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Applications

Title Summary Lead Contact
UKMEDP001
Predicting Fitness to Practise issues from admission profiles in UK medical school entrants

Approved on 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 are 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 recognized that this data is 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 to that may include performance measures such as ARCP progression and FtP events.

References

  1. Papadakis M, Hodgson C, Teherani A,Kohatsu N. 2004 Unprofessional Behavior in Medical School Is Associated with Subsequent Disciplinary Action by a State Medical Board. Acad Med 79: 244-249. This key cardinal paper reported a case control study in which 68 doctors sanctioned by the Medical Board of California were found to be twice as likely to have concerns regarding professionalism highlighted in their medical school records.
  2. Norman G. Identifying the bad apples. 2015Adv Health Sci EducTheory Pract. 20(2):299-303. Norman challenges the case made by Powis and others regarding non-academic attributes and models the sensitivity and specificity of tests required to screen out doctors who might later fall foul of FtP concerns.
  3. Powis D. 2015. Selecting medical students: An unresolved challenge. Medteach 37: 252-260 (doi:10.3109/0142159X.2014.993600) This review and analysis piece presents an argument for moving beyond selecting for academic excellence by ‘selecting out’ for undesirable non-academic attributes. Amongst others it suggests the Personal Qualities Assessment (as piloted by UKCAT) has potential in this area.
  4. GMC 2012. Report to Undergraduate Board. (Accessed28/7/2105) This report includes the number and type of declarations made by applicants for Provisional registration in the UK.
  5. GMC. 2007 Medical students: professional behaviour and fitness to practice. In conjunction with Maintaining Good Medical Practice (2007) this student focused guidelines describes the expectation of medical students and forms the basis of medical schools approach to Fitness to Practice.

Doctor Paul Tiffin
p.a.tiffin@dur.ac.uk
UKMEDP002
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 on 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 have 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. Bodger, O., et al. Graduate entry medicine: selection criteria and student performance. PloS one, 6(11), (2011): e27161.
  2. 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.
  3. 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.
  4. 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.
  5. 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. • 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.

Professor Chris McManus
i.mcmanus@ucl.ac.uk
UKMEDP003
Do the Educational Performance Measure decile score and SJT predict successful completion of the foundation programme?

Approved on 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"
Summary: Please outline your proposed research. 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. The output of this research will allow us to fulfil our duties outlined in The Trainee Doctor “10 Periodically, the GMC will analyse evidence from these sources to draw together a picture of the state of foundation and specialty training throughout the UK. This will show performance against standards by postgraduate deaneries, LEPs, medical Royal Colleges and Faculties and specialty associations and will seek to show which factors are most significant in predicting good and poor educational outcomes within training programmes and at the end of training “ It will also assist Medical Schools in meeting the following standard: “172 Quality management will involve the collection and use of information about the progression of students. It will also involve the collection and use of information about the subsequent progression of graduates in relation to the Foundation Programme and postgraduate training, and in respect of any determinations by the GMC.” From Tomorrow’s Doctors (2009) Note that from January 2016, these standards will be superseded by Promoting excellence: standards for medical education and training , the relevant requirement will be “R2.5 Organisations must evaluate information about learners’ performance, progression and outcomes – such as the results of exams and assessments – by collecting, analysing and using data on quality and on equality and diversity” The output of the analysis will help us begin to explore whether the EPM deciles and the SJT score are predictive of trainee performance as measured by ARCP and recruitment outcomes during the foundation programme and therefore whether it is appropriate to split medical school cohorts into groups based on EPM deciles and or SJT to report on their progress at foundation ARCP and at recruitment into specialty training from F2 in order to provide more granular reports on outcomes to medical school deans. We will use the output to enhance the existing medical school progression reports. This could, if the analysis shows that it would be appropriate, allow a medical dean to see the ARCP and recruitment outcomes of their top performing graduates versus their less well performing graduates; where the definition of these groups is determined by this proposed analysis. We may find that ARCP outcomes for foundation are not suitably granular for establishing whether EPM and SJT are useful predictors of which trainees will struggle in foundation training. To establish whether the SJT and EPM predict which trainees required additional support from their foundation schools would require UKMED to have identifiable data on doctors in difficulty on the foundation programme. These may be doctors who received support in order that they were able to achieve an outcome 1 or an outcome 6 and therefore may not have been awarded an unsatisfactory outcome. The UKFPO Annual report for 2014 says there were 186 F1 and 163 F2s from UKMED medical school monitored via foundation schools’ doctors in difficulty (DiD) policies and processes. We do not know which ARCP outcomes these DiD s were finally awarded. The output will also allow comparison of the ARCP and the recruitment outcomes across foundation schools adjusting for the prior attainment of the trainees (i.e. their performance on entry to the foundation programme). We know from the FPAS application handbook that higher ranking applicants get their first choice of school. So viewing outcomes by foundation school with no adjustment may reflect the given school’s intake more than the training it offers. In addition the output will inform our work on differential attainment. We will be able to see whether ethnicity and gender adds to the prediction of ARCP and recruitment outcomes, after accounting for prior attainment as measured by the EPM decile score and SJT in the model. We will seek to understand the variation in EPM decile score and SJT by ethnicity, gender and socio-economic status. Finally we will seek to understand whether the EPM decile score and SJT relate to trainee’s own rating of their level of preparedness as captured on the NTS 2015. This will inform our work on the construct validity of the NTS preparedness indicator. The outputs of this work could be used to help the GMC decide how the SJT and EPM decile scores might contribute to a UK licensing assessment. The analysis might help the UKPFO consider the best way to rank students for entry to the foundation. There are limitations to this study; the UKMED phase 1 cohort does not include graduates from non-UK medical schools who do apply to Foundation training using the FPAS system. In future years UKMED may include those non-UK graduates from the point they apply to foundation training. Note these cases will never have data from the Higher Education Statistics Agency. Any conclusions will therefore be limited to UK graduates. Note that SJT data are only available from 2013 onwards; in 2012 SJT was piloted for the first time and the 2012 parallel recruitment exercise data are not included within UKMED. The 2012 parallel recruitment exercise is described in the Medical School Council report. Those who entered foundation in 2013 will now have a complete set of ARCP outcomes for the two years of their foundation programme so a complete cohort study is possible.

References

  1. Patterson, F., Ashworth, V., Zibarras, L., Coan, P., Kerrin, M. and O'Neill, P. (Sep 2012). Evaluations of situational judgement tests to assess non-academic attributes in selection. Medical Education, 46(9), 850-868. doi: 10.1111/j.1365-2923.2012.04336.x Patterson et al conducted a review of the emerging international research evidence for the use of situational judgement tests (SJTs.) They conclude further research is required to explore theoretical developments and the underlying construct validity of SJTs.
  2. Simon E1, Walsh K, Paterson-Brown F, Cahill D. (Feb 2015). Does a high ranking mean success in the Situational Judgement Test? Clinical Teacher. 2015 Feb;12(1):42-5. Simon et al (2015) report on the relationship between EPM decile scores and SJT scores; but the data were harvested from trainees in a self-reported survey rather than directly from the UKFPO. Their survey achieved a response rate of 8% (N= 3,175 – 12 medical school); so their finding that there is no relationship between the EPM decile score and the SJT may not be correct. It is not clear why this approach was taken rather than obtaining the data directly from the UKFPO.
  3. Patterson F., Lievens F, Kerrin M., Munro N , Irish B. . The predictive validity of selection for entry into postgraduate training in general practice: evidence from three longitudinal studies. British Journal of General Practice 2013 ; 63: 734 – 741 Patterson et al (2013) found that the SJT accounted for 6% of the variation in end of GP training assessments, but is not clear if this finding relates to the AKT or the CSA.
  4. Patterson F, Carr V, Zibarras L, et al (2009). New machine-marked tests for selection into core medical training: Evidence from two validation studies. Clinical Medicine; 9(5): 1–4. Patterson concluded that the SJT was the best single predictor of CMT interview scores, but does not use outcomes from training e.g. MRCP membership exam results to explore the predictive validity of the SJT for CMT trainees. The authors note that The 2008 CMT sample comprised only a subset of applicants – those who applied to both CMT and GP. It could be argued that this sample may not fully represent the CMT applicant population as a whole, so that results may not readily generalise to the applicants not included in this sample.

