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1.  Profiling strugglers in a graduate-entry medicine course at Nottingham: a retrospective case study 
BMC Medical Education  2012;12:124.
Background
10-15% of students struggle at some point in their medicine course. Risk factors include weaker academic qualifications, male gender, mental illness, UK ethnic minority status, and poor study skills. Recent research on an undergraduate medicine course provided a toolkit to aid early identification of students likely to struggle, who can be targeted by established support and study interventions. The present study sought to extend this work by investigating the number and characteristics of strugglers on a graduate-entry medicine (GEM) programme.
Methods
A retrospective study of four GEM entry cohorts (2003–6) was carried out. All students who had demonstrated unsatisfactory progress or left prematurely were included. Any information about academic, administrative, personal, or social difficulties, were extracted from their course progress files into a customised database and examined.
Results
362 students were admitted to the course, and 53 (14.6%) were identified for the study, of whom 15 (4.1%) did not complete the course. Students in the study group differed from the others in having a higher proportion of 2ii first degrees, and scoring less well on GAMSAT, an aptitude test used for admission. Within the study group, it proved possible to categorise students into the same groups previously reported (struggler throughout, pre-clinical struggler, clinical struggler, health-related struggler, borderline struggler) and to identify the majority using a number of flags for early difficulties. These flags included: missed attendance, unsatisfactory attitude or behaviour, health problems, social/family problems, failure to complete immunity status checks, and attendance at academic progress committee.
Conclusions
Problems encountered in a graduate-entry medicine course were comparable to those reported in a corresponding undergraduate programme. A toolkit of academic and non-academic flags of difficulty can be used for early identification of many who will struggle, and could be used to target appropriate support and interventions.
doi:10.1186/1472-6920-12-124
PMCID: PMC3567936  PMID: 23249471
Graduate-entry medicine struggler identification flags UK
2.  Development of a 'toolkit' to identify medical students at risk of failure to thrive on the course: an exploratory retrospective case study 
BMC Medical Education  2011;11:95.
Background
An earlier study at Nottingham suggested that 10-15% of the medical student intake was likely to fail completely or have substantial problems on the course. This is a problem for the students, the Faculty, and society as a whole. If struggling students could be identified early in the course and additional pastoral resources offered, some of this wastage might be avoided. An exploratory case study was conducted to determine whether there were common indicators in the early years, over and above academic failure, that might aid the identification of students potentially at risk.
Methods
The study group was drawn from five successive cohorts. Students who had experienced difficulties were identified in any of four ways: from Minutes of the Academic Progress Committee; by scanning examination lists at key stages (end of the first two years, and finals at the end of the clinical course); from lists of students flagged to the Postgraduate Deanery as in need of extra monitoring or support; and from progress files of those who had left the course prematurely. Relevant data were extracted from each student's course progress file into a customised database.
Results
1188 students were admitted over the five years. 162 (14%) were identified for the study, 75 of whom had failed to complete the course by October 2010. In the 87 who did graduate, a combination of markers in Years 1 and 2 identified over half of those who would subsequently have the most severe problems throughout the course. This 'toolkit' comprised failure of 3 or more examinations per year, an overall average of <50%, health or social difficulties, failure to complete Hepatitis B vaccination on time, and remarks noted about poor attitude or behaviour.
Conclusions
A simple toolkit of academic and non-academic markers could be used routinely to help identify potential strugglers at an early stage, enabling additional support and guidance to be given to these students.
doi:10.1186/1472-6920-11-95
PMCID: PMC3229499  PMID: 22098629
3.  Non-cognitive characteristics predicting academic success among medical students in Sri Lanka 
BMC Medical Education  2012;12:66.
Background
To identify non-cognitive and socio-demographic characteristics determining academic success of Sri Lankan medical undergraduates.
Methods
A retrospective study among 90 recently graduated students of the Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka. Students were stratified into two equal groups; ‘High-achievers’ (honours degree at the final MBBS examination) and ‘Low-achievers’ (repeated one or more subjects at the same examination). A revised version of the Non-cognitive Questionnaire (NQ) with additional socio-demographic data was the study instrument. Academic performance indicator was performance at the final MBBS examinations. A binary logistic regression analysis was performed using the dichotomous variable ‘Honours degree at final MBBS’ as the dependant factor.
Results
Males were 56.7%. Mean age ± SD was 26.4 ± 0.9 years. ‘High-achievers’ were significantly younger than ‘Low-achievers’. Significant proportion of ‘High-achievers’ were from the Western province and selected to university from Colombo district. A significant majority of ‘High-achievers’ entered medical school from their first attempt at GCE A/L examination and obtained ‘Distinctions’ at the GCE A/L English subject. ‘High-achievers’ demonstrated a significantly higher mean score for the following domains of NQ; Positive self-concept and confidence, realistic self-appraisal, leadership, preference of long range goals and academic familiarity.
