterns in the movements of the future doctors: from their family-home to University and from University to training locations. This research is new in two aspects: we propose a robust and spatio-temporal quantitative statistical framework, while the majority of previous research is mainly qualitative; we take into account the starting point of each student pathway (for most of them their family-home postcode, although this may not be true for older entrants) and their geographic trajectories (movements to different post-codes representing education, training and work).
This project will focus on the following analysis: 1. Movements from ‘home’ (prior to entering medical studies) through to working as a consultant/GP. The end point will only be possible for those who have obtained their Certificate of Completion of Training (CCT). The majority of these will be GPs as GP training is shorter than the training time for other specialties. (It would be possible to extend the data analysis over time as more trainees within the data base complete a CCT) Currently we have 6,832 doctors in the HESA data now working as GPs If additional resources are available (e.g. more MSc students interested or by applying for funding a PhD), the following analyses (ordered for importance) will be carried out: 2. Home to medical school- full cohort. HESA data include all cases starting at a UK Medical school from 2002 to 2015.
3. Medical school to foundation – only those who have graduated by 2016 so those starting in 2011 and earlier. 4. Foundation to specialty training only those who entered foundation from 2012 (the first year UKFPO foundation application data are available). The data available for each of these analyses will overlap but may not consist of precisely the same cases, therefore they may require different individual analysis. This will represent a significant improvement compared to previous research based on qualitative methodologies (interviews), which focused on a restricted temporal window and did not account fully for the original residence of the student (often the family home).
Daniel Smith
DSmith@gmc-uk.org
UKMEDP46
Are there differences between those doctors who apply for a training post in FY2 and those who take time out of training?

Approved at 25 September 2017 UKMED Advisory Board
Accurately predicting medical workforce supply is increasingly challenging as doctors no longer behave in time-recognised ways in terms of career decision making (Arthur et al., 2005; Cleland et al., 2016, 2017). For example, in the UK context, medical graduates are choosing not to progress through training as predicted. In 2016, nearly 50% of those graduates completing the Foundation Programme did not apply for specialty/GP training at the expected point in time (UKFPO Career Destination Reports 2015, 2016; Scanlan et al., 2017).
Simply put, one in two of today’s medical graduates left the training pipeline at the first opportunity to do so in order while keeping their options open (i.e. with full registration and eligibility to apply for higher training). Instead, they opted to take a break from training. The percentage working overseas for a period of time has remained static, the number taking other types of NHS service posts including Development Fellow posts has increased as has those who decided to leave clinical practice.
Given this “brain drain”, more understanding of the differences and similarities between those doctors who progress directly from FY2 into training, and those who take time out of training is crucial as this can inform policy and practice in relation to medical selection and attracting trainees to medical training across the breadth of specialties, and thus ensure sufficient doctors to deliver service now and in the future (Collins & Young, 2000; Gorman, 2017).
Benard Kumwenda
r01bk15@abdn.ac.uk
UKMEDP51
A comparison of the properties of BMAT, GAMSAT and UKCAT.

Approved at 25 September 2017 UKMED Advisory Board
Currently the UK Clinical Aptitude Test (UKCAT) and the Biomedical Admissions Test (BMAT) are the two main aptitude tests used for selection into standard medical and dental undergraduate courses in the UK. Previously, both tests have been shown to significantly predict undergraduate performance in medical students (1, 2). However, to date, no direct comparison has been made between the two assessments, in terms of their ability to predict important outcomes, their sensitivity to sociodemographic variables and the degree to which they incrementally add value within the selection system, above and beyond that provided by conventional measures of academic attainment.
The Graduate Medical School Admissions Test (GAMSAT) is used for selection into some graduate entry medical courses. There is some weak evidence for the predictive validity of the GAMSAT in the early years of medical school (3, 4). However, no large studies of the predictive validity of GAMSAT in the UK have been conducted. It has also been noted (4) that the GAMSAT appears to possess more predictive performance than the UKCAT when predicting Educational Performance Measure (EPM), but as this was not the primary research aim, this issue was not explored in depth.
Comparisons of the properties of the three tests would allow the strengths and relative weaknesses of each of the tests to be evaluated, as well as their potential to widen (or narrow) participation in medicine. Thus, the results will provide selectors with an informed choice.