Mr Daniel Smith
dsmith@gmc-uk.org
UKMEDP020
The role of academic attainment in understanding sex differences in specialty choice and fitness to practise.

Approved on 15 June 2016 UKMED Advisory Board


Published in BMJ Open in March 2019 as "Effect of sex on specialty training application outcomes: a longitudinal administrative data study of UK medical graduates"
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

Doctor Emily Unwin
emily.unwin.12@ucl.ac.uk
UKMEDP022
The allocation of doctors to specialty and general practice training posts by demographic and socio-economic characteristics

Approved on 15 June 2016 UKMED Advisory Board


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 both across medical specialties and between specialties and general practice (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 and general practice. 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. GMC 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
UKMEDP026
“Getting on” in medicine: a programme of study of careers trajectories and decisions of doctors

Approved on 25 February 2016 UKMED Advisory Board

Published in 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"
Published in BMC Medical Education in December 2018 as "Geographical mobility of UK trainee doctors, from family home to first job: a national cohort study"
Published in BMJ Open in March 2019 as "Relationship between sociodemographic factors and specialty destination of UK trainee doctors: 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. 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
UKMEDP030
What demographic and educational factors predict doctors' decisions to apply for training programmes in particular medical specialties?

Approved on 15 June 2016 UKMED Advisory Board

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"
Published in BJPsych Bulletin in May 2019 as "Sociodemographic and educational characteristics of doctors applying for psychiatry training in the UK: Secondary analysis of data from the UK Medical Education Database 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 [1-3]. Intentions to follow a particular career pathway however are subject to change [4] 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 [5]. 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, 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 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. The NHS, Specialty Recruitment: Competition Ratios. This website provides data on the competition for specialty placements through comparison of applications to specialty training against the number of places available for that specialism, allowing identification of application shortfall in specific areas, i.e. Psychiatry, General Practice and Paediatrics.

Doctor Tom Gale
thomas.gale@plymouth.ac.uk
UKMEDP032
What factors predict doctors' successful completion of core training in medicine and anaesthetics and their subsequent decisions to pursue higher specialty training

Approved on 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. 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. 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. 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.

Doctor Tom Gale
thomas.gale@plymouth.ac.uk
UKMEDP038
How do the professional outcomes of medical graduates from gateway courses compare to graduates from standard entry medicine courses?

Approved on 28 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.

References

  1. There are two published papers comparing results on the 6-year programme at Kings to the 5-year programme and one paper concerned with results at Southampton. Garlick PB, Brown G: Widening participation in medicine. British Medical Journal 2008, 336:1111–1113. Garlick and Brown report on the entry criteria and the within school performance of the students on the 6-year programme and compare them to those on the 5-year programme. They report that the students on the two programmes have identical first time pass rates during the clinical years of the programme. They conclude that medical students admitted with lower grades can succeed if the grades were obtained at a low achieving school.
  2. Mahesan N, Crichton S, Sewell H, Howell S: The effect of an intercalated BSc on subsequent academic performance. BMC Med Educ 2011, 11:76. Mahesan et al report that students on the 6-year programme at King’s attained Year 5 results which were on average over 4 points lower than students on the regular 5-year programme (95% CI -6.30 to -2.21).
  3. Curtis SA et al. Successful widening access to medicine. Part 2: Curriculum design and student progression. The Royal Society of Medicine 2014; 107 (9):393-397 Curtis et al report that 85% of students on the 6 year programme at Southampton who progress to year 1, graduate with a medical degree in comparison to 95% of students from the 5 year programme There are no published papers comparing the progression of those on the 6-year to the 5-year course at Norwich.
  4. There are two large multicentre UKCAT studies looking at the relationships between performance at medical school and demographic variables, attainment on entry and aptitude on entry: Predictive validity of the UKCAT for medical school undergraduate performance: a national prospective cohort study BMC Medicine 2016 14:140, Paul A. Tiffin, Lazaro M. Mwandigha, Lewis W. Paton, H. Hesselgreaves, John C. McLachlan, Gabrielle M. Finn and Adetayo S. Kas 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 twelve UK medical schools BMC Medicine 2013, 11:244
  5. IC McManus, Chris Dewberry, Sandra Nicholson and Jonathan S Dowell. Although the schools are not named in either of these studies, they cannot have included Kings or Southampton as neither school is listed in the table of schools providing medical school progression data to the UKCAT consortium . Norwich will have been included.

Mr Daniel Smith
Daniel.smith@gmc-uk.org
UKMEDP039
What factors lead to success in obtaining an ophthalmology specialty training (OST) post and completing postgraduate ophthalmology examinations?

Approved on 12 June 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 (4) 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 (5). 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]. 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]. 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. McNally SA., (2008) Competition ratios for different specialties and the effect of gender and immigration status. JR Soc Med;101 (10):489-492 This paper examines competition ratios for postgraduate specialties and the likely success rates of candidates. In particular, the author looks at whether or not gender and immigration status are associated with higher success rates in attaining specialty-training posts.
  4. 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]. 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.
  5. 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.

Doctor Aditi Das
aditi.das@moorfields.nhs.uk
UKMEDP041
Development of a UKMED multidimensional measure of widening access status.

Approved on 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).

Doctor Paul Lambe
paul.lambe@plymouth.ac.uk
UKMEDP042
Understanding variation in BME medical exam performance across the UK

Approved on 26 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.

References

  1. Ferguson, E., D. James, and L. Madeley, Factors associated with success in medical school: systematic review of the literature. BMJ, 2002. 324(7343): p. 952-7. [Systematic review providing relevant background on BAME performance in medical school]
  2. Haq, I., et al., Effect of ethnicity and gender on performance in undergraduate medical examinations. Med Educ, 2005. 39(11): p. 1126-8. [Jane Dacre paper - observational cohort study of year 3 undergraduates, looking at relationships between BAME status and performance]
  3. 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 Med, 2013. 11: p. 244. [Sentinal paper looking at pre-medical school performance as a predictor - relevant to our plans for case-mix adjusted analyses]
  4. Woolf, K., et al., Exploring the underperformance of male and minority ethnic medical students in first year clinical examinations. Adv Health Sci Educ Theory Pract, 2008. 13(5): p. 607-16. [Impact of underperformance in BAME cohorts evaluated]
  5. Woolf K, R.A., Viney R, Rigby M, Needleman S, Griffin A., Fair training pathways for all: Understanding experiences of progression. General Medical Council Report, 2016. [Essential GMC report highlighting variation in attainment]

Doctor James Galloway
james.galloway@kcl.ac.uk
UKMEDP043
Does medical school entry performance and medical school performance predict success on the Intercollegiate Membership of The Royal College of Surgeons (MRCS) exam ?

Approved on 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.

