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Abstract
BackgroundMisconduct during medical school predicts subsequent fitness to practise (FtP) events in doctors, but relatively little is known about which factors are associated with such issues during undergraduate education. This study exploits the newly created UK medical education database (UKMED), with the aim of identifying predictors of conduct or health-related issues that could potentially impair FtP. The findings would have implications for policies related to both the selection and support of medical students.MethodsData were available for 14,379 students obtaining provisional registration with the General Medical Council who started medical school in 2007 and 2008. FtP declarations made by students were available, as were various educational and demographic predictor variables, including self-report ‘personality measures’ for students who participated in UK Clinical Aptitude Test (UKCAT) pilot studies. Univariable and multivariable logistic regression models were developed to evaluate the predictors of FtP declarations.ResultsSignificant univariable predictors (p < 0.05) for conduct-related declarations included male gender, white ethnicity and a non-professional parental background. Male gender (OR 3.07) and higher ‘self-esteem’ (OR 1.45) were independently associated with an increased risk of a conduct issue.Female gender, a non-professional background, and lower self-reported ‘confidence’ were, among others, associated with increased odds of a health-related declaration. Only ‘confidence’ was a significant independent predictor of a health declaration (OR 0.69). Female gender, higher UKCAT score, a non-professional background and lower ‘confidence’ scores were significant predictors of reported depression, and the latter two variables were independent predictors of declared depression.ConclusionsWhite ethnicity and UK nationality were associated with increased odds of both conduct and health-related declarations, as were certain personality traits. Students from non-professional backgrounds may be at increased risk of depression and therefore could benefit from targeted support. The small effect sizes observed for the ‘personality measures’ suggest they would offer little potential benefit for selection, over and above those measures already in use.
Highlights
Misconduct during medical school predicts subsequent fitness to practise (FtP) events in doctors, but relatively little is known about which factors are associated with such issues during undergraduate education
Gender (p = 0.79) and ethnicity (p = 0.80) were not significantly different between the two populations. For those that participated in the non-cognitive trials, Pearson chi-squared tests indicated that older entrants were more likely to have been allocated to the Managing Emotions and Resilience Scales (MEARS) test than the other three non-cognitive tests, and non-white students were more likely to have been randomly allocated to the IVQ33/ITQ50 than another non-cognitive scale
This study has focussed on the predictors of fitness to practise issues declared at provisional registration
Summary
Misconduct during medical school predicts subsequent fitness to practise (FtP) events in doctors, but relatively little is known about which factors are associated with such issues during undergraduate education. This study exploits the newly created UK medical education database (UKMED), with the aim of identifying predictors of conduct or health-related issues that could potentially impair FtP. Previous research suggests that those with conduct issues occurring during undergraduate training may be ‘at risk’ of future censure regarding breaches of professionalism. This is largely based on the findings from North American case-control studies [5,6,7] where medical school concerns were associated with the risk of future professional misconduct. The feasibility of any such screening out approach has been questioned, arguing that even a good test will result in many false positives when prevalence is low
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