Abstract
BackgroundSelection 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.MethodsData 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.ResultsCorrelation 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.ConclusionsThe 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.
Highlights
Selection of medical students in the UK is still largely based on prior academic achievement, doubts have been expressed as to whether performance in earlier life is predictive of outcomes later in medical school or post-graduate education
The Academic Backbone is conceptualized in terms of the development of more sophisticated underlying structures of knowledge (‘cognitive capital’ and ‘medical capital’)
Analysis of the results concentrated on the correlations and path analyses that make up the Academic Backbone
Summary
Selection of medical students in the UK is still largely based on prior academic achievement, doubts have been expressed as to whether performance in earlier life is predictive of outcomes later in medical school or post-graduate education. Educational and professional achievements later in life often depend on educational and professional attainments earlier in life. This principle was recognized long ago in the context of education, with a 1924 article in the Bulletin of the School of Education of Indiana University saying: ‘the best predictor of future achievement is the level of achievement attained at the time of the prediction. The principle is often stated as: ‘the best predictor of future behaviour is past behaviour’. An early use of the phrase was in the study by Berdie et al [2], who said that: ‘the best predictor of future behavior is past behavior. Correlations between high school and college grade averages are about .50’
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