References

  1. McManus IC, Elder AT, de Champlain A, Dacre JE, Mollon J, Chis L. Graduates of different medical schools show substantial differences in performance on MRCP(UK_ Part 1, Part 2 and PACES examinations. BMC Med 2008; 6: 5. The difference in MRCP performance was explained by candidate's medical school and highlighted the need for others to assess UK medical school performance and all postgraduate examinations. UKCAT, GAMSAT and BMAT were not in place at the time of this study (indeed graduate entry programmes did not exist for the cohorts in McManus et al.'s study but they now make up 10% of medical school places. To date, no other research group has investigated the relationship between medical school, UKCAT/BMAT/GAMSAT performance, medical school performance and performance on UK postgraduate surgical assessments.
  2. Tiffin PA, Mwandigha LM, Paton LW, Hesselgreaves H, McLachlan JC, Finn GM, Kasim AS. Predictive validity of the UKCAT for medical school undergraduate performance: a national prospective cohort study. BMC Medicine 2016; 14: 140. This study demonstrated that UKCAT scores are predictive of undergraduate medical school performance, supporting the concept of the predictive validity of UKCAT.
  3. MacKenzie RK, Cleland JA, Ayansina D, Nicholson S. Does the UKCAT predict performance on exit from medical school? A national cohort study. BMJ open 2016; 6: e011313. This study was the first to link the UKCAT and UKFPO databases and found that UKCAT score is predictive of medical school final outcome. The relationship between UKCAT/BMAT/GAMSAT score, EPM deciles, and mandatory postgraduate UK College examinations has yet to be explored.

Professor Jennifer Cleland
jen.cleland@abdn.ac.uk
UKMEDP044
From family-home to education and from education to training: the spatial patterns of future doctors.

Approved on 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).

References

  1. Goldacre et al. 2013. Geographical movement of doctors from education to training and eventual career post: UK cohort studies. J R Soc Med 106: 96-104. This paper has a similar objective of our project, however they used qualitative methods with which it is not possible to estimate the significance and strength of geographical patterns. In addition, the authors focused on historical data (1974 to 2008) which largely precede the current pathways for training (Foundation training from 2005 and revised Specialty training pathways from 2007).
  2. Brice and Corrigan, 2010. The changing landscape of medical education in the UK. Medical Teacher, 32: 727-732. This paper gives a background of the context in which students and doctors’ movements happen. We will take into account in our analysis the changing landscape of medical education.
  3. Goddard et al. 2010. Where did all the GPs go? Increasing supply and geographical equity in England and Scotland. Journal of Health Services Research & Policy 15: 28-35. This work analysed the factors associated with the distribution of GPs across England and Scotland. They do not take into account their education and training pathways. However, their results may help the understanding of the geographical patterns estimated by our project, and give a direction for future analyses.
  4. Parkhouse and Lambert, 1997. Home, training and work: mobility of British doctors. Medical Education 31: 399-407. This paper has a similar objective of our project but it is restricted to 1974 to 1993 only. Again as in Goldacre (2013), they use qualitative methods.
  5. Dowell et al. 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 Med Educ. 2015 Oct 1;15:165. doi: 10.1186/s12909-015-0445-8. It is not clear how transferrable to the UK context these findings may be and the benefits to care from socioeconomic diversity amongst clinicians in the UK or other countries is as yet unproven. Rural origin is the factor most strongly associated with subsequent rural practice with evidence from remote areas of the western world that students recruited from rural backgrounds are more likely to practice in under-served remote and rural areas.

Daniel Smith Analyst
daniel.smith@gmc-uk.org
UKMEDP046
Are there differences between those doctors who apply for a training post in FY2 and those who take time out of training?

Approved on 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).

References

  1. Cleland JA, Johnston P, Watson V, Krucien N, Skatun D. 1) What do UK doctors-in-training value in a post? A discrete choice experiment. Medical Education 2016: 50; 189-202. 2) What do UK medical students value most in their career? A discrete choice experiment. Medical Education 2017: 51; 839-851, and 3) Scanlan et al. Location and Support are Critical to Attracting Junior Doctors: A Discrete Choice Experiment. In submission to Medical Education. This series of studies used a novel methodology to progress understanding of medical careers decision making from data collected in simple, information-seeking surveys, to using an approach which identified the relative strength, or value, of careers preferences, found that trainees and placed most value on good working conditions and location(being near family and friends) when making careers-related decisions. Interesting, female students place more value on location than do male students, which is of relevance given the greater number of female medical graduates nowadays. The third paper is this series focused specifically on FY2s (2016 cohort). It identified that FY2 doctors who applied for a training post placed less value on supportive culture and excellent working conditions than those who did not apply (ie those who were planning to take time out of training). It also identified that male F2s valued geographical locality and a supportive culture less than their female counterparts, and those who entered medicine as graduates placed less value on a desirable location and supportive culture than those who entered medical school as school leavers. The relevance of these papers are that they provide insight into the factors which are important to contemporary cohorts of UK medical students and doctors in training in their careers decision making. However, their focus was generic “push-pull” factors rather than specialty choice (e.g., a preference for surgery or general practice) and they did not investigate possible links between these preferences and specialty preferences.
  2. Gorman D. Matching the production of doctors with national need. Medical Education 2017, early online view. This is a literature-based analysis of the complexity of health system planning and the consequent alignment of medical school selection processes. it concludes that some student selection processes result in desirable (to the planners) career and career location updates. However, the article makes clear that many different factors need to be aligned to lead to change - it is not just admissions but also pedagogy, government investment and integrated medical school and postgraduate training) ie workforce planning is complex so "simple" solutions are inappropriate.

Mr Benard Kumwenda
r0bk15@abdn.ac.uk
UKMEDP051
A comparison of the properties of BMAT, GAMSAT and UKCAT

Approved on 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

Doctor Paul Tiffin
pat512@york.ac.uk
UKMEDP054
Declared disability in the UKMED dataset 2002-2016: an exploratory descriptive analysis

Approved on 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.

Doctor Michael Murphy
m.j.murphy@dundee.ac.uk
UKMEDP057
Selection Tests as a predictor of acceptance rate and post-graduate success of widening participation students in undergraduate medicine

Approved on 05 November 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.

References

  1. Cleland JA, Dowell J, Nicholson S, Patterson F. (2014). How can greater consistency in selection between medical schools be encouraged? (accessed 21/07/2017). This paper evaluates the various elements of selection methods used by UK Medical Schools and the effectiveness of their predictive validity.
  2. Crawford, C. (2014). Socio-economic differences in university outcomes in the UK: drop-out, degree completion and degree class. Institute for Fiscal Studies Working Paper W14/31 Published 04 Nov 2014 (accessed 21/07/2017). Using accessible data on students pre and post entry to HE, this paper identifies variances in outcomes of WP and non-WP cohorts on the same course, highlighting differences in data returns when controlling for school characteristics rather than socio-economic background.
  3. Holton, M. (2017). Traditional or non-traditional students?: Incorporating UK students' living arrangements into decisions about going to university. Journal of Further and Higher Education. This paper looks at how students’ residential situation whilst studying might affect the support they require for on-course success through a qualitative study drawing on the experiences of a sample of students from a range of accommodation at one institution.

Professor Kevin Murphy
k.g.murphy@imperial.ac.uk
UKMEDP058
Modelling the consultant physician workforce

Approved on 24 February 2018 UKMED Advisory Board


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: RCP London. 2. Census of consultant physicians and higher specialty trainees 2016-17.

Doctor Johnny Boylan
ohn.boylan@rcplondon.ac.uk
UKMEDP072
Factors associated with working as a locum

Approved on 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 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.