References

  1. McManus I, Ferguson E, Wakeford R, Powis D, James D. Predictive validity of the BioMedical Admissions Test (BMAT): an evaluation and case study. Med Teach. 2011;33:53 - 7.
  2. Tiffin PA, Mwandigha LM, Paton LW, Hesselgreaves H, McLachlan JC, Finn GM, et al. Predictive validity of the UKCAT for medical school undergraduate performance: a national prospective cohort study. BMC Medicine. 2016;14(1):140.
  3. Coates H. Establishing the criterion validity of the Graduate Medical School Admissions Test (GAMSAT). Med Educ 2008; 42:999-1006. 4. Garrud and McManus. UKMED Project - Impact of accelerated graduate-entry medicine courses – Final Report

Dr Paul Tiffin
paul.tiffin@york.ac.uk
UKMEDP54
Declared disability in the UKMED dataset 2002-2016: an exploratory descriptive analysis.

Approved at 25 September 2017 UKMED Advisory Board
Disability is an important consideration in the selection of medical students, in undergraduate and postgraduate medical training, and in the practice of medicine. First, adjustments may be required in order to accommodate disabled individuals. Second, disability may affect the fitness of individuals to practise medicine and/or their choice of postgraduate specialty. Third, disability may affect academic performance. Fourth, disability is the subject of legislation (1) which is a key imperative in decisions about disability and how to deal with it. Finally, and related to the previous point, equity with respect to disability and selection is important at both undergraduate and postgraduate level.
The General Medical Council (GMC) recognises the importance of disability, providing guidance to medical schools (2). Likewise the Medical Schools Council (MSC) provides advice on how to adjust for disability in the selection of medical students (3). A 2007 report by the British Medical Association (BMA) focused on inequality for disabled doctors and medical students (4).
The focus of these documents appropriately reflects the key imperative of relevant legislation, and they provide useful, practical advice on what can be done to accommodate disabled colleagues. Many important questions about disability nevertheless remain unanswered; some of these are outlined in the Research section below. The advent and linkage of the UKMED databases provides the framework for these and other questions to be explored in far more detail than ever before.

References

  1. Equality Act 2010 and Disability Discrimination Act 1995. Although the Equality Act replaced the Disability Discrimination Act, the latter was the key legislative driver during a significant part of the proposed study.
  2. Gateways to the professions: Advising medical schools: encouraging disabled students. GMC (last updated November 2016). Key guidance to medical schools regarding appropriate measures and approaches to declared disability.
  3. Recommendations on selection of medical students with specific learning disabilities including dyslexia. Medical Schools' Council 2005. Generic guidance on the approach to applicants declaring disability.
  4. BMA: Disability equality within healthcare: the role of healthcare professionals (2007). Useful policy document which provided useful sources of further information, e.g. Appendix 5 provides UCAS data on the number of applicants and acceptances to higher education and pre-clinical medicine by disability.

Dr Michael Murphy
m.j.murphy@dundee.ac.uk
UKMEDP57
Selection tests as a predictor of acceptance rate and post-graduate success of widening participation students in undergraduate medicine

Approved at 25 September 2017 UKMED Advisory Board
Students from non-traditional backgrounds are underrepresented in UK medical schools. Those that successfully receive a place are also at the greatest risk of non-completion. The impact of specific admissions processes on widening participation (WP) and their ability to select students who will be successful are unclear. We will compare the outcomes of WP medical students across different Medical Schools.
Specifically, the study will focus on the use of the Biomedical Admissions Test (BMAT) and UK Clinical Aptitude Test (UKCAT) to determine:
1) The relative proportions of WP students at medical schools using the BMAT or UKCAT as part of their selection criteria.
2) Whether WP students attending BMAT-selecting Medical School perform significantly differently (including degree outcomes and drop-out rates) compared to their non-WP peers and compared to WP/Non-WP students in UKCAT-selecting Medical Schools.
3) The effect of WP status and admissions tests on the proportion of local WP students that they attract.
4) The effect of WP status and admissions tests on the employment of medical graduates; particularly the geographic location of trainee positions and whether they receive their first choice placement.
This will provide evidence regarding the utility of BMAT and UKCAT as determinants of success for students from WP backgrounds, and to identify possible relationships between WP status and admissions tests, propensity to attend a local medical school and propensity to return to or remain in a home region following graduation. Understanding these relationships will allow us to make recommendations regarding admissions processes to optimise WP student success.
Dr Kevin Murphy
k.g.murphy@imperial.ac.uk
UKMEDP58
Modelling the consultant physician workforce

