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

Indicators for management of coral reefs and their applications to marine protected areas

Informed planning and decision-making in the management of natural resources requires an ability to integrate complex interactions in ecosystems and communicate these effectively to stakeholders. This involves coping with three fundamental dilemmas. The first comes from the irregular pulse of nature. The second is the recognition that there are no strictly objective criteria for judging the well-being of an ecosystem. The third is posed by the quest for indicators with some integrative properties that may be used to analyze an ecosystem and impart the information to the relevant resource users. This paper presents some examples of indicators used to: 1) assess the status of a coral reef and, in particular, the state of its fisheries resources; 2) identify reefs that are most threatened by human activities; and 3) evaluate the likelihood of success of management interventions. These indicators are not exhaustive, but illustrate the range of options available for the management of coral reef ecosystems

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

Association of prior depressive symptoms and suicide attempts with subsequent victimisation - analysis of population-based data from the Adult Psychiatric Morbidity Survey

Background: Symptoms of mental disorder, particularly schizophrenia, predispose to victimisation. Much less is known about the relationship between depressive symptoms and later victimisation in the general population, the influence of these symptoms on types of subsequent victimisation, or the role of symptom severity. We investigated this in nationally representative data from the UK. Methods: Data were from the Adult Psychiatric Morbidity Survey 2007. Multivariable logistic regressions estimated association between: a. prior depressive symptoms, and b. prior depressive symptoms with suicide attempt, and types of more recent victimisation. Gender-specific associations were estimated using multiplicative interactions. Results: Prior depressive symptoms were associated with greater odds of any recent intimate partner violence (IPV), emotional IPV, sexual victimisation, workplace victimisation, any victimisation, and cumulative victimisation (adjusted odds ratio (aOR) for increasing types of recent victimisation: 1.47, 95% confidence interval (CI): 1.14, 1.89). Prior depressive symptoms with suicide attempt were associated with any recent IPV, emotional IPV, any victimisation, and cumulative victimisation (aOR for increasing types of recent victimisation: 2.33, 95%: 1.22, 4.44). Limitations: Self-reported recalled data on previous depressive symptoms, may have limited accuracy. Small numbers of outcomes for some comparisons resulted in imprecision of these estimates. Conclusion: Aside from severe mental illness such as schizophrenia, previous depressive symptoms in the general population are associated with greater subsequent victimisation. Men and women with prior depressive symptoms may be vulnerable to a range of types of victimisation, and may benefit from interventions to reduce this vulnerability

Views and experiences of men who have sex with men on the ban on blood donation: a cross sectional survey with qualitative interviews.

OBJECTIVE: To explore compliance with the UK blood services' criterion that excludes men who have had penetrative sex with a man from donating blood, and to assess the possible effects of revising this policy. DESIGN: A random location, cross sectional survey followed by qualitative interviews. SETTING: Britain. PARTICIPANTS: 1028 of 32,373 men in the general population reporting any male sexual contact completed the survey. Additional questions were asked of a general population sample (n=3914). Thirty men who had had penetrative sex with a man participated in the qualitative interviews (19 who had complied with the blood services' exclusion criterion and 11 who had not complied). Main outcome measure Compliance with the blood services' lifetime exclusion criterion for men who have had penetrative sex with a man. RESULTS: 10.6% of men with experience of penetrative sex with a man reported having donated blood in Britain while ineligible under the exclusion criterion, and 2.5% had donated in the previous 12 months. Ineligible donation was less common among men who had had penetrative sex with a man recently (in previous 12 months) than among men for whom this last occurred longer ago. Reasons for non-compliance with the exclusion included self categorisation as low risk, discounting the sexual experience that barred donation, belief in the infallibility of blood screening, concerns about confidentiality, and misunderstanding or perceived inequity of the rule. Although blood donation was rarely viewed as a "right," potential donors were seen as entitled to a considered assessment of risk. A one year deferral since last male penetrative sex was considered by study participants to be generally feasible, equitable, and acceptable. CONCLUSIONS: A minority of men who have sex with men who are ineligible to donate blood under the current donor exclusion in Britain have nevertheless done so in the past 12 months. Many of the reasons identified for non-compliance seem amenable to intervention. A clearly rationalised and communicated one year donor deferral is likely to be welcomed by most men who have sex with men

Indicators for the management of coral reefs and their applications to marine protected areas

