Fair access to medicine? Retrospective analysis of UK medical schools application data 2009-2012 using three measures of socioeconomic status

Background: Medical students have historically largely come from more affluent parts of society, leading many countries to seek to broaden access to medical careers on the grounds of social justice and the perceived benefits of greater workforce diversity. The aim of this study was to examine variation in socioeconomic status (SES) of applicants to study medicine and applicants with an accepted offer from a medical school, comparing the four UK countries and individual medical schools. Methods: Retrospective analysis of application data for 22 UK medical schools 2009/10-2011/12. Data were analysed for all 32,964 UK-domiciled applicants aged &lt;20 years to 22 non-graduate medical schools requiring applicants to sit the United Kingdom Clinical Aptitude Test (UKCAT). Rates of applicants and accepted offers were compared using three measures of SES: (1) Postcode-assigned Index of Multiple Deprivation score (IMD); (2) School type; (3) Parental occupation measured by the National Statistics Socio Economic Classification (NS-SEC). Results: There is a marked social gradient of applicants and applicants with accepted offers with, depending on UK country of residence, 19.7-34.5 % of applicants living in the most affluent tenth of postcodes vs 1.8-5.7 % in the least affluent tenth. However, the majority of applicants in all postcodes had parents in the highest SES occupational group (NS-SEC1). Applicants resident in the most deprived postcodes, with parents from lower SES occupational groups (NS-SEC4/5) and attending non-selective state schools were less likely to obtain an accepted offer of a place at medical school further steepening the observed social gradient. Medical schools varied significantly in the percentage of individuals from NS-SEC 4/5 applying (2.3 %-8.4 %) and gaining an accepted offer (1.2 %-7.7 %). Conclusion: Regardless of the measure, those from less affluent backgrounds are less likely to apply and less likely to gain an accepted offer to study medicine. Postcode-based measures such as IMD may be misleading, but individual measures like NS-SEC can be gamed by applicants. The previously unreported variation between UK countries and between medical schools warrants further investigation as it implies solutions are available but inconsistently applied.</p

Bedrock Geology of Sonora Quadrangle, Washington and Benton Counties, Arkansas

A digital geologic map of Sonora quadrangle was produced at 1:24,000 scale using the geographic information system GIS) software Maplnfo. The geology of Sonora quadrangle consists of sedimentary rocks from the Ordovician, Devonian, Mississippian, and Pennsylvanian Systems. The Cotter, Powell, and Everton formations represent the Ordovician System. The Clifty and Chattanooga formations represent the Devonian System. The St. Joe Limestone, Boone, Batesville, and Fayetteville formations represent the Mississippian System. The Hale formation represents the Pennsylvanian System. The St. Joe Limestone crops out extensively in Sonora quadrangle and is unconformably overlain by the Boone formation in the southern portion of the quadrangle. This unconformity adds credence to the suggestion that the St. Joe Limestone should be elevated to formation status rather than remain as a member of the Boone formation. The Fayetteville formation consists of the informally named lower Fayetteville Shale, Wedington Sandstone, and informally named upper Fayetteville Shale. The only member of the Hale formation observed in Sonora quadrangle was the Cane Hill member. The two prominent geologic structures in Sonora quadrangle are the White River fault running generally east-west and the Fayetteville fault running generally southwest-northeast. Other subsidiary faults are associated with these primary faults, creating fault zones within the quadrangle. Detailed mapping of stratigraphy and structure in Sonora quadrangle provides new insights into the geologic evolution and sea-level history of the Ozark Plateaus and the southern craton margin during the Paleozoic Era

Bedrock Geology of Rogers Quadrangle, Benton County, Arkansas

A digital geologic map of Rogers quadrangle was produced at 1:24,000 scale using the geographic information system (GIS) software Maplnfo. Data regarding stratigraphic relations observed in the field were digitized onto the United States Geological Survey (USGS) digital raster graphic (DRG) of Rogers quadrangle. The geology of Rogers quadrangle consists of sedimentary rocks of the Ordovician, Devonian, and Mississippian systems. The Cotter, Powell, and Everton formations represent the Ordovician System. The Clifty and Chattanooga formations represent the Devonian System. The St.Joe and Boone formations represent the Mississippian System. This mapping effort represents the first time stratigraphy of Rogers quadrangle was mapped utilizing digital technologies. The prominent geologic structures in Rogers quadrangle are east- west and north - south trending normal faults, commonly inferred from stratigraphic relations across small drainages inundated by Beaver Lake; the most extensive faulting was located in the Blackburn Creek arm and the Prairie Creek sub-basin of Beaver Lake. Complex faulting in the Prairie Creek area appears to have a long geologic history; here the Devonian Chattanooga Shale lies directly on top of the Ordovician Cotter formation, suggesting that the Ordovician Powell and Everton formations and much of the Devonian Clifty formation were either never deposited or have eroded from this area. In either case, the Prairie Creek area appears to represent a structural high developed during the Middle to Late Ordovician that was eventually inundated by rising sea level to permit deposition of the Chattanooga Shale. Detailed mapping of Rogers and other northwest Arkansas quadrangles is providing new insights into the geologic evolution of the southern continental craton and Ozark Plateaus during the Paleozoic Era

