Abstract

BackgroundThe 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.MethodWe 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.ResultsGraduates 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.ConclusionCandidates 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.

Highlights

  • 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

  • The Education Committee of the General Medical Council (GMC), in its wide-ranging report of June 2006, Strategic Options for Undergraduate Education in the United Kingdom [1], highlighted the lack of information available to assess whether graduates from different UK universities vary significantly in the knowledge, skills or behaviours which are likely to be relevant to their future competence or performance as doctors

  • Candidates who had been qualified for a longer time performed significantly worse at Part 1 (t = 4.393, p = 0.000011), Part 2 (t = 32.1, p < 10-12) and PACES (t = 4.471, p = 0.000007); see Figures S1–3 in Additional file 1

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Summary

Introduction

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. Part 1 and Part 2, which are taken sequentially, both consist of best-of-five multiple choice examinations, with Part 1 concentrating on diagnosis, basic management and basic medical science, while Part 2 has longer questions involving more complex data interpretation, including photographic and other visual material, and considers more in-depth issues of diagnosis and management within internal medicine. Both examinations are blue-printed to cover the typical range of acute and chronic conditions presenting in the wide range of patients seen in general medical practice, and the diagnostic, therapeutic and management options which need to considered. As a result the five separate medical schools of the University of London are all recorded as 'London'

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