Medical workforce issues are among the most crucial problems facing the NHS (Ref 1 and 2). Some factors contributing to this are: - Fewer international doctors (possibly related to immigration controls and Brexit) - Increased less than full time working within the medical workforce (possibly related to feminisation of the workforce) and - New junior doctors' contract dispute leading to recent industrial action and the exposure of system wide non contractual issues within the trainee workforce linked to low morale and inflexibility of training programmes.
The government has pledged to increase medical school places by 1500 beginning September 2018 to attempt to address this complex issue. We plan to construct a Markov mathematical model to model future progression from medical school entry to becoming a consultant physician using UKMED data to provide the numbers moving between different training stages up to higher specialty training (HST)
JRCPTB data will be used for progression from HST level. Sensitivity analysis will facilitate targeting of future interventions to increase the number of consultant physicians available in general and in frontline specialities such as acute medicine and geriatric medicine.

References

  1. Underfunded, underdoctored, overstretched: The NHS in 2016. RCP London.
  2. September 2016 2. Census of consultant physicians and higher specialty trainees 2016-17. Medical Workforce Unit, RCP London.

Dr Johnny Boylan
John.Boylan@rcplondon.ac.uk
UKMEDP72
Factors associated with choosing to work as a locum

Approved at 25 September 2017 UKMED Advisory Board
Little is known about the numbers of doctors who leave training and become locums. This study seeks to establish the proportion of Drs who have worked in the UK as an F2 Dr between 2012 and 2016 and subsequently worked as a locum.
We will consider those who worked as locum where there is evidence of failure to progress in training as captured by ARCP and recruitment data and those who worked as a locum where there is no evidence of failure to progress in training.
We will examine whether working as locum with no previous evidence of failure to progress in training is associated with demographic factors, geographic factors, specialty factors, previous academic performance, working or wanting to work less than full-time (LTFT) and the workload indicator from the final NTS submission prior to working as a locum.
Daniel Smith
DSmith@gmc-uk.org
UKMEDP73
Recruitment of trainees to obstetrics and gynaecology training programmes.

Recruitment to Obstetrics and Gynaecology has shown a large fall in expression of interest in the specialty over time. This has become a significant issue, as more trainees are needed to cover a high-risk speciality such as O&G. Recruitment to O&G varies between medical schools, as does the amount of time spent doing O&G within the curriculum.
Factors thought to influence career choice also includes experience as a student. In addition, by the third year after qualification, only 46% of those whose only choice was previously obstetrics and gynaecology were still committed to this career.
This research proposal will examine which factors predict recruitment to obstetrics and gynaecology training at undergraduate level and in the early years after qualification. We will consider the following factors:
1) medical school and course type and course level/school level data measuring timing and amount of teaching/exposure students had to obstetrics and gynaecology
2) socio-demographic variables
3) academic attainment on entry and exit from medical school
This research proposal will help understand which factors affect recruitment to the specialty and help approach likely challenges ahead. In particular, the aim is to enable exchange of information between medical schools and support areas of development of undergraduate O&G medical education in medical schools where recruitment is low and in addition to aid revision of the current RCOG undergraduate curriculum. Also the information will be used to allow resources to be targeted at areas in the early postgraduate years, which may increase recruitment.
Philippa Marsden
Philippa.marsden@newcastle.ac.uk
UKMEDP77
The relationship between medical student Conscientiousness Index scores and later clinical performance: a pilot study


Approved at 22 May 2018 UKMED Advisory Board
Performance by medical and other healthcare students while in education may provide a guide to their later clinical practice. Demonstrating that a metric has Predictive Validity would therefore allow targeted training to be directed to individuals who may cause concern during their education or permit appropriate selection. It is known that cognitive ability has significant Predictive Validity for later clinical practice in a number of settings. However, there are currently no demonstrated measures of personality related performance with such Validity.
Our project involves data captured as part of the Conscientiousness Index (CI) project(1). Data on students’ performance of routine tasks such as attendance and submission of assignments, was assembled to form a single score, known as the Conscientiousness Index. Positive, statistically significant correlations were observed with outcome performance such as examinations scores and independent staff ratings of professionalism. The process has since been repeated in other health care settings(2,3).
The CI Scores will represent the Predictor Variable and we wish to explore the relationship with this data with several Outcome Variables as contained in the UKMED database. In order to allow us to draw any conclusion on the predictive validity of the CI for future performance as a doctor, two principal methods of analysis will be used in this pilot: linear regression and data dichotomisation into high and low scoring individuals. The long term benefit is to healthcare in the UK in particular, and potentially worldwide, in establishing the Predictive Validity of a personality trait measure, rather than to individuals.