The binary logistic regression indicates that age, being selected to university from Colombo district, residency in Western province, entering university from GCE A/L first attempt, obtaining a ‘Distinction’ for GCE A/L English subject, higher number of patient-oriented case discussions, positive self-concept and confidence, leadership qualities, preference of long range goals and academic familiarity all significantly increased the odds of obtaining a Honours degree.
Conclusion
A combined system incorporating both past academic performance and non-cognitive characteristics might help improve the selection process and early recognition of strugglers.
doi:10.1186/1472-6920-12-66
PMCID: PMC3547768  PMID: 22863153
Academic performance; Predictors; Non-cognitive characteristics; Medical students; Sri Lanka
4.  Can the 12-item general health questionnaire be used to identify medical students who might ‘struggle’ on the medical course? A prospective study on two cohorts 
BMC Medical Education  2013;13:48.
Background
Students who fail to thrive on the Nottingham undergraduate medical course frequently suffer from anxiety, depression or other mental health problems. These difficulties may be the cause, or the result of, academic struggling. Early detection of vulnerable students might direct pastoral care and remedial support to where it is needed. We investigated the use of the short-form General Health Questionnaire (GHQ-12) as a possible screening tool.
Methods
Two consecutive cohorts (2006 and 2007) were invited to complete the GHQ-12. The questionnaire was administered online, during the second semester (after semester 1 exams) for the 2006 cohort and during the first semester for the 2007 cohort. All data were held securely and confidentially. At the end of the course, GHQ scores were examined in relation to course progress.
Results
251 students entered the course in 2006 and 254 in 2007; 164 (65%) and 160 (63%), respectively, completed the GHQ-12. In both cohorts, the study and non-study groups were very similar in terms of pre-admission socio-demographic characteristics and overall course marks. In the 2006 study group, the GHQ Likert score obtained part-way through the first year was negatively correlated with exam marks during Years 1 and 2, but the average exam mark in semester 1 was the sole independent predictor of marks in semester 2 and Year 2. No correlations were found for the 2007 study group but the GHQ score was a weak positive predictor of marks in semester 2, with semester 1 average exam mark again being the strongest predictor. A post-hoc moderated-mediation analysis suggested that significant negative associations of GHQ scores with semester 1 and 2 exams applied only to those who completed the GHQ after their semester 1 exams. Students who were identified as GHQ ‘cases’ in the 2006 group were statistically less likely to complete the course on time (OR = 4.74, p 0.002). There was a non-significant trend in the same direction in the 2007 group.
Conclusions
Results from two cohorts provide insufficient evidence to recommend the routine use of the GHQ-12 as a screening tool. The timing of administration could have a critical influence on the results, and the theoretical and practical implications of this finding are discussed. Low marks in semester 1 examinations seem be the best single indicator of students at risk for subsequent poor performance.
doi:10.1186/1472-6920-13-48
PMCID: PMC3616988  PMID: 23548161
5.  Association of Medical Students' Reports of Interactions with the Pharmaceutical and Medical Device Industries and Medical School Policies and Characteristics: A Cross-Sectional Study 
PLoS Medicine  2014;11(10):e1001743.
Aaron Kesselheim and colleagues compared US medical students' survey responses regarding pharmaceutical company interactions with the schools' AMSA PharmFree scorecard and Institute on Medicine as a Profession's (IMAP) scores.
Please see later in the article for the Editors' Summary
Background
Professional societies use metrics to evaluate medical schools' policies regarding interactions of students and faculty with the pharmaceutical and medical device industries. We compared these metrics and determined which US medical schools' industry interaction policies were associated with student behaviors.
Methods and Findings
Using survey responses from a national sample of 1,610 US medical students, we compared their reported industry interactions with their schools' American Medical Student Association (AMSA) PharmFree Scorecard and average Institute on Medicine as a Profession (IMAP) Conflicts of Interest Policy Database score. We used hierarchical logistic regression models to determine the association between policies and students' gift acceptance, interactions with marketing representatives, and perceived adequacy of faculty–industry separation. We adjusted for year in training, medical school size, and level of US National Institutes of Health (NIH) funding. We used LASSO regression models to identify specific policies associated with the outcomes. We found that IMAP and AMSA scores had similar median values (1.75 [interquartile range 1.50–2.00] versus 1.77 [1.50–2.18], adjusted to compare scores on the same scale). Scores on AMSA and IMAP shared policy dimensions were not closely correlated (gift policies, r = 0.28, 95% CI 0.11–0.44; marketing representative access policies, r = 0.51, 95% CI 0.36–0.63). Students from schools with the most stringent industry interaction policies were less likely to report receiving gifts (AMSA score, odds ratio [OR]: 0.37, 95% CI 0.19–0.72; IMAP score, OR 0.45, 95% CI 0.19–1.04) and less likely to interact with marketing representatives (AMSA score, OR 0.33, 95% CI 0.15–0.69; IMAP score, OR 0.37, 95% CI 0.14–0.95) than students from schools with the lowest ranked policy scores. The association became nonsignificant when fully adjusted for NIH funding level, whereas adjusting for year of education, size of school, and publicly versus privately funded school did not alter the association. Policies limiting gifts, meals, and speaking bureaus were associated with students reporting having not received gifts and having not interacted with marketing representatives. Policy dimensions reflecting the regulation of industry involvement in educational activities (e.g., continuing medical education, travel compensation, and scholarships) were associated with perceived separation between faculty and industry. The study is limited by potential for recall bias and the cross-sectional nature of the survey, as school curricula and industry interaction policies may have changed since the time of the survey administration and study analysis.
