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

Background: Selection of medical students in the UK is still largely based on prior academic achievement, although doubts have been expressed as to whether performance in earlier life is predictive of outcomes later in medical school or post-graduate education. This study analyses data from five longitudinal studies of UK medical students and doctors from the early 1970s until the early 2000s. Two of the studies used the AH5, a group test of general intelligence (that is, intellectual aptitude). Sex and ethnic differences were also analyzed in light of the changing demographics of medical students over the past decades. Methods: Data from five cohort studies were available: the Westminster Study (began clinical studies from 1975 to 1982), the 1980, 1985, and 1990 cohort studies (entered medical school in 1981, 1986, and 1991), and the University College London Medical School (UCLMS) Cohort Study (entered clinical studies in 2005 and 2006). Different studies had different outcome measures, but most had performance on basic medical sciences and clinical examinations at medical school, performance in Membership of the Royal Colleges of Physicians (MRCP(UK)) examinations, and being on the General Medical Council Specialist Register. Results: Correlation matrices and path analyses are presented. There were robust correlations across different years at medical school, and medical school performance also predicted MRCP(UK) performance and being on the GMC Specialist Register. A-levels correlated somewhat less with undergraduate and post-graduate performance, but there was restriction of range in entrants. General Certificate of Secondary Education (GCSE)/O-level results also predicted undergraduate and post-graduate outcomes, but less so than did A-level results, but there may be incremental validity for clinical and post-graduate performance. The AH5 had some significant correlations with outcome, but they were inconsistent. Sex and ethnicity also had predictive effects on measures of educational attainment, undergraduate, and post-graduate performance. Women performed better in assessments but were less likely to be on the Specialist Register. Non-white participants generally underperformed in undergraduate and post-graduate assessments, but were equally likely to be on the Specialist Register. There was a suggestion of smaller ethnicity effects in earlier studies. Conclusions: The existence of the Academic Backbone concept is strongly supported, with attainment at secondary school predicting performance in undergraduate and post-graduate medical assessments, and the effects spanning many years. The Academic Backbone is conceptualized in terms of the development of more sophisticated underlying structures of knowledge ('cognitive capital’ and 'medical capital’). The Academic Backbone provides strong support for using measures of educational attainment, particularly A-levels, in student selection

Construct-level predictive validity of educational attainment and intellectual aptitude tests in medical student selection: meta-regression of six UK longitudinal studies

Background: Measures used for medical student selection should predict future performance during training. A problem for any selection study is that predictor-outcome correlations are known only in those who have been selected, whereas selectors need to know how measures would predict in the entire pool of applicants. That problem of interpretation can be solved by calculating construct-level predictive validity, an estimate of true predictor-outcome correlation across the range of applicant abilities. Methods: Construct-level predictive validities were calculated in six cohort studies of medical student selection and training (student entry, 1972 to 2009) for a range of predictors, including A-levels, General Certificates of Secondary Education (GCSEs)/O-levels, and aptitude tests (AH5 and UK Clinical Aptitude Test (UKCAT)). Outcomes included undergraduate basic medical science and finals assessments, as well as postgraduate measures of Membership of the Royal Colleges of Physicians of the United Kingdom (MRCP(UK)) performance and entry in the Specialist Register. Construct-level predictive validity was calculated with the method of Hunter, Schmidt and Le (2006), adapted to correct for right-censorship of examination results due to grade inflation. Results: Meta-regression analyzed 57 separate predictor-outcome correlations (POCs) and construct-level predictive validities (CLPVs). Mean CLPVs are substantially higher (.450) than mean POCs (.171). Mean CLPVs for first-year examinations, were high for A-levels (.809; CI: .501 to .935), and lower for GCSEs/O-levels (.332; CI: .024 to .583) and UKCAT (mean = .245; CI: .207 to .276). A-levels had higher CLPVs for all undergraduate and postgraduate assessments than did GCSEs/O-levels and intellectual aptitude tests. CLPVs of educational attainment measures decline somewhat during training, but continue to predict postgraduate performance. Intellectual aptitude tests have lower CLPVs than A-levels or GCSEs/O-levels. Conclusions: Educational attainment has strong CLPVs for undergraduate and postgraduate performance, accounting for perhaps 65% of true variance in first year performance. Such CLPVs justify the use of educational attainment measure in selection, but also raise a key theoretical question concerning the remaining 35% of variance (and measurement error, range restriction and right-censorship have been taken into account). Just as in astrophysics, ‘dark matter’ and ‘dark energy’ are posited to balance various theoretical equations, so medical student selection must also have its ‘dark variance’, whose nature is not yet properly characterized, but explains a third of the variation in performance during training. Some variance probably relates to factors which are unpredictable at selection, such as illness or other life events, but some is probably also associated with factors such as personality, motivation or study skills

Stress, burnout and doctors' attitudes to work are determined by personality and learning style: a twelve year longitudinal study of UK medical graduates

The study investigated the extent to which approaches to work, workplace climate, stress, burnout and satisfaction with medicine as a career in doctors aged about thirty are predicted by measures of learning style and personality measured five to twelve years earlier when the doctors were applicants to medical school or were medical students

Design of generalised Chebyshev lowpass filters using coupled line/stub sections

A new method for the design of distributed lowpass filters enables exact realisation of the series short circuited transmission lines which are normally approximated via unit elements in other filter realisations. The filters are based upon basic sections using a pair of coupled lines which are terminated at one end in open-circuited stubs. The approach enables realisation of transmission zeros at the quarter –wave frequency hence giving improved stopband performance. A complete design is presented and demonstrates performance in good agreement with theory