References

  1. McLachlan J, Finn G, McNaughton RJ The Conscientiousness Index: an objective scalar measure of conscientiousness correlates to staff expert judgements on students’ professionalism. Academic Medicine 2009; 84: 559-65.
  2. M. A. Sawdon, K. Whitehouse, G. M. Finn, J. C. McLachlan, D. Murray. Relating professionalism and conscientiousness to develop an objective, scalar, proxy measure of professionalism in anaesthetic trainees. BMC Medical Education. 17:49.
  3. Kelly M, O'Flynn S, McLachlan J, Sawdon M. The Clinical Conscientiousness Index: a valid tool to explore professionalism in the clinical undergraduate setting. Academic Medicine 2012.

Marina Sawdon
marina.sawdon@sunderland.ac.uk
UKMEDP81
Junior Doctors’ Training Satisfaction and Progress: Longitudinal Examination of Medical Students Individual Differences, Academic Attainment and Work/Learning Environment


Approved at 22 May 2018 UKMED Advisory Board
Junior doctors in the NHS are under considerable work pressure (1) which may negatively impact their well-being and professional development. To retain a satisfied and competent work force, it is important to better understand which factors predict junior doctors’ work satisfaction, educational satisfaction, and successful progression through training.
The link between work conditions and job satisfaction are widely researched (2) but less is known about how work conditions and individual differences (e.g. personality and learning habits) affect junior doctors’ in the UK satisfaction and training progression. Previous studies have shown doctors’ personality and early career experiences (e.g. stress) predict their perceptions of their workplace four to five years later (3). Surface learning habits and stress can lead to poorer learning and lower academic achievement in medical school (4) which in turn may negatively affect junior doctors’ postgraduate examination performance (5).
Poor academic performance in medical school can also result in difficulties securing a training position within a competitive specialty and/or geographic location, with weaker trainees ending up working and learning in more challenging environments. Work conditions and individual differences both predict learning and satisfaction, but we do not know how they affect junior doctors’ work and educational satisfaction and progression through training. Neither do we know whether satisfaction is related to educational outcomes. This research project will investigate how individual differences among medical students and work/learning conditions are linked to junior doctors’ satisfaction and training progression.

References

  1. General Medical Council. Training environments 2017: Key findings from the national training surveys [Internet]. 2017. Available from: https://www.gmc-uk.org/NTS_Report_2017.3.pdf_72689147.pdf
  2. Antoniou AS, Davidson MJ, Cooper CL. Occupational stress, job satisfaction and health state in male and female junior hospital doctors in Greece. Journal of managerial psychology. 2003 Sep 1;18(6):592-621.
  3. McManus IC, Keeling A, Paice E. Stress, burnout and doctors’ attitudes to work are determined by personality and learning style: A twelve year longitudinal study of UK medical graduates. BMC Med. 2004;2:1–12.
  4. May, W., Chung, E. K., Elliott, D., & Fisher, D. (2012). The relationship between medical students’ learning approaches and performance on a summative high-stakes clinical performance examination. Medical Teacher, 34(4), e236-e241.
  5. McManus, I. C., Woolf, K., Dacre, J., Paice, E., & Dewberry, C. (2013). The Academic Backbone: longitudinal continuities in educational achievement from secondary school and medical school to MRCP (UK) and the specialist register in UK medical students and doctors. BMC medicine, 11(1), 242.

Asta Medisauskaite
a.medisauskaite@ucl.ac.uk
UKMEDP82
Do measures of doctors’ academic ability and their Situational Judgement Test (SJT) scores moderate the relationship between sources of workplace stress and experiencing workplace burnout?


Approved at 22 May 2018 UKMED Advisory Board
For the first time, the 2018 National Training Survey (NTS) includes a measure of workplace burnout – the workplace-based burnout items from the Copenhagen Burnout Inventory. Based on previous research we hypothesise that higher levels of burnout will be associated with a higher workload, a less supportive environment and poorer clinical supervision
These potential sources of workplace stress are also measured by the NTS. We will explore whether the relationships between the sources of workplace stress and burnout are moderated by the doctors’ academic achievement as measured by their Educational Performance Measure - the EPM decile and their SJT scores. Are more highly performing doctors and those with high SJT scores less likely to experience feeling of burnout when exposed to the same levels of workplace stress?
Daniel Smith
DSmith@gmc-uk.org
UKMEDP83
Factors associated with non-standard outcome at Annual Review of Competence Progression (ARCP) of higher trainees within surgical specialities in the United Kingdom.


