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

Ecologically sustainable noise barrier – further developments

This paper reports on the second phase of a research project aimed at the development of an environmentally friendly noise barrier for urban freeways, also known as KMAK (Krezel and McManus, 2007). The concrete barrier, which has some unique capabilities to mitigate transportation noise, is made from recycled concrete (RC) aggregate and industrial by-products such as fly ash and reclaimed water. The current developmental work expands on a research project that resulted in a two-layer (2L) concrete barrier. Two prototypes of the 2L barrier were produced, followed by extensive acoustic testing and a number of simulations where standard timber and/or concrete barriers were substituted with KMAK barrier (Krezel et al, 2004). Current research investigates a variety of architectural finishes applied to the original KMAK barrier with the aim of improving its visual appearance and also fine-tuning its acoustic performance. The new three-layer (3L) barrier optimises sound absorption in a frequency range characteristic to that of transportation noise, especially road traffic noise. Three major aspects related to the development of architectural finishes were considered; environmentally responsible materials, surface features and production methods. The light-weight material used in the architectural finish is based on ordinary Portland cement (OPC) and uses very fine fraction of RC aggregate. The manufacturing process of the 3L barrier was tested in a commercial setting and two sets of prototype barrier were cast. An innovative, cost effective method of applying pattern and perforation to the surface of architectural finish was also developed and tested. The findings of the current investigation demonstrate that there is a positive correlation between surface features, percentage of perforation as well as depth of the architectural layer and increased potential of the 3L barrier to mitigate transportation noise. On average, the addition of perforated architectural finish contributes to 20% increase in sound absorption. The preliminary results also show that the sound absorbency of the 3L barrier can be better controlled and tuned to specific noise frequency. The visual appearance has been significantly improved with the addition of the architectural finish, which makes the barrier an attractive, feasible and viable alternative to road barriers made from standard concrete or timber.<br /

The ranking of factors influencing the behaviour of light structures on expansive soils in Victoria, Australia

In this paper a Neural Network Model was used to develop a ranking of the potential damage influences for light structures on expansive soils in Victoria. These influences include geology, Thornthwaite moisture index, vegetation covers, construction foundation type, construction wall type, geographical region and age of building when first inspected. Approximately 400 cases of damage to light structures in Victoria, Australia were considered in this study. Feedforward Backpropagation was adopted to train the data. The ranking of importance was estimated using connection weight approach and then compared to results calculated from sensitivity analysis. From the analysis, the ranking of importance for potential damage factor was noted.<br /

Receptor for Fc on the surfaces of schistosomes

Schistosoma mansoni masks its surface with adsorbed host proteins including erythrocyte antigens, immunoglobulins, major histocompatibility complex class I, and beta (2)-microglobulin (beta (2)m), presumably as a means of avoiding host immune responses, How this is accomplished has not been explained. To identify surface receptors for host proteins, we biotinylated the tegument of live S, mansoni adults and mechanically transformed schistosomula and then removed the parasite surface with detergent, Incubation of biotinylated schistosome surface extracts witt l human immunoglobulin G (IgG) Fc-Sepharose resulted in purification of a 97-kDa protein that was subsequently identified as paramyosin (Pmy), using antiserum specific for recombinant Pmy, Fc also bound recombinant S. mansoni Pmy and native S. japonicum Pmy, Antiserum to Pmy decreased the binding of Pmy to Fc-Sepharose, and no proteins bound after removal of Pmy from extracts. Fluoresceinated human Fe bound to the surface, vestigial penetration glands, and nascent oral cavity of mechanically transformed schistosomula, and rabbit anti-Pmy Fab fragments ablated the binding of Fc to the schistosome surface, Pmy coprecipitated with host IgG from parasite surface extracts, indicating that complexes formed on the parasite surface as well as in vitro. Binding of Pmy to Fe was not inhibited by soluble protein A, suggesting that Pmy does not bind to the region between the CH2 and CH3 domains used by many other Fc-binding proteins. beta (2)m did not bind to the schistosome Fc receptor (Pmy), a finding that contradicts reports from earlier workers but did bind to a heteromultimer of labeled schistosomula surface proteins, This is the first report of the molecular identity of a schistosome Fc receptor; moreover it demonstrates an additional aspect of the unusual and multifunctional properties of Pmy from schistosomes and other parasitic flatworms

Data mining techniques for the assessment of factors contributing to the damage of residential houses in Australia

This paper reports on the preparation and management processes of inconsistent data on damage on residential houses in Victoria, Australia. There are no existing specific and fully relevant databases readily available except for the incomplete paper-based and electronic-based reports. Therefore, the extracting of information from the reports is complicated and time consuming in order to extract and include all the necessary information needed for analysis of damage on residential houses founded on expansive soils. Data mining is adopted to develop a database. Statistical methods and Artificial Intelligence methods are used to quantify the quality of data. The paper concludes that the development of such database could enable BHC to evaluate the usefulness of the reports prepared on the reported damage properties for further analysis