The relationship between intelligence, working memory, academic self-esteem, and academic achievement

Academic achievement is crucial for life and long-term outcomes. The aim of the present study is to examine the joint role of cognitive (intelligence and working memory) and non-cognitive (academic self-esteem) factors in predicting academic achievement (mathematics and reading literacy) in a sample of Italian sixth and eighth graders. The results showed that within the cognitive factors considered, intelligence was the best predictor of achievement. As regards to non-cognitive factors, academic self-esteem was effective at predicting achievement after controlling for cognitive measures. Academic self-esteem was also found to have an indirect effect, mediated by intelligence, on academic achievement. Both theoretical and practical implications of the present results are discussed

Microwave bandpass filters using re-entrant resonators.

Design techniques for microwave bandpass filters using re-entrant resonators are presented. The key feature is that each re-entrant resonator in the filter generates a passband resonance and a finite frequency transmission zero, above the passband. Thus an Nth degree filter can have N finite frequency transmission zeros with a simple physical realization. A physically symmetrical 5 pole re-entrant bandpass filter prototype with 5 transmission zeros above the passband was designed and fabricated. Measured results showed good correspondence with theories

Dynamic facial expressions of emotions are discriminated at birth

The ability to discriminate between different facial expressions is fundamental since the first stages of postnatal life. The aim of this study is to investigate whether 2-days-old newborns are capable to discriminate facial expressions of emotions as they naturally take place in everyday interactions, that is in motion. When two dynamic displays depicting a happy and a disgusted facial expression were simultaneously presented (i.e., visual preference paradigm), newborns did not manifest any visual preference (Experiment 1). Nonetheless, after being habituated to a happy or disgusted dynamic emotional expression (i.e., habituation paradigm), newborns successfully discriminated between the two (Experiment 2). These results indicate that at birth newborns are sensitive to dynamic faces expressing emotions

Separating math from anxiety: The role of inhibitory mechanisms.

Deficits in executive functions have been hypothesized and documented for children with severe mathematics anxiety (MA) or developmental dyscalculia, but the role of inhibition-related processes has not been specifically explored. The main aim of the present study was to shed further light on the specificity of these profiles in children in terms of working memory (WM) and the inhibitory functions involved. Four groups of children between 8 and 10 years old were selected: one group with developmental dyscalculia (DD) and no MA, one with severe MA and developmental dyscalculia (MA-DD), one with severe MA and no DD (MA), and one with typical development (TD). All children were presented with tasks measuring two inhibition-related functions, that is, proactive interference and prepotent response, and a WM task. The results showed that children with severe MA (but no DD) were specifically impaired in the proactive interference task, while children with DD (with or without MA) failed in the WM task. Our findings point to the importance of distinguishing the cognitive processes underlying these profiles

Which doctors and with what problems contact a specialist service for doctors? A cross sectional investigation

Background: In the United Kingdom, specialist treatment and intervention services for doctors are underdeveloped. The MedNet programme, created in 1997 and funded by the London Deanery, aims to fill this gap by providing a self-referral, face-to-face, psychotherapeutic assessment service for doctors in London and South-East England. MedNet was designed to be a low-threshold service, targeting doctors without formal psychiatric problems. The aim of this study was to delineate the characteristics of doctors utilising the service, to describe their psychological morbidity, and to determine if early intervention is achieved. Methods: A cross-sectional study including all consecutive self-referred doctors (n = 121, 50% male) presenting in 2002–2004 was conducted. Measures included standardised and bespoke questionnaires both self-report and clinician completed. The multi-dimensional evaluation included: demographics, CORE (CORE-OM, CORE-Workplace and CORE-A) an instrument designed to evaluate the psychological difficulties of patients referred to outpatient services, Brief Symptom Inventory to quantify caseness and formal psychiatric illness, and Maslach Burnout Inventory. Results: The most prevalent presenting problems included depression, anxiety, interpersonal, self-esteem and work-related issues. However, only 9% of the cohort were identified as severely distressed psychiatrically using this measure. In approximately 50% of the sample, problems first presented in the preceding year. About 25% were on sick leave at the time of consultation, while 50% took little or no leave in the prior 12 months. A total of 42% were considered to be at some risk of suicide, with more than 25% considered to have a moderate to severe risk. There were no significant gender differences in type of morbidity, severity or days off sick. Conclusion: Doctors displayed high levels of distress as reflected in the significant proportion of those who were at some risk of suicide; however, low rates of severe psychiatric illness were detected. These findings suggest that MedNet clients represent both ends of the spectrum of severity, enabling early clinical engagement for a significant proportion of cases that is of importance both in terms of personal health and protecting patient care, and providing a timely intervention for those who are at risk, a group for whom rapid intervention services are in need and an area that requires further investigation in the UK

Transversal directional filters for channel combining

A new concept for the design of power combiners based on matched directional filters is presented. The directional filters consist of individual balanced sections composed of hybrids and single resonators. Each of the sections corresponds to a pole of an all-pass function composed of the sum of S11 and S12 of the desired filter transfer function. A simple synthesis method is presented. The filter combiner has the advantage of ease of tunability because each pole is associated with a single resonator. Furthermore, no cross couplings are required to realize finite frequency transmission zeros