Approved at 22 May 2018 UKMED Advisory Board
There are ten surgical specialities recognised within the United Kingdom (UK) National Health Service (NHS) (1). Entry into surgical specialties is competitive: in 2016 competition ratios at national recruitment for surgical specialities ranged from 1.31-6.57 to 1 training place (2.) However, despite competitive entry some trainees leave training before reaching the end of the curriculum. Hampton et al. suggested that between 2008-2012 1.7% of surgical trainees relinquished their training number, with drop-out rates as high as 4.2% in some deaneries (3). However, methodology was poor with data acquired by contacting each deanery directly, with variable and mostly poor response rates. There has also been suggestion from other sources that in surgery, as well as other medical specialties, non completion of training and non standard outcome at ARCP is higher in female trainees and in those from a minority ethnic background (4). For reasons of equality, fairness, workforce planning and finance it is important to investigate factors affecting retention in training and award of non standard outcome at ARCP (5). Identification of these factors will allow further targeted research and support to be given, structures and attitudes modified and supported and remedial action to be taken if and where required, to ensure progression through training for all who are able to display the required competencies described by a curriculum.

References

  1. Surgery and the NHS in numbers — Royal College of Surgeons - https://goo.gl/csnf94 accessed 28/2/2018. First data collected demonstrating demographics of current surgical workforce in the United Kingdom.
  2. 2016 Higher Speciality recruitment competition ratios. https://specialtytraining.hee.nhs.uk/Portals/1/Content/Resource%20Bank/Competition%20Ratio%27s/Competition%20Ratios%202016.pdf) Access 28/2/2018. Most recent recruitment figures for surgical specialities in the United Kingdom.
  3. Hampton T, Greenhalgh R, Ryan D, and Das-Purkayastha P. Female surgical trainee attrition. The Bulletin of the Royal College of Surgeons of England 2016 98:3, 134-137 Paper highlighted not only attrition in surgical trainees generally but that females were more likely to leave training programmes than males.
  4. How Do Doctors Progress Through Training? The General Medical Council. https://www.gmc-uk.org/How_do_doctors_progress_through_key_milestones_in_training.pdf_67018769.pdf (accessed 13/3/2018.) Data published from GMC showing that in other medical specialities that has demonstrated demographic factors have impacted on ARCP outcomes.
  5. The Berwick report; Improving the safety of patients in England. National Advisory Group on the Safety of Patients in England. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/226703/Berwick_Report.pdf Accessed 28/02/2018. Specific recommendation to Health Education England regarding providing appropriate training for trainees and workforce provision and planning.

Hannah Boyd-Carson
hannahboydcarson@doctors.org.uk
UKMEDP84
The Sociodemographic Characteristics of Oral and Maxillofacial Surgeons.


Approved at 22 May 2018 UKMED Advisory Board
Oral and Maxillofacial Surgery (OMFS) is a unique surgical speciality because it requires two degrees, and this, as well as a number of other factors, increases training costs.[1] The amount that those engaged in the OMFS training pathway must pay out of their own pocket to achieve the mandatory requirements to complete the training has previously been estimated to cost £71,431 - £113,105.[1, 2] Although accelerated three year dentistry degrees provide a small financial cushion for qualified medics who intend to become OMFS surgeons, many years of university fees, debt and lost personal income can be a daunting financial barrier.[3] Training for OMFS is roughly three-to-four time more expensive than other surgical specialties, and surgery as a whole is significantly more expensive than medicine.[1, 4] Owing to the profound financial implications of choosing to follow the training pathways towards becoming a OMF surgeon, it may be hypothesized that due to the expense of OMFS training, only students who have a more financially stable support network are able to undertake this career. We aim to perform a retrospective examination of the pre-medical school socioeconomic demographics of those who enrol within OMFS and progress through training using data from the UKMED database. Using this data, we aim to describe the socioeconomic profile of medical graduates embarking on a career in OMFS. This will provide a great insight to determine whether efforts should be made to improve the financial accessibility of OMFS for potential future trainees.