References

  1. A Pubmed search on “locum” did not return any recent research on who works as a locum or why. Research that was obtained is old, with small sample sizes and relies on self-report. The Campbell at al study is of note as it suggests that colleagues give locums lower performance ratings. BMJ. 2011 Oct 27;343:d6212. doi: 10.1136/bmj.d6212. Factors associated with variability in the assessment of UK doctors' professionalism: analysis of survey results. Campbell JL1, Roberts M, Wright C, Hill J, Greco M, Taylor M, Richards S.
  2. Campbell et al found that locum doctors received lower rating from their colleagues on a measure of professional performance obtained using a GMC questionnaire. Can Fam Physician. 2010 May;56(5):e183-90.
  3. Locum practice by recent family medicine graduates. Myhre DL1, Konkin J, Woloschuk W, Szafran O, Hansen C, Crutcher R. In a survey of 152 graduates who had completed family medicine training between 2001 and 2005 and undertaken locum work the authors found female and younger family physicians were more likely to practise as locums. The most common reason for doing so was as a practice exploration to increase experience or competence.
  4. Br J Gen Pract. 1999 Jul; 49(444):519-21. Locum doctors in general practice: motivation and experiences. Questionnaires were returned by 111 doctors currently working as locums in general practice. Four main reasons for working as a locum GP were given: as a short-term option while between posts, to gain experience of different practices before commitment to one practice, to balance work and family or other commitments, and to continue part-time work after retirement.

Mr Daniel Smith
daniel.smith@gmc-uk.org
UKMEDP073
Recruitment of trainees to obstetrics and gynaecology training programmes.

Approved on 04 March 2018 UKMED Advisory Board



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.

References

  1. Morgan H. How can recruitment be improved in obstetrics and gynaecology? The Obstetrician & Gynaecologist 2011; 13:175–182. This article covers the fall in O&G application over time and explores the reasons for motivation for choosing O&G as a career.
  2. Turner G, Lambert TW, Goldacre MJ, Barlow D. Career choices for obstetrics and gynaecology: national surveys of graduates of 1974–2002 from UK medical schools. BJOG 2006; 113:350–6. This paper looks at trends in career choice for O&G among UK medical graduate and suggests that workforce planning and career progression planning may be attributable, rather than lack of enthusiasm for the specialty.
  3. Alberti H, Randles H, and Robert K McKinley R. Exposure of undergraduates to authentic GP teaching and subsequent entry to GP training: a quantitative study of UK medical schools. Br J Gen Pract 28 February 2017; bjgp17X689881. These researchers explored the correlation between time spent in general practice as an undergraduate and choice of GP training as a career. Time spent as an undergraduate in O&G varies between medical school and it would be interesting to investigate whether this has any correlation with recruitment to the specialty.
  4. Harding A, Rosenthal J, Al-Seaidy M, Pereira Gray D, and McKinley R. Provision of medical student teaching in UK general practices: a cross-sectional questionnaire study. Br J Gen Pract 2015; 65 (635): e409-e417. This study also quantifies current exposure of medical students to general practice and compares it with past provision and also with postgraduate provision.
  5. Cleland, JA, Johnston, PW, Anthony, M., Khan, N. & Scott, NW. A survey of factors influencing career preference in new-entrant and exiting medical students from four UK medical schools. Medical Education 2014; 14: 151. This study shows that medical schools appear to differ in their influence over career preference and recommend that comparisons across medical school populations must control for medical school processes as well as differences in the students when looking at career preference.

Doctor Philippa Marsden
Philippa.marsden@newcastle.ac.uk
UKMEDP077
The relationship between medical student Conscientiousness Index scores and later clinical performance: a pilot study

Approved on 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.

Doctor Marina Sawdon
marina.sawdon@sunderland.ac.uk
UKMEDP081
Junior Doctors’ Training Satisfaction and Progress: Longitudinal Examination of Medical Students Individual Differences, Academic Attainment and Work/Learning Environment

Approved on 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.
  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.

Miss Asta Medisauskaite
a.medisauskaite@ucl.ac.uk
UKMEDP082
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 on 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?

References

  1. Chambers, C.N L. Frampton, C.M. Barclay, M and McKee, M. (2016). Burnout prevalence in New Zealand's public hospital senior medical workforce: a cross-sectional mixed methods study. BMJ Open. 2016; 6(11): e013947. doi: 10.1136/bmjopen-2016-013947 The authors used the Copenhagen Burnout Inventory to measure burnout. They found higher burnout associated with working in emergency medicine and psychiatry compared to other specialties, working more than 14 consecutive hours and being a woman. The authors claim that their study is the first to report levels of burnout through the Copenhagen Burnout Inventory in a multi-specialty nationwide survey of senior doctors and dentists in any country.
  2. Kristensen, Tage S., Borritz, Marianne, Villadsen, Ebbe, and Christensen, Karl B. (2005). The Copenhagen burnout inventory: A new tool for the assessment of burnout. Work and Stress, 19(3), 192–207. The outcome variable we propose to use here is the work-related burnout sub-scale of the Copenhagen Burnout Inventory (CBI). Kristensen et al note that “according to Schaufeli and Enzmann (1998, p. 71) the Maslach Burnout Inventory (MBI) has been applied in more than 90% of all empirical burnout studies in the world, which almost gives the MBI monopoly status in the field (Maslach & Jackson, 1981, 1986).“ However we could not use the MBI on the NTS because the it is a proprietary measure and all NTS items are public domain.
  3. McManus, I. C., Keeling, A., & Paice, E. (2004). Stress, burnout and doctors' attitudes to work are determined by personality and learning style: A twelve year longitudinal study of UK medical graduates. BMC Medicine, 2:29. McManus and colleagues found that burnout can be predicted by measures of learning style and personality taken 5 to 12 years before the measure of burnout when the doctors were applicants to medical school or were medical students. In this proposed study the SJT measure could come from up to 5 years before the measure of burnout.
  4. Medical Schools Council on behalf of the cross-stakeholder Project Group (May 2012). Improving Selection to the Foundation Programme Final Report of the Parallel Recruitment Exercise. Accessed 19 November 2017. This Improving Selection to the Foundation Programme report notes that one of the target domains that the SJT for selection into the foundation programme aims to measure is “Coping with pressure”. On this basis we expect a relationship between the SJT score and the measure of burnout.
  5. Dimou ,FM, Eckelbarger D. (2016). Surgeon Burnout: A Systematic Review. J Am Coll Surg. 2016 Jun; 222(6):1230-1239. doi: 10.1016/j.jamcollsurg.2016.03.022. Dimou and colleagues reviewed 39 articles measuring burnout in Surgeons published since 2000 that met their inclusion criteria. They discuss commonly reported risk factors for burnout but make no mention of educational attainment, presumably because this was not captured in any of studies they reviewed. This may be a gap in the literature, this will be confirmed when further literature searches are completed.

Mr Daniel Smith
daniel.smith@gmc-uk.org
UKMEDP083
Factors associated with non-standard outcome at Annual Review of Competence Progression (ARCP) of higher trainees within surgical specialities in the United Kingdom.

Approved on 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 accessed 28/2/2018. First data collected demonstrating demographics of current surgical workforce in the United Kingdom.
  2. 2016 Higher Speciality recruitment competition ratios. 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 (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. Accessed 28/02/2018. Specific recommendation to Health Education England regarding providing appropriate training for trainees and workforce provision and planning.

Miss Hannah Boyd-Carson
hannahboydcarson@doctors.org.uk
UKMEDP084
The Sociodemographic Characteristics of Oral and Maxillofacial Surgeons

Approved on 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.

Mr Declan Murphy
murphy.declan.1994@gmail.com
UKMEDP085
Evaluating the outcomes and impact of less than full time training on the medical workforce

Approved on 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. [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. [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 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. [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.

Doctor Magdalen Baker
magdalen.baker.13@ucl.ac.uk
UKMEDP087
Do ethnic differences in performance and selection across medical education persist when controlling for prior educational attainment?