Informed planning and decision-making in the management of natural resources requires an ability to integrate complex interactions in ecosystems and communicate these effectively to stakeholders. This involves coping with three fundamental dilemmas. The first comes from the irregular pulse of nature. The second is the recognition that there are no strictly objective criteria for judging the “well-being” of an ecosystem. The third is posed by the quest for indicators with some integrative properties that may be used to analyze an ecosystem and impart the information to the relevant resource users. This paper presents some examples of indicators used to: 1) assess the status of a coral reef and, in particular, the state of its fisheries resources; 2) identify reefs that are most threatened by human activities; and 3) evaluate the likelihood of success of management interventions. These indicators are not exhaustive, but illustrate the range of options available for the management of coral reef ecosystems.Marine parks, Coral reefs, Fishery resources

The Instructional Perspectives of Community College Mathematics Faculty

This study investigated the beliefs, feelings, and behaviors of full-time mathematics faculty at community colleges in a Midwestern state. The online questionnaire for this study included the modified Instructional Perspectives Inventory [IPI] (Henschke, 1989; Stanton, 2005). The subscales of the IPI are: (1) Teacher empathy with learners; (2) Teacher trust of learners; (3) Planning and delivery of instruction; (4) Accommodating learner uniqueness; (5) Teacher insensitivity toward learners; (6) Experience-based learning techniques; and, (7) Teacher-centered learning processes. Approximately 23.4% of invited participants responded to the survey, yielding a sample size of 34. Statistical analyses included calculations of mean, standard deviation, and standard error for summative subscale scores and summative overall IPI scores. Using a rankings scale proposed by Stanton (2005) [ Low below average , below average , average , above average , high above average ], all groups for this study were found to be average or below average in the application of andragogical / adult education principles. Analyses of Variance (ANOVA\u27s) revealed statistically significant differences for subscales one, two, four, five, and for summative overall IPI scores. Using a reliability rating scale suggested by George and Mallery (as cited in Gliem & Gliem, 2003, p. 87), subscales one through six were interpreted as having good or acceptable internal consistency. Subscale seven was found to have questionable consistency for this population. Recommendations for future research with the IPI include a consideration of the influence of gender, a calculation and interpretation of Cronbach\u27s alpha reliability coefficient and the Spearman-Brown prophecy coefficient, and the inclusion of a qualitative research component

Cross-comparison of MRCGP & MRCP(UK) in a database linkage study of 2,284 candidates taking both examinations: assessment of validity and differential performance by ethnicity.

MRCGP and MRCP(UK) are the main entry qualifications for UK doctors entering general [family] practice or hospital [internal] medicine. The performance of MRCP(UK) candidates who subsequently take MRCGP allows validation of each assessment. In the UK, underperformance of ethnic minority doctors taking MRCGP has had a high political profile, with a Judicial Review in the High Court in April 2014 for alleged racial discrimination. Although the legal challenge was dismissed, substantial performance differences between white and BME (Black and Minority Ethnic) doctors undoubtedly exist. Understanding ethnic differences can be helped by comparing the performance of doctors who take both MRCGP and MRCP(UK)

Mental Health of Children and Young People in England, 2017: Trends and characteristics

This survey series provides England’s best source of data on trends in child mental health. Emotional, behavioural, hyperactivity, and other types of mental disorder were assessed in 5 to 15 year olds in 1999, 5 to 16 year olds in 2004, and 5 to 19 year olds in 2017. One in eight (12.8%) 5 to 19 year olds had a mental disorder when assessed in 2017. Rates were similar in boys and girls. Data for 5 to 15 year olds show a slight upward trend over time in the prevalence of emotional disorders.Rates for behavioural, hyperactivity and other disorders have remained broadly stable

UK pension sustainability and fund manager governance: agent duties to the principal

Sustainable investing includes the application of non-financial (Environmental, Social and Governance (ESG)) criteria to asset selection in institutional investor portfolios (Capelle-Blancard and Mojon 2011). The article explores the implications for applying ESG screening to the institutional investors making the asset selections. Institutional investors are a heterogeneous group of investors, with fund managers specifically being some of the largest listed organisations globally (Ingley and van der Walt 2004). Whether their own corporate management duties to fiduciary governance (the G in ESG) benefiting their shareholders has any material impact on the financial returns outcomes of the pension asset management contract, and specifically whether there is a fiduciary conflict favouring of the exclusive best interest of fund management shareholders is the question addressed by the paper