An ethnographic exploration of influences on prescribing in general practice : Why is there variation in prescribing practices?

Background: Prescribing is a core activity for general practitioners, yet significant variation in the quality of prescribing has been reported. This suggests there may be room for improvement in the application of the current best research evidence. There has been substantial investment in technologies and interventions to address this issue, but effect sizes so far have been small to moderate. This suggests that prescribing is a decision-making process that is not sufficiently understood. By understanding more about prescribing processes and the implementation of research evidence, variation may more easily be understood and more effective interventions proposed.Methods: An ethnographic study in three Scottish general practices with diverse organizational characteristics. Practices were ranked by their performance against Audit Scotland prescribing quality indicators, incorporating established best research evidence. Two practices of high prescribing quality and one practice of low prescribing quality were recruited. Participant observation, formal and informal interviews, and a review of practice documentation were employed.Results: Practices ranked as high prescribing quality consistently made and applied macro and micro prescribing decisions, whereas the low-ranking practice only made micro prescribing decisions. Macro prescribing decisions were collective, policy decisions made considering research evidence in light of the average patient, one disease, condition, or drug. Micro prescribing decisions were made in consultation with the patient considering their views, preferences, circumstances and other conditions (if necessary).Although micro prescribing can operate independently, the implementation of evidence-based, quality prescribing was attributable to an interdependent relationship. Macro prescribing policy enabled prescribing decisions to be based on scientific evidence and applied consistently where possible. Ultimately, this influenced prescribing decisions that occur at the micro level in consultation with patients.Conclusion: General practitioners in the higher prescribing quality practices made two different 'types' of prescribing decision; macro and micro. Macro prescribing informs micro prescribing and without a macro basis to draw upon the low-ranked practice had no effective mechanism to engage with, reflect on and implement relevant evidence. Practices that recognize these two levels of decision making about prescribing are more likely to be able to implement higher quality evidence.Publisher PDFPeer reviewe

From child to adult: An exploration of shifting family roles and responsibilities in managing physiotherapy for cystic fibrosis

Although chest physiotherapy is central to the management of cystic fibrosis many report problems with adherence. Research in other long-term conditions suggests that non-adherence may be exacerbated as the child grows older and self-care responsibilities are transferred to the young person. We explored the nature and variation in roles of family members, how responsibility was transferred from the parent/family to the child, and what factors aided or hindered this process.We conducted in-depth interviews with 32 children with a diagnosis of cystic fibrosis aged 7–17 years, and with 31 parents attending cystic fibrosis clinics in two Scottish regions. Family responsibilities were primarily focused on mothers. The level and nature of involvement varied along a continuum that separated into six parental and five child roles and changed over time. However, this movement was frequently reversed during periods of illness or mistrust. The day to day experience of such a transfer was not straightforward, linear or unproblematic for any of the family members. Three factors were identified as assisting the transfer of responsibility: parents’ perceptions of the benefits of transferring responsibility, children's perceptions of the benefits, and the available physical, social and psychological resources to support such a transfer.The principles and lessons from “concordance” (a therapeutic alliance based on a negotiation between equals and which may lead to agreement on management or agreement to differ) may provide a foundation for newly developing relationships between parents and their children emerging into adulthood. Further research is required to develop more specifically the content and structure of required support, its effectiveness in achieving more concordant relationships, and the resulting impact on adherence, perceived health and well-being from the perspective of the young person and parent