Approved on 07 December 2018 UKMED Advisory Board


This study aims to investigate the causes of ethnic differences in performance and selection across every stage of medical education, by examining the attainment and selection outcomes of Black and Minority Ethnic (BME) doctors in comparison to their white peers, taking into account ethnic differences in prior attainment. The lower achievement of BME medical students is widely acknowledged [1, 2]. While BME students enter medical school with slightly poorer A levels [3], the ethnic attainment gap widens at medical school [1], and persists into postgraduate medicine, with BME doctors performing relatively poorly in postgraduate examinations, in recruitment, and in ARCPs [1, 4], and being less likely to get their first choice of Foundation programme [5]. However, no comprehensive study to our knowledge has examined the ethnic attainment gap at each stage of medical education, whilst controlling for prior attainment. McManus and colleagues found that it is more difficult for BME students to enter medical school even when they achieve the same A-level grades as their white peers [3]. This suggests the need to investigate the comparative selection outcomes for ethnic minorities within medical education. A large scale study investigating outcomes at each selection point of the medical education continuum, using more recent UKMED data and more granular ethnic groupings, would be extremely beneficial to our understanding in ethnic differences in selection outcomes. This research would create the most comprehensive picture available of ethnic differences throughout the medical education and training pathway, supporting long-term aims of developing and targeting effective solutions.

References

  1. Woolf, K., Potts, H.W. W and McManus, I.C., 2011. Ethnicity and academic performance in UK trained doctors and medical students: systematic review and meta-analysis. BMJ, 342: d901.
  2. McManus, I. C., Woolf, K., Dacre, J., et al. 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: 242.
  3. McManus, I.C., Woolf, K. and Dacre, J., 2008. The educational background and qualifications of UK medical students from ethnic minorities. BMC medical education, 8(1): 21.
  4. General Medical Council (GMC). 2015. The state of medical education and practice in the UK. Accessed 1st June 2018.
  5. Kumwenda, B., Cleland, J.A., Prescott, G.J., Walker, K. and Johnston, P.W., 2018. Relationship between sociodemographic factors and selection into UK postgraduate medical training programmes: a national cohort study. BMJ open, 8(6): e021329.

Miss Halima Shah
halima.shah@ucl.ac.uk
UKMEDP088
Investigating associations of post-graduate examination performance with socio-demographic characteristics, performance at medical school, medical school, SJT and foundation school: a focus on first stage examinations of MRCP, MRCGP and MRCPsych

Approved on 07 December 2018 UKMED Advisory Board


This study aims to examine the relationship between performance in the first stage of MRCP, MRCGP and MRCPsych with sociodemographic characteristics, the EPM (decile and additional educational achievements), Situational Judgement Test (SJT), medical school and foundation school. We particularly focus on specialties with a key community component, as well as the MRCP, because candidates, who pursue many other specialties with a community component, begin with the MRCP. Additionally, it is timely to reconsider the study of McManus et al. (2008) who demonstrated considerable variation in MRCP examination performance relative to candidates’ medical school. They concluded that “unexplained differences” at entry to medical school and specific medical school components might explain this variation. However, they were unable to look at whether candidate socio-economic background was a contributory factor. This is critical to investigate given: variation between medical schools in student socio-demographics; increasing policy focus on widening access to medicine; and emerging evidence of a relationship between socio-economic background and specialty choice (which will be reflected in who sits particular postgraduate examinations). Improvements in routine data management and the availability of standard performance measures mean it is now possible to do a more forensic examination of these associations. It is important to look at the educational performance measure (EPM) decile and additional educational achievements separately since the relationship between additional educational achievements and success in postgraduate professional exams remains unknown. This work will improve understanding, inform assessment and selection policy and help inform UK government policy regarding the future of healthcare delivery.

References

  1. Jones M, Hutt P, Eastwood S, Singh S. Impact of an intercalated BSc on medical student performance and careers: a BEME systematic review: BEME Guide No 28. Medical Teacher 2013, 35: e1493-e1510. This review investigated studies which considered the association of undertaking an intercalated BSc and subsequent factors. Whilst they concluded that undertaking a BSc was associated with improved UG performance, it was beyond the scope of the review to consider associations with performance in post-graduate exams. Our current study will investigate this relationship through examination of relationship between exam performance and the additional educational achievements component of the EPM.
  2. Kumwenda B, Cleland JA, Walker K, Lee AJ, Greatrix R. The relationship between school type and academic performance at medical school: a national, multi-cohort study. BMJ Open 2017, 7:e016291. This study examined the relationship between socio-demographic characteristics and EPM ranking, finding that students from state schools were more likely to finish in the highest rank of EPM than those from independent schools. Indicators of socio-economic status (eg receipt of income support or free school meals, parental education, POLAR area of residence) did not predict performance at medical school. The present study provides an opportunity to assess whether these findings are borne out in professional exams.
  3. McManus IC, Elder AT, de Champlain A, Dacre JE, Mollon J, Chis L. Graduates of different UK medical schools show substantial differences in performance on MRCP (UK) Part 1, Part 2 and PACES examinations. BMC Medicine 2008, 6:5. This paper found differential attainment in MRCP examination performance relative to medical school. Our proposed study extends on these analyses to include further pertinent variables and a larger cohort of medical schools (33 as opposed to 19).
  4. Smith DT, Tiffin PA. Evaluating the validity of the selection measures used for the UK’s foundation medical training programme: a national cohort study. BMJ Open 2018, 8: e021918. This study found that whilst EPM decile and SJT scores were associated with completion of the Foundation Programme, additional educational achievements had no bearing. The currently proposed study will examine whether these findings hold in professional exams (MRCP, MRCGP and MRCPsych).
  5. Tyrer SP, Leung W-C, Smalls J, Katona C. The relationship between medical school of training, age, gender and success in the MRCPsych examinations. Psychiatric Bulletin 2002, 26:257-263. This study found success in RCPsych Part 1 and Part 2 examinations was associated with medical school of training (higher pass rates in graduates of UK/Ireland) and age of candidate. It was beyond the scope of this study to consider socio-demographic factors, ethnicity and variations related to medical schools within the UK. Our study will address these questions.

Isobel Cameron
i.m.cameron@abdn.ac.uk
UKMEDP089
The UK Medical Applicant Cohort Study: Applications and Outcomes Study

Approved on 07 December 2018 UKMED Advisory Board


In March 2018, 1500 new English medical school places were created with an aim to “widen the social profile of medical students”.(1) Increasing the proportion of doctors from ‘non-traditional’ backgrounds (i.e. from under-represented social groups) is a priority in medical education; however the evidence for how to achieve it is still relatively poor. The United Kingdom’s 38 medical schools differ in how they select and educate students, resulting in considerable variability in outcomes for graduates of different medical schools.(2, 3) In particular, some schools attract and/or accept considerably more non-traditional applicants.(4) It is uncertain why. Most medical selection research examines the technical aspects of selection tests; however understanding how applicant choices affect selection outcomes is also needed since, as one admissions dean put it, “we can only select from those who apply”.(5) Long term follow-up of applicants is necessary to understand how applicant factors predict outcomes. The proposed research is part of a National Institute for Health Research funded study, which aims to understand and improve medical applicant choices and outcomes. In the current study we propose to analyse applications to study medicine in the UK from 2007 to 2017 to establish: • Which medical school and applicant factors predict the combination of medical schools that applicants chose to apply to (the maximum being four); • whether the choices of traditional and non-traditional applicants differ; • whether choices predict the likelihood of receiving at least one offer; • whether choices mediate the relationship between applicant social background and likelihood of receiving at least one offer.

References

  1. Health Education England. New medical schools to open to train doctors of the future. 20th March 2018. Accessed 31st July 2018.
  2. Gale TCE, Lambe PJ, Roberts MJ. Factors associated with junior doctors’ decisions to apply for general practice training programmes in the UK: secondary analysis of data from the UKMED project." BMC Medicine. 2017. 15(1): 220.
  3. McManus IC, Elder AT, Dacre JE, Mollon J, Chis L. Graduates of different UK medical schools show substantial differences in performance on MRCP(UK) Part 1, Part 2 and PACES examinations. BMC Medicine. 2008. 6:5 https://doi.org/10.1186/1741-7015-6-5
  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 Medical Education. 2016;16(1):11.
  5. Cleland JA, Nicholson S, Kelly N, Moffat M. Taking context seriously: explaining widening access policy enactments in UK medical schools. Medical Education. 2015;49(1):25-35.

