The results do show that there are differences between medical schools in the UK on graduate performance in the FRCA examination. A graduate from Oxford, Cambridge, Birmingham, Nottingham and Edinburgh is more likely to pass the primary FRCA at the first attempt than a graduate from Belfast or Dundee. These results are in some agreement with the medical school graduate performance in the MRCP examination[4
] with Oxford, Cambridge, Edinburgh and Newcastle upon Tyne being in the top quartile and Belfast, Dundee, Aberdeen in the bottom quartile of both series.
A study at the University of Liverpool has shown that 5–6 years after graduation, trainees do feel their undergraduate education does impact on their competencies as doctors[10
] and are able to relate their experiences to their undergraduate education, suggesting that undergraduate education has some impact on post graduate performance. In addition there is some correlation with these results and the rankings in the 2008 Times
survey grading medical schools[12
] with the top quartile medical schools (Oxford, Cambridge, Edinburgh, Bristol and Newcastle) being ranked 1,2,3 = 9th
respectively and the bottom quartile medical schools (Sheffield, Aberdeen, Leicester, Dundee and Belfast) being ranked 19th
respectively. However, the performance in post graduate examination does not correlate with career choice as those medical school graduates who are most likely to pursue a career in anaesthesia are from Bristol, Edinburgh and Southampton whilst Oxford and Cambridge graduates are less likely to make that career choice[13
Female graduates are underperforming in both the MCQ and oral parts of the primary FRCA examination compared to male graduates, and are less likely to pass the examination at the first attempt. The underperformance by females has also been found in Parts 1 and 2 of the Membership of the Royal College of Physicians examination (MRCP(UK))[4
], both of which are MCQ type examinations, however they performed better than males in the clinical assessment section (PACES) of the examination[14
]. This is in contrast to performance at medical school where females tend to outperform males[15
] and are more likely to be awarded an honours degree[17
]. In school science examinations male students have historically outperformed female school students although this has recently been reversed[18
]. One reason suggested for this change is that the assessment system in schools now favours female students compared to male students[19
]. The revision strategy of male students of 'cramming-it-all-in-at-the-last-minute' is perhaps less beneficial for assessment throughout the year for modular examinations and coursework, but the "cramming" approach may be best suited for final summative assessments such as postgraduate medical examinations. In 1974 females comprised approximately 27% of those qualifying from medical school[13
], but by 1991 50% of the medical student population were female and by 2005 constituted 61% of the undergraduate student population[20
]. So after years of underrepresentation, females now outnumber males[21
] in the medical workforce in the UK: Although overall 44.8% of candidates were female in this study their representation increased for each year of qualification, such that for those qualifying after 2002 58% were female; this is similar to the 58% of doctors who were female who responded to a BMA survey[22
] in 2006. The primary FRCA examination format has not changed during the period of the study, however other factors may affect gender performance such as part time training, which may lead to difficulties with career progression[23
] although this has been disputed[24
], and the stresses involved in achieving a satisfactory work-life balance[20
]. However, there are concerns that negative marking, which is intended to correct for guessing, may discriminate between students on their risk taking behaviour[25
] and as female students are less likely to take risks[26
] this could lead to gender bias. The RCA is aware of these concerns and negative marking has been replaced by number-right scoring in all its examinations from September 2008.
The Universities of Manchester, Glasgow and Liverpool introduced integrated problem-based learning curricula replacing their traditional lecture based courses in 1994 and 1996 respectively. There have been concerns expressed about these recent reforms [27
] in UK medical education and fears that moving to a PBL system may have a negative impact on the basic science knowledge of PBL graduates which may impact on the ability of PBL to pass science based postgraduate exams[28
]. These results suggest that reforming a medical curriculum from a traditional course to an integrated PBL in the UK does not impact on the ability of graduates to undertake science based post graduate examinations; this is confirmed by results from studies in North America[30
] which have also shown there are no significant differences between PBL and traditional graduates on their licensing exams. Although there is variation in the content of medical school curricula in the UK, all medical schools have to incorporate the recommendations of Tomorrow's Doctors
]into their curricula but this data confirms that some elements of performance do not change.
There was a highly significant correlation between the 3 parts of the MCQ. It would be expected that all candidates would have prior knowledge of physiology and pharmacology, but it is unlikely that any of the candidates will have been taught and examined on physics with clinical measurement. This therefore tests their ability to attain and apply new knowledge and it would be expected that students who do well in this area would also be better able to apply previous physiology or pharmacology knowledge from their undergraduate education.
There are some limitations to the study. Only a small percentage of medical graduates will take the anaesthesia examinations, therefore performance in these examinations cannot be extrapolated to all post graduate examinations. Although the recent introduction of Modernising Medical Careers (MMC) for postgraduate medical education has resulted in some reform of medical training in the UK, this will have had little impact on the results of this study as the pre and post MMC trainees have experienced similar training pathways. However, the exposure of undergraduates to anaesthesia will vary between medical schools; for instance, with the advent of student selected components into undergraduate curricula students can voluntarily undertake an undergraduate attachment in anaesthesia. In addition MMC has allowed foundation doctors the opportunity to take a short rotation in anaesthesia, or a related specialty such as intensive care medicine; exposure that would more likely lead to a career in the speciality, but would not necessarily lead to an improvement in overall results. A confounding factor may be that even if graduates remain close to their medical school where they qualified the differences in performance may rather reflect the quality of postgraduate course available for anaesthesia trainees in that locality.