1188 students registered over the five-year entry period and 75 (6%) had failed to graduate by June 2010. Two were still on the course so excluded from further analysis. There were no statistically significant differences in terms of observed socio-demographics at course entry (sex, domicile, age group or declared disability) between those who failed to complete and those who completed despite difficulties [6
]. Examination of their A-level grades showed that 63/69 (91%) had at least two A grades and the majority (41/69, 59%) at least three (no data for four students).
Of the remaining 73, 61 left the course voluntarily and 12 had their courses terminated in Year 1 or 2 for academic failure. The highest rates of attrition were in the early years of the course, as shown in Figure
Timing of course attrition during the five academic year divisions, for 73 students who failed to complete the course.
We examined the patterns and reasons for attrition on a yearly basis. In all cases the year of exit is the academic year of study, regardless of the number of years spent on the course.
There were 24 voluntary withdrawals during Year 1 and eight course terminations for academic failure. Eleven withdrawals were within the first semester, including one who failed to register at all, two who changed their minds about studying medicine within two months, and a third who requested suspension but later withdrew. Six cited personal or family health problems as a reason for withdrawal, and at least 14 transferred to non-medical courses. Reasons for withdrawals, and subsequent career choices, were not always evident in the course files.
Five students repeated the first year, two for health reasons and three after appealing against termination decisions. Of the five, only two proceeded to Year 2, with two withdrawing and one subsequently removed for academic failure. A further three students restarted the course in the following academic year after voluntary suspension, two for personal or family health problems and one who felt too young to be on the course. Two later withdrew and one proceeded after an appeal against termination.
A further seven termination notices were issued after academic failure, three of these students mounting unsuccessful appeals on the basis of family or personal circumstances.
Fourteen students failed to progress beyond Year 2, nine withdrawing and five having their courses terminated. One withdrawal had already repeated Year 1 for academic failure, and another had performed poorly and failed to engage with Faculty support. Three had passed Year 1 but withdrew for personal reasons, one financial and two not happy on the course. Four students withdrew after course suspension, all with health or family problems. The terminations included two students who had been suspended in Semester 3 for academic failure and personal issues, then re-started Year 2. Overall, ten of these students had failed Year 1 exams and at least six appeared to have lost motivation for a medical career.
Pre-admission features of those who left in years 1 and 2
We reviewed the pre-admission qualifications and interview data for these 46 students who left the course so early. Of the Year 1 leavers, 19/32 (59%) were female, and 5 (16%) domiciled overseas. One was a graduate. The majority of the students (25/32, 78%) had been given normal conditional offers after interviews in December-March; three had unconditional places (1 graduate and 2 overseas students admitted under special arrangements); one was a Reserve offer, and three were late offers made in July-August after earlier rejection. Interview data was missing for four students (two overseas, one graduate, and one late offer). 24 had interview scores, 19 of these being 14/16 or more, and the remainder 12 or 13. Of the four with interview grades, three were AAA and the other ABA.
Eight of the 14 further leavers in Year 2 were female (57%) and two overseas (14%), including one graduate. There was one unconditional offer (graduate) and one late offer, the rest being normal conditional offers. All but one had a score or grade shown, with nine scoring at least 14/16, and three having AAA interview grades.
When the brief comments made at interview were considered, there were few with any notion of concern about the applicant’s commitment, motivation, insight and overall suitability. The only ones noted were “Empathy: didn’t mention listening”; “Empathy: slight self-centred example given”, and ”pleasant, not enormously focused, general insight fair”. The majority were very positive, such as “outstanding”; make offer, very good”; ”motivated, articulate, insight, mature”; “good communicator, team player”.
Attrition later in the course
Sixteen students left the course at the end of the third year, mostly with good academic records. Four gained a first-class BMedSci degree, two choosing to complete their clinical course elsewhere and two moving to a research career. Of the remaining 12 (nine with an upper second and three a lower second), two withdrew for a non-medical course and one transferred elsewhere for personal reasons. Eight students took suspensions to re-consider their options before withdrawing. Mental health issues affected at least six students who decided to leave the course at this point.
Six students withdrew in the fourth academic year. Four had good academic records and 2.1 degrees, but three of these had long-standing mental health problems and the fourth decided against a medical career. A fifth student had a poorer academic record and finally disclosed health problems and transferred to another course. The sixth had a very poor academic record with disrupted progress and a multitude of non-academic difficulties.
Of even greater concern are five students who withdrew during the final year of the course. Two had good academic records, but succumbed to recurrent mental health problems. Both took time out for treatment but then withdrew. The other three had a history of academic problems in Years 1 and 2. Two eventually failed Finals before withdrawing, and the other withdrew after suspension for health and personal reasons. Two of the three failed to engage with Faculty support.
Interview grades and scores were examined. Of those exiting in Year 3, all had good scores, with positive comments where recorded, with the exception of one. This student was a late interviewee, noted to be “quiet, introverted”, and subsequently suffered mental health difficulties and withdrew.
Amongst the Year 4 leavers, the student with the poorest academic record had been a late interviewee but scored 14/16 and said to be “bright, mature”. One student with mental health problems had a known pre-admission history. Two of the Year 5 withdrawals had been late interviewees, one said to be “very able and pleasant”, the other “bright, articulate, insight, talks well”.
Other factors affecting students
The data collected suggested that social isolation may also be a significant factor in a small number of students, for example for an overseas student who fails to settle within a peer group, or for any student who lives at home rather than alongside their peers, thereby missing some of the camaraderie of student existence.
There was no numerical evidence that overseas students were more at risk of attrition, but anecdotally we know that a few make very strenuous efforts to stay on the course, sometimes under pressure from family or sponsoring governments. Financial problems may have contributed to students’ difficulties but did not feature in the recorded data. Two late-course leavers disclosed family pressures to read medicine.
Summary of results
It proved difficult to categorise the reasons for early course exit. In many cases the line between voluntary withdrawal and academic failure was blurred because some students ‘went before they were pushed’, and others transferred out unexpectedly or before sitting exams. However, Table
gives a best estimate of the withdrawals over the entire course, and shows the extent of associated health and/or personal issues. Voluntary withdrawals occur throughout the course but especially in the first year, and it seems that some students who realise they have made the wrong decision make an early and positive decision to transfer elsewhere. Withdrawal in the clinical course may be inevitable for students with ongoing health problems despite support and ‘time out’ for recovery. Fear of ‘black-marking’ may have deterred some from seeking earlier help, and external pressure to read medicine may eventually be disclosed as a contributory factor.
Summary of course attrition during the five academic year divisions, for 73 students who failed to complete the course