Doctor Katherine Woolf
k.woolf@ucl.ac.uk
UKMEDP091
Access to HE qualifications and widening participation in medicine

Approved on 07 December 2018 UKMED Advisory Board


Access to HE Diplomas developed to provide pre-university qualifications for mature learners without the usual secondary educational qualifications such as A-levels. Around 35,000 mature students now take Access to HE diplomas each year and circa 600 on diplomas allied to medicine (Mizon, personal communication) that are offered by eight colleges nationally. Overall, success in entering HE runs at 65-70% for those gaining the qualification (Farmer, 2017), but an initial trawl of the UKMED database has only identified 211 medical students entering with Access to HE qualifications between 2011-6, suggesting that the conversion rate to medicine degree programmes may be substantially lower. At present the majority of UK medical schools do not recognise Access to HE qualifications as a sufficient requirement, and amongst those that do recognition may be restricted to Diplomas from only one or a few of the colleges offering them. One reason is probably a perception that these students may be at greater risk of not completing a medicine programme, though there is evidence that they have considerable persistence in their educational courses (Hinsliff-Smith et al, 2012). A more recent study (Wilkinson et al, 2015) reports positive experiences of Access to HE students entering the Bradford-Leeds medicine course, but no evidence about their likelihood of progressing and completing the programme. This project proposes to improve the evidence base in two ways: (i) establishing more clearly the numbers and demographic profile of students entering medical school each year with Access Diplomas, and (ii) their relative success at medical school (progression & completion, FPAS educational performance measure, FPAS Situational Judgment Test).

References

  1. Farmer J. Mature Access: the contribution of the Access to Higher Education Diploma. Perspectives: Policy and Practice in Higher Education. 2017 Jul 3;21(2-3):63-72.
  2. Hinsliff-Smith K, Gates P, Leducq M. Persistence, how do they do it? A case study of Access to Higher Education learners on a UK Diploma/BSc Nursing programme. Nurse Education Today. 2012 Jan 1;32(1):27-31.
  3. Wilkinson D, Dew C, Storey T, Barber J, Awad Y, Pattison J. Mature student progression to healthcare programmes in HE. University of Leeds, October 2015

Doctor Paul Garrud
paul.garrud@nottingham.ac.uk
UKMEDP097
Investigating Core Medical Trainees’ experience of the training environment and associations with workplace-based assessments, progression, training and examination outcomes from an Equality & Diversity (E&D) perspective.

Approved on 19 February 2019 UKMED Advisory Board


Under the Public Sector Equality Duty conferred by the 2010 Equality Act, it is the statutory responsibility of organisations with a public function (such as Medical Royal Colleges) to collect, analyse and interpret data on the outcomes of their training and assessment programmes (1) and to consider how the nine protected groups defined by the Equality Act are differentially impacted by these programmes. This research / data analysis project looks at these issues in more depth for UK core medical training (CMT) by investigating the progression of trainees as influenced by the quality of their training environment (measured by the JRCPTB’s CMT quality criteria), performance in workplace-based assessments and the bearing these factors have on their training outcomes (measured by non-completion of CMT and ARCP outcomes) and examination outcomes (measured by time taken to pass each part of the MRCP examination and number of attempts). Previous studies (2-5) have confirmed the association of certain factors, such as demographics and recruitment scores, with training and examination outcomes however indicators of the quality of the training environment, and its interaction with the formative assessments that take place there, have not been included in previous CMT research or examined from an equality and diversity perspective. We recognise the size and complexity of the analyses required, however we believe this study is essential to deepening understanding of differential attainment.

References

  1. Promoting excellence: standards for medical education and training postgraduate curricula (2015). The guidance confirms that Medical Royal Colleges are required to conduct data analysis and monitor outcomes for equality and diversity reasons (see for example, R2.5).
  2. Patterson, F., Lopes, S., Harding, S., Vaux, E., Berkin, L. and Black, D. (2017), The predictive validity of a situational judgement test, a clinical problem solving test and the core medical training selection methods for performance in specialty training. Clinical Medicine 17.1 (2017): 13-17. The paper examines the long-term validity of CMT and GP selection methods in predicting performance in the Membership of Royal College of Physicians (MRCP(UK)) examinations. CMT selection methods (interview scores and situational judgement tests) predict performance and have good evidence of validity
  3. Stegers-Jager, K., Themmen, A., Cohen-Schotanus, J., & Steyerberg, E. (2015). Predicting performance: Relative importance of students’ background and past performance. Medical Education, 49, 933–945. The study determines the relative importance of pre‐admission characteristics and past performance in medical school in predicting student performance in pre‐clinical and clinical training. It confirms the importance of past performance as a predictor of future performance in pre‐clinical training, but also reveals the importance of a student's background as a predictor in clinical training performance.
  4. Ludka-Stempień, K (2015). Predictive validity of the examination for the Membership of the Royal Colleges of Physicians of the United Kingdom. Doctoral thesis, University College London. The study investigated the relationships between MRCP(UK) scores and results of seventeen knowledge exams and two clinical skills assessments (including specialty exams and MRCGP), training performance assessment outcomes (ARCP), and cases of licence limitations and erasures. It concluded that MRCP(UK) is a valid exam and that gender, ethnicity, and UK primary medical qualification (PMQ) and UK training had a significant effect on performance in MRCP(UK); UK PMQ played a predominant role among these factors.
  5. Dewhurst NG, McManus IC, Mollon J, Dacre JE, Vale JA (2007). Performance in the MRCP(UK) examination 2003–4: analysis of pass rates of UK graduates in the clinical examination in relation to self-reported ethnicity and gender. BMC Medicine 5: 8-10.1186/1741-7015-5-8. The study observed that pass rates for MRCP(UK) examinations varied with ethnicity and gender.

Doctor Miriam Armstrong
miriam.armstrong@jrcptb.org.uk
UKMEDP098
Understanding progression in psychiatry training

Approved on 22 February 2019 UKMED Advisory Board


Attrition is a major concern within psychiatric training. Based on one study in 2012, just 65.8% of psychiatry trainees in the UK plan to stay in psychiatry.(1) In 2017 the fill rates for many higher specialty programmes in psychiatry (ST4) was lower than 60%.(2) The aim of this study, therefore, is to analyse the factors which could help to explain these high attrition rates. The London School of Psychiatry recently carried out a survey with core medical trainees (CT3) which identified a number of factors related to job satisfaction which were central to the decision to step out of training. The systematic review published in 2017 on the crisis in psychiatry in the UK also identified a number of work and learning related barriers associated with choosing psychiatry as a career; for example, 25-50% of trainees were leaving because of lack of resources or lack of adequate supervision.(3) Moreover, studies on trainees in other specialties revealed that training progression depended on trainees’ sociodemographic characteristics. For example, females were doing better in exams,(4) but were more likely to dropout.(5) While this evidence suggests that work/learning related factors and sociodemographic characteristics are important to successful progression through training, these assumptions have not been tested with a large longitudinal sample investigating various work/learning and sociodemographic factors together and cannot be generalizable. We will use mixed methods to explore the dropout rates in psychiatry training nationally and will investigate the factors which predict if a trainee progresses through training successfully or drops out.