References

  1. O’Callaghan J, Mohan HM, Sharrock A, Gokani V, Fitzgerald JE, Williams AP, et al. Cross-sectional study of the financial cost of training to the surgical trainee in the UK and Ireland. BMJ open. 2017;7(11):e018086.
  2. Isaac R, Ramkumar D, Ban J, Kittur M. Can you afford to become an oral and maxillofacial surgeon? BMJ. 2016;352:i163.
  3. Chadha A, Dastaran M, Herd MK. The first UK dental undergraduate programme for medical graduates–a student perspective. British dental journal. 2009;206(7):353.
  4. Stroman L, Weil S, Butler K, McDonald CR. The cost of a number: can you afford to become a surgeon? The Bulletin of the Royal College of Surgeons of England. 2015;97(3):107-11.

Declan Murphy
murphy.declan.1994@gmail.com

Jon Rees
jon.rees@sunderland.ac.uk
UKMEDP85
Evaluating the outcomes and impact of less than full time training on the medical workforce.


Approved at 22 May 2018 UKMED Advisory Board
The NHS is facing a serious shortage of doctors and hospitals are struggling to fill all their junior doctor posts. More junior doctors are taking career breaks because of concerns around work-life balance and a perceived rigidity within the structure of a medical career. Alongside this, the general interest in part-time working among junior doctors is rising, meaning that the demand for this style of training is likely to increase. Aim of the project: To examine how junior doctors working part-time affects their progression through, and completion of, training to become specialists compared to those working full-time. Method: 1. Demographics (ethnicity, age, sex), exam scores (e.g. A levels, Foundation SJTs) and socioeconomic data (including markers of widening participation) held for approximately 60,000 junior doctors will be compared between full-time and part-time doctors using statistical methods. 2. Time taken to complete specialist training and the rate of securing a consultant post will be compared between full-time and part-time junior doctors within a sample of approximately 2500 junior doctors. Questionnaires will be used to investigate working patterns after completion of training (i.e. full-time or part-time) and reasons for training part-time or full-time. 3. Thirty participants comprising junior doctors and trainers of doctors will be interviewed to understand their experiences of undertaking or providing LTFT training. Findings will be used to make informed recommendations to the leading organisations in charge of training doctors on how to improve part-time working and use it to retain doctors within the profession for the benefit of patients.

References

  1. United Kingdom Foundation Programme Office. (2017). The Foundation Programme Career Destination Report 2016. www.foundationprogramme.nhs.uk/news/story/annual-report-2016 [Accessed 5th June 2017] The NHS is facing a serious shortage of doctors and the number of junior doctors taking breaks in their careers after their first two (Foundation) years of training has been rising, jumping from 28% in 2011 to 50% in 2016.
  2. Federation of the Royal Colleges of Physicians of the UK. Census of consultant physicians and higher specialty trainees in the UK, 2014–15: data and commentary. London: RCP, 2016. www.rcplondon.ac.uk/projects/outputs/2014-15-census-uk-consultants-and-higher-specialty-trainees [Accessed 10 November 2017] In recent years NHS hospitals have experienced growing problems recruiting junior doctors into specialty training posts, with falling numbers of junior doctors training to be medical specialists and this has caused significant gaps in the provision of patient care, with some NHS services needing to close because of doctor shortages.
  3. Rich A., Viney R., Needleman S., Griffin A., Woolf K., ‘‘You can’t be a person and a doctor’: the work-life balance of doctors in training – a qualitative study’, BMJ Open, Volume 6, issue 12 (2016); accessed online at http://bmjopen.bmj.com/content/6/12/e013897.full [Accessed 10 April 2017] The challenges of maintaining work-life balance affects junior doctors’ morale, their well-being and their decisions about their careers. LTFT working was felt to be a possible solution to the barriers to work-life balance, especially among female trainees with children.
  4. General Medical Council. Promoting flexibility in postgraduate training. GMC 2017. https://www.gmc-uk.org/education/30540.asp [Accessed 10 November] In 2017 the General Medical Council, the UK medical regulator, made recommendations to promote existing mechanisms for flexible training and to encourage others to continue to make working arrangements for trainees more flexible, however we do not know how an increase in LTFT training will impact on the workforce and patient care.
  5. Randive, S., Johnston, C., Fowler, A. and Evans, C. (2015). Influence of less than full-time or full-time on totality of training and subsequent consultant appointment in anaesthesia. Anaesthesia, 70(6), pp.686-690. This study by Randive et al is a good example of one of the very few studies which has used objective data from doctors’ training records to study the influence of LTFT working on progression through training and career outcomes after training – both of which are key factors which need to be considered during workforce planning.

Magdalen Baker
magdalen.baker.13@ucl.ac.uk