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

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)

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

Shear-free, Irrotational, Geodesic, Anisotropic Fluid Cosmologies

General relativistic anisotropic fluid models whose fluid flow lines form a shear-free, irrotational, geodesic timelike congruence are examined. These models are of Petrov type D, and are assumed to have zero heat flux and an anisotropic stress tensor that possesses two distinct non-zero eigenvalues. Some general results concerning the form of the metric and the stress-tensor for these models are established. Furthermore, if the energy density and the isotropic pressure, as measured by a comoving observer, satisfy an equation of state of the form $p = p(\mu)$, with $\frac{dp}{d\mu} \neq -\frac{1}{3}$, then these spacetimes admit a foliation by spacelike hypersurfaces of constant Ricci scalar. In addition, models for which both the energy density and the anisotropic pressures only depend on time are investigated; both spatially homogeneous and spatially inhomogeneous models are found. A classification of these models is undertaken. Also, a particular class of anisotropic fluid models which are simple generalizations of the homogeneous isotropic cosmological models is studied.Comment: 13 pages LaTe

A methodology to understand student choice of Higher Education Institutions: the case of the United Kingdom

The need to understand how prospective students decide which Higher Education Institution to attend is becoming of paramount importance as the policy context for Higher Education moves towards market-based systems in many countries. This paper provides a novel methodology by which student preferences between institutions can be assessed, using the UK as a case study. It applies both revealed preference and discrete choice modelling techniques to estimate the priority attributes and potential trade-offs of students choosing between different United Kingdom universities. Whereas the former methodology has the advantage of being based on actual decisions, the latter provides an experimental setting for more nuanced findings to be elicited; the combination of approaches allows for a rich and detailed set of results. This methodology can also be used to ask detailed strategic questions of higher education institutions, and further applied to other international markets

Self-monitoring for improving control of blood pressue in patients with hypertension

The objective of this review is to determine the effect of SBPM in adults with hypertension on blood pressure control as compared to OBPM or usual care

Meta-analytic findings reveal lower means but higher variances in visuospatial ability in dyslexia

Conflicting empirical and theoretical accounts suggest that dyslexia is associated with either average, enhanced, or impoverished high-level visuospatial processing relative to controls. Such heterogeneous results could be due to the presence of wider variability in dyslexic samples, which is unlikely to be identified at the single study level, due to lack of power. To address this, the current study reports a meta-analysis of means and variances in high-level visuospatial ability in 909 non-dyslexic and 956 dyslexic individuals. The findings suggest that dyslexia is associated not only with a lower mean performance on visuospatial tasks, but also with greater variability in performance. Through novel meta-analytic techniques, we demonstrate a negative effect size for mean differences (-.457), but a positive effect size for SD differences (+.118; SD ratio = 1.107). In doing so, this is the first study to demonstrate impoverished visuospatial processing of the majority of individuals with dyslexia in addition to greater variance in performance in this group. The findings advocate for further consideration of both the presence of, and reasons for, increased variance in perception, attention and memory across neurodevelopmental disorders

Graduates of different UK medical schools show substantial differences in performance on MRCP(UK) Part 1, Part 2 and PACES examinations

Background: The UK General Medical Council has emphasized the lack of evidence on whether graduates from different UK medical schools perform differently in their clinical careers. Here we assess the performance of UK graduates who have taken MRCP( UK) Part 1 and Part 2, which are multiple-choice assessments, and PACES, an assessment using real and simulated patients of clinical examination skills and communication skills, and we explore the reasons for the differences between medical schools. Method: We perform a retrospective analysis of the performance of 5827 doctors graduating in UK medical schools taking the Part 1, Part 2 or PACES for the first time between 2003/2 and 2005/3, and 22453 candidates taking Part 1 from 1989/1 to 2005/3. Results: Graduates of UK medical schools performed differently in the MRCP( UK) examination between 2003/2 and 2005/3. Part 1 and 2 performance of Oxford, Cambridge and Newcastle-upon-Tyne graduates was significantly better than average, and the performance of Liverpool, Dundee, Belfast and Aberdeen graduates was significantly worse than average. In the PACES ( clinical) examination, Oxford graduates performed significantly above average, and Dundee, Liverpool and London graduates significantly below average. About 60% of medical school variance was explained by differences in pre-admission qualifications, although the remaining variance was still significant, with graduates from Leicester, Oxford, Birmingham, Newcastle-upon-Tyne and London overperforming at Part 1, and graduates from Southampton, Dundee, Aberdeen, Liverpool and Belfast underperforming relative to pre-admission qualifications. The ranking of schools at Part 1 in 2003/2 to 2005/3 correlated 0.723, 0.654, 0.618 and 0.493 with performance in 1999-2001, 1996-1998, 1993-1995 and 1989-1992, respectively. Conclusion: Candidates from different UK medical schools perform differently in all three parts of the MRCP( UK) examination, with the ordering consistent across the parts of the exam and with the differences in Part 1 performance being consistent from 1989 to 2005. Although pre-admission qualifications explained some of the medical school variance, the remaining differences do not seem to result from career preference or other selection biases, and are presumed to result from unmeasured differences in ability at entry to the medical school or to differences between medical schools in teaching focus, content and approaches. Exploration of causal mechanisms would be enhanced by results from a national medical qualifying examination