References

Doctor Asta Medisauskaite
a.medisauskaite@ucl.ac.uk
UKMEDP101
Investigating the potential factors that might influence Prescribing Safety Assessment (PSA) scores amongst UK final year medical students and their predictive validity for performance in early postgraduate training

Approved on 17 May 2019 UKMED Advisory Board


Prescribing is the main approach used by the NHS to treat illness, alleviate symptoms and prevent future disease – around 1.5 billion prescriptions are written annually costing £15 billion [1]. Sub-optimal prescribing is common in both primary and secondary care – approximately 10% of hospital and 5% of general practice prescriptions contain errors – these represent a major threat to public health and impose significant additional costs to the service [1]. While healthcare system factors contribute it is clear that all new prescribers should possess the necessary knowledge and skills to face this challenging environment. These concerns led to the development of the Prescribing Safety Assessment (PSA) by the British Pharmacological Society (BPS) and Medical Schools Council [2,3] to enable final year medical students to demonstrate that they were competent to assume independent prescribing responsibilities. The PSA has been delivered to the graduates of all UK medical schools since 2014 (around 45,000 candidates). There are grounds for believing that the PSA is meeting its original objectives of raising the profile of prescribing skills amongst students and their medical schools, identifying candidates who are less well prepared in this key patient safety area and stimulating learning. There are also some reasons to believe that overall performance in the assessment environment is improving (e.g. improving scores on anchor items, reducing variation between schools). The priority now is to investigate (i) the factors predict PSA performance, (ii) the relationship between PSA performance and other measures of attainment and (iii) the extent to which performance in the PSA predicts subsequent postgraduate performance (predictive validity). Previous studies have linked undergraduate performance to subsequent postgraduate attainment but these have usually involved very broad performance measures [4]. The unique feature of this study is that it will investigate these relationships for an assessment that focuses on a very narrow skillset (prescribing and supervising the use of medicines) that has been the focus of concern. The proposed studies are large and will require complex analysis. However, we believe this study is essential to provide a clearer understanding of the factors that influence PSA scores and how predictive these are of subsequent performance in early medical training. Indeed, a recent external review of the PSA has called for this research to be undertaken [5]. We have brought together a research team with significant expertise, knowledge, resources and data analysis experience required to complete this work.

References

  1. 2. Maxwell SRJ, Cameron IT, Webb DJ. Prescribing safety: ensuring that new graduates are prepared. Lancet 2015;385:579–581. This paper describes the background and rationale for the development of the PSA.
  2. 3. Maxwell SRJ, Coleman JJ, Bollington L, Taylor C, Webb DJ. Prescribing Safety Assessment 2016: Delivery of a national prescribing assessment to 7343 UK final-year medical students. Br J Clin Pharmacol 2017;83:2249–2258. This paper describes the construction and process of delivering the PSA and provides a full report of the outcomes including the pass rate against a pre-specified standard of competence, psychometric measurements, inter school variability and evidence of improvement in performance.
  3. 4. Patterson, F., Lopes, S., Harding, S., Vaux, E., Berkin, L. and Black, D. (2017), The predictive validity of a situational judgement test, a clinical problem solving test and the core medical training selection methods for performance in specialty training. Clinical Medicine 2017;17.1:13–17. This paper examines the long-term validity of postgraduate training selection methods (including a clinical problem-solving test and situational judgement test) in predicting performance in the Membership of Royal College of Physicians (MRCP(UK)) examinations and demonstrated good evidence of predictive validity.
  4. 5. McLachlan JC. Independent review of the Prescribing Safety Assessment. April 2019. This paper provides a thorough review of the strengths and weaknesses of the PSA process and provides a series of important recommendations for research and development. Importantly, Recommendation 3 is “That a Predictive Validity study is retrospectively conducted through UKMED”.
  5. 1. Elliott R, Camacho E, Campbell F, Jankovic D, Martyn St James M, Kaltenthaler E, Wong R, Sculpher M, Faria R, (2018). Prevalence and Economic Burden of Medication Errors in The NHS in England. Rapid evidence synthesis and economic analysis of the prevalence and burden of medication error in the UK. Policy Research Unit in Economic Evaluation of Health and Care Interventions. Universities of Sheffield and York. This paper provides a thorough review of the prevalence and impact of medication errors (including prescribing errors) highlighting their impact on patients and public health as well as the significant economic burden they impose on UK healthcare.

Professor Simon Maxwell
s.maxwell@ed.ac.uk
UKMEDP103
Predictors of postgraduate exam performance in psychiatrists

Approved on 17 May 2019 UKMED Advisory Board


Previous work has explored the determinants of postgraduate performance in both medical specialities and general practice. In particular there has been considerable interest in the nature and causes of differential attainment in postgraduate educational performance between UK and International Medical Graduates (IMGs) (1-4). However, to date, a detailed analysis has not been carried out in relation to psychiatry. It is interesting to note that some degree of differential attainment in relation to the GP ‘Clinical Skills Assessment’ was noted between UK graduates who described their ethnicity as ‘White’ and those who identified as ‘Black and Minority Ethnic’ (BME). A previous investigation suggested that subtle communication and sociocultural differences may underlie differences in attainment between these two medical graduate groups (5). The effective practice of psychiatry demands excellent communication skills and cultural competence. It is noteworthy that one of the largest differential attainment gaps at Annual Review of Competence Panel (ARCP) between UK Graduates (UKGs) and IMGs was for psychiatry (3). Thus, this study intends to elicit the predictors of psychiatric postgraduate exam performance in both UKGs and IMGs and describe any trends in differential attainment in relation to both graduate group (e.g. UKGs, IMGs) and ethnic self-identification.

References

  1. Patterson F, Tiffin PA, Lopes S, Zibarras L. Unpacking the dark variance of differential attainment on examinations in overseas graduates. Medical Education. 2018;52(7):736-46.
  2. McManus IC, Wakeford R. PLAB and UK graduates’ performance on MRCP(UK) and MRCGP examinations: data linkage study. BMJ. 2014;348.
  3. Tiffin PA, Illing J, Kasim AS, McLachlan JC. Annual Review of Competence Progression (ARCP) performance of doctors who passed Professional and Linguistic Assessments Board (PLAB) tests compared with UK medical graduates: national data linkage study. BMJ. 2014;348.
  4. Esmail A, Roberts C. Academic performance of ethnic minority candidates and discrimination in the MRCGP examinations between 2010 and 2012: analysis of data. BMJ. 2013;347(347):f5662.
  5. Roberts C, Atkins S, Hawthorne K. Performance features in clinical skills assessment: Linguistic and cultural factors in the Membership of the Royal College of General Practitioners examination. London: King's College London; 2014.

Doctor Paul Tiffin
pat512@york.ac.uk
UKMEDP104
How do students on gateway courses progress through medicine, compared to standard entry peers of similar backgrounds?

Approved on 17 May 2019 UKMED Advisory Board


Students from lower socioeconomic backgrounds are still traditionally underrepresented in medicine in the UK (1). Subsequently, there has been a recent increase in the number of medical schools offering placements on Gateway Year (GWY) programmes. Designed as a form of widening participation (WP), GWY programmes offer places based on contextual admissions, requiring students successfully complete a Year 0, or Gateway year, in order to matriculate onto standard entry (SE) medicine programmes. There has been limited research suggesting that students on GWY year programmes have slightly lower retention rates compared to SE cohorts, and that GWY year students typically perform academically lower than SE peers in preclinical years, but then as well in clinical years, compared to SE peers (2, 3, 4). However, such research has been limited in the number of GWY programmes (two, single-site studies) included. Further, the existing research compares progression of GWY to SE students as a whole, which may not account for mediating factors related to being from a WP background. This proposed project aims to better understand progression and retention rates of GWY students throughout medical school by not just comparing outcomes of GWY students to those on SE, but with particular focus on how GWY students compare to students of similar socioeconomic, “WP,” background who have met admissions criteria for SE. By comparing GWY students specifically to similar demographic subsets of SE students, this research might provide better context for understanding progression of GWY students, and WP students, overall.