Use of UKCAT scores in student selection by UK medical schools, 2006-2010

<p>Abstract</p> <p>Background</p> <p>The United Kingdom Clinical Aptitude Test (UKCAT) is a set of cognitive tests introduced in 2006, taken annually before application to medical school. The UKCAT is a test of aptitude and not acquired knowledge and as such the results give medical schools a standardised and objective tool that all schools could use to assist their decision making in selection, and so provide a fairer means of choosing future medical students.</p> <p>Selection of students for UK medical schools is usually in three stages: assessment of academic qualifications, assessment of further qualities from the application form submitted via UCAS (Universities and Colleges Admissions Service) leading to invitation to interview, and then selection for offer of a place. Medical schools were informed of the psychometric qualities of the UKCAT subtests and given some guidance regarding the interpretation of results. Each school then decided how to use the results within its own selection system.</p> <p>Methods</p> <p>Annual retrospective key informant telephone interviews were conducted with every UKCAT Consortium medical school, using a pre-circulated structured questionnaire. The key points of the interview were transcribed, 'member checked' and a content analysis was undertaken.</p> <p>Results</p> <p>Four equally popular ways of using the test results have emerged, described as Borderline, Factor, Threshold and Rescue methods. Many schools use more than one method, at different stages in their selection process. Schools have used the scores in ways that have sought to improve the fairness of selection and support widening participation. Initially great care was taken not to exclude any applicant on the basis of low UKCAT scores alone but it has been used more as confidence has grown.</p> <p>Conclusions</p> <p>There is considerable variation in how medical schools use UKCAT, so it is important that they clearly inform applicants how the test will be used so they can make best use of their limited number of applications.</p

The fairness, predictive validity and acceptability of multiple mini interview in an internationally diverse student population--a mixed methods study

BACKGROUND: International medical students, those attending medical school outside of their country of citizenship, account for a growing proportion of medical undergraduates worldwide. This study aimed to establish the fairness, predictive validity and acceptability of Multiple Mini Interview (MMI) in an internationally diverse student population. METHODS: This was an explanatory sequential, mixed methods study. All students in First Year Medicine, National University of Ireland Galway 2012 were eligible to sit a previously validated 10 station MMI. Quantitative data comprised: demographics, selection tool scores and First Year Assessment scores. Qualitative data comprised separate focus groups with MMI Assessors, EU and Non-EU students. RESULTS: 109 students participated (45% of class). Of this 41.3% (n = 45) were Non-EU and 35.8% (n = 39) did not have English as first language. Age, gender and socioeconomic class did not impact on MMI scores. Non-EU students and those for whom English was not a first language achieved significantly lower scores on MMI than their EU and English speaking counterparts (difference in mean 11.9% and 12.2% respectively, P<0.001). MMI score was associated with English language proficiency (IELTS) (r = 0.5, P<0.01). Correlations emerged between First Year results and IELTS (r = 0.44; p = 0.006; n = 38) and EU school exit exam (r = 0.52; p<0.001; n = 56). MMI predicted EU student OSCE performance (r = 0.27; p = 0.03; n = 64). In the analysis of focus group data two overarching themes emerged: Authenticity and Cultural Awareness. MMI was considered a highly authentic assessment that offered a deeper understanding of the applicant than traditional tools, with an immediate relevance to clinical practice. Cultural specificity of some stations and English language proficiency were seen to disadvantage international students. Recommendations included cultural awareness training for MMI assessors, designing and piloting culturally neutral stations, lengthening station duration and providing high quality advance information to candidates. CONCLUSION: MMI is a welcome addition to assessment armamentarium for selection, particularly with regard to stakeholder acceptability. Understanding the mediating and moderating influences for differences in performance of international candidates is essential to ensure that MMI complies with the metrics of good assessment practice and principles of both distributive and procedural justice for all applicants, irrespective of nationality and cultural background

Enhanced operating flexibility and optimised off-design operation of coal plants with post-combustion capture

AbstractThe inherent nature of electricity necessitates a permanent balance between generation and demand in electricity systems. This has obvious implications for the operation of CCS power plants in decarbonised electricity systems with inflexible nuclear and variable renewable supply. The low variable costs of nuclear and some intermittent renewable technology allow them to run as base-load generators and shift fossil fuel plants from base-load to mid- merit plants. CCS power plants can be expected to increasingly operate in ways to balance variations, sometimes simultaneously, in the production of some intermittent renewable technologies and variations in electricity demand, resulting in more frequent ramping and start/stop cycles. As a result, they may also operate over a wide output range to maintain the quality and security of electricity supply by providing ancillary services, e.g. capacity and energy reserve, to the electricity network. This work characterises the operating envelope, the performance and the corresponding compressed CO2 flow of coal power plants for a range of loads, with or without voluntary by-pass of the capture unit. Optimised part-load operating strategies provide novel insights into the additional capabilities of CCS power plants specifically designed for enhanced operating flexibility