References

  1. Medical Schools Council: Selection Alliance. Selection Alliance 2018 Report: An update ont eh Medical School’s Council’s work in selection and widening participation. 2018 November.
  2. Garlick Pamela B, Brown Gavin. Widening participation in medicine BMJ 2008; 336 :1111
  3. D’Silva, R., Curtis, S., Cleland, J., Barker, M., Rowland, J. Progression and retention: Are there differences betwen students entering via a Gateway programme and traditional entrants? In: Proceedings of the Association for the Study of Medical Education Annual Scientific Meeting [conference proceedings on the Internet]; 2017; University of Exeter, Exeter.
  4. Curtis, S., Blundell, C., Platz, C., & Turner, L. (2014). Successfully widening access to medicine. Part 2: Curriculum design and student progression. Journal of the Royal Society of Medicine, 107(10), 393–397.

Miss Angelique Duenas
hyad29@hyms.ac.uk
UKMEDP105
Exploring the convergent validity of the Prescribing Safety Assessment (PSA)

Approved on 17 May 2019 UKMED Advisory Board


The University Clinical Aptitude Test (UCAT), first introduced in 2006 as the UKCAT, aims to discriminate between applicants with the same academic qualifications more fairly, to facilitate widening participation with recruitment from under represented social groups, and to accurately and robustly identify the attributes of a good clinician in potential students. The Prescribing Safety Assessment (PSA) examination was developed jointly by the Medical Schools Council and the British Pharmacological Society to address concerns about the prescribing abilities of newly-qualified doctors. The PSA assessment board has identified research work that can be used to further develop the PSA, one area being the relationship between the UCAT cognitive elements and prediction of PSA scores, especially the calculation items in the PSA (1). The UCAT includes quantitative reasoning questions which may predict the outcome in the calculation item (CAL) section of the PSA. Previously, it has been demonstrated that UKCAT scores demonstrate a statistically significant but modest degree of incremental predictive validity throughout undergraduate training(2). The proposed research will analyse the predictive value of the cognitive elements of the UCAT in relation to the scores achieved in the PSA, particularly the calculation skills items of the PSA. The BioMedical Admissions Test (BMAT) is another method that some medical schools use to select appropriate students for a degree and career in Medicine. Whilst the UCAT is more widely used and the focus of one of the PSA assessment board's research objectives, the ability to assess the link between PSA scores and previous BMAT scores is important for the validity of both assessments. Also, it is currently unknown whether performance on the PSA projects other aspects of postgraduate educational performance. For example, it may be that the PSA is associated with performance on tests of clinical knowledge, or even clinical skills, as evaluated by postgraduate Royal College membership exams.

References

  1. 1. Maxwell SRJ, Coleman JJ, Bollington L,Taylor C, Webb DJ. Prescribing Safety Assessment 2016: Delivery of a national prescribing assessment to 7343 UK final-year medical students. British Journal of Clinical Pharmacology 2017; (83).
  2. 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 Med [Internet]. 2016 Dec [cited 2019 Mar 28];14(1).

Doctor David Hepburn
david.hepburn@hyms.ac.uk
UKMEDP106
The fairness of the UKFPO post allocation process from the perspective of the patient

Approved on 17 May 2019 UKMED Advisory Board


Students graduating from UK medical schools spend two years in the UK Foundation Programme, based in NHS Trusts. Around 7,000 students are allocated to Foundation Programme training posts every year, with allocations based on students’ performance in key assessments. The allocation process prioritises student location preferences at both Foundation School (largely based on UK regions) and NHS Trust (local) level, so the students scoring highest on the assessments get their first choice location. While this seems fair to students, at its limit it would mean that all the best-performing students are allocated to hospital A in region X and all the worst-performing students to hospital B in region Y. This could be perceived as unfair from the perspective of the patient, because it could mean that the quality of care received depends – in part – on patients’ geographical location. This study will therefore explore if there is a notable difference in students’ performance in three key assessments (the Situational Judgment Test, Educational Performance Measure and Prescribing Safety Assessment) by region of allocation and, for the West Midlands, within the region. We will use data for around 35,000 students graduating from UK medical schools between 2014 and 2018. The main analysis will use a one-way analysis of variance (ANOVA) approach to assess for differences in mean scores by Foundation School and we will produce a “heat map” for each outcome.

References

  1. The UKFPO reports suggest that there may be differences in the ability of students allocated to different regions, but only the lowest score of a student allocated to each region is provided; we will consider the mean and variability in scores (UKFPO, 2018).
  2. Smith and Tiffin (2018) report that Situational Judgment Test and Educational Performance Measure scores are predictive of Foundation Programme performance, so differences at entry could translate into differences in quality of care for patients.
  3. Cousans et al. (2018) report that Situational Judgment Test and Educational Performance Measure scores are predictive of Foundation Programme performance, focusing on those the low and high end of the performance distribution.
  4. Junior doctors from different regions report differences in satisfaction with their training (GMC, 2018).
  5. The importance of considering training quality as a potential confounding variable in the relationship between scores at entry and performance in post is highlighted by Archer et al. (2015); combined with the results of the GMC surveys, we might expect that training quality is one of the factors used by students in making their region-preferencing decisions.

Doctor Celia Brown
celia.brown@warwick.ac.uk
UKMEDP107
Can Situational Judgment Test (SJT), Educational Performance Measure (EPM) and/or Prescribing Safety Assessment (PSA) scores predict the likelihood of being sanctioned by the General Medical Council (GMC)?

Approved on 17 May 2019 UKMED Advisory Board


The aim of this project is to determine if performance in assessments taken while at medical school can predict whether a doctor will be sanctioned by the General Medical Council. Sanctions can take a number of forms, including of erasure, suspension, conditions, undertakings and warnings; all of which are serious outcomes for the doctor in question. Other evidence suggests that performance in “academic” assessments may be predictive of such outcomes, so we wish to add to the evidence base by considering three national assessments: the Situational Judgment Test, Educational Performance Measure and Prescribing Safety Assessment, for which scores are now available for almost all doctors graduating from UK medical schools and beginning work in the NHS. We will include data for doctors starting the UK Foundation Programme in 2013-18 (from 2014 for the Prescribing Safety Assessment), and consider any sanctions imposed up to five years after graduation. We will therefore analyse data for around 42,000 doctors and 140,000 person-years of “exposure” (time working in the NHS when a sanction could be imposed). Our primary analysis will consider if there is a difference in the mean performance scores in the three assessments between those with and without a sanction. We will also consider if raising the minimum standard of performance required on any of the assessments could reduce the rate of sanctions, by investigating the “dose-response” relationship between scores and the probability of a sanction.

References

  1. Wakeford et al. (2018) report that better performance on the MRCP and MRCGP examinations (which are similar in format to those to be considered in our study) reduces the risk of a GMC sanction, although reverse causality is a potential problem.
  2. Yates and James’ case-control study (2010) finds that poor performance at medical school is a predictor of subsequent GMC sanctions; we now have data from a much larger sample to extend this work.
  3. Smith and Tiffin (2018) used UKMED data to show that the Educational Performance Measure and Situational Judgment Test can predict performance in the Foundation Programme; we will extend this work by considering a different post-graduate outcome and a further assessment taken at medical school (the Prescribing Safety Assessment).
  4. Cousans et al. (2017) compare the Foundation Programme outcomes of a sub-group of high and low performers on the Situational Judgment Test and report that low scorers on the Situational Judgment Test have poorer supervisor ratings.
  5. Unwin et al. (2014) report that male gender is a risk factor for being sanctioned by the GMC, suggesting that it is critical to control for gender as a likely confounding variable in our analysis.

Doctor Celia Brown
celia.brown@warwick.ac.uk

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