Conclusions
As medical schools review policies regulating medical students' industry interactions, limitations on receipt of gifts and meals and participation of faculty in speaking bureaus should be emphasized, and policy makers should pay greater attention to less research-intensive institutions.
Please see later in the article for the Editors' Summary
Editors' Summary
Background
Making and selling prescription drugs and medical devices is big business. To promote their products, pharmaceutical and medical device companies build relationships with physicians by providing information on new drugs, by organizing educational meetings and sponsored events, and by giving gifts. Financial relationships begin early in physicians' careers, with companies providing textbooks and other gifts to first-year medical students. In medical school settings, manufacturers may help to inform trainees and physicians about developments in health care, but they also create the potential for harm to patients and health care systems. These interactions may, for example, reduce trainees' and trained physicians' skepticism about potentially misleading promotional claims and may encourage physicians to prescribe new medications, which are often more expensive than similar unbranded (generic) drugs and more likely to be recalled for safety reasons than older drugs. To address these and other concerns about the potential career-long effects of interactions between medical trainees and industry, many teaching hospitals and medical schools have introduced policies to limit such interactions. The development of these policies has been supported by expert professional groups and medical societies, some of which have created scales to evaluate the strength of the implemented industry interaction policies.
Why Was This Study Done?
The impact of policies designed to limit interactions between students and industry on student behavior is unclear, and it is not known which aspects of the policies are most predictive of student behavior. This information is needed to ensure that the policies are working and to identify ways to improve them. Here, the researchers investigate which medical school characteristics and which aspects of industry interaction policies are most predictive of students' reported behaviors and beliefs by comparing information collected in a national survey of US medical students with the strength of their schools' industry interaction policies measured on two scales—the American Medical Student Association (AMSA) PharmFree Scorecard and the Institute on Medicine as a Profession (IMAP) Conflicts of Interest Policy Database.
What Did the Researchers Do and Find?
The researchers compared information about reported gift acceptance, interactions with marketing representatives, and the perceived adequacy of faculty–industry separation collected from 1,610 medical students at 121 US medical schools with AMSA and IMAP scores for the schools evaluated a year earlier. Students at schools with the highest ranked interaction policies based on the AMSA score were 63% less likely to accept gifts as students at the lowest ranked schools. Students at the highest ranked schools based on the IMAP score were about half as likely to accept gifts as students at the lowest ranked schools, although this finding was not statistically significant (it could be a chance finding). Similarly, students at the highest ranked schools were 70% less likely to interact with sales representatives as students at the lowest ranked schools. These associations became statistically nonsignificant after controlling for the amount of research funding each school received from the US National Institutes of Health (NIH). Policies limiting gifts, meals, and being a part of speaking bureaus (where companies pay speakers to present information about the drugs for dinners and other events) were associated with students' reports of receiving no gifts and of non-interaction with sales representatives. Finally, policies regulating industry involvement in educational activities were associated with the perceived separation between faculty and industry, which was regarded as adequate by most of the students at schools with such policies.
What Do These Findings Mean?
These findings suggest that policies designed to limit industry interactions with medical students need to address multiple aspects of these interactions to achieve changes in the behavior and attitudes of trainees, but that policies limiting gifts, meals, and speaking bureaus may be particularly important. These findings also suggest that the level of NIH funding plays an important role in students' self-reported behaviors and their perceptions of industry, possibly because institutions with greater NIH funding have the resources needed to implement effective policies. The accuracy of these findings may be limited by recall bias (students may have reported their experiences inaccurately), and by the possibility that industry interaction policies may have changed in the year that elapsed between policy grading and the student survey. Nevertheless, these findings suggest that limitations on gifts should be emphasized when academic medical centers refine their policies on interactions between medical students and industry and that particular attention should be paid to the design and implementation of policies that regulate industry interactions in institutions with lower levels of NIH funding.
Additional Information
Please access these websites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001743.
The UK General Medical Council provides guidance on financial and commercial arrangements and conflicts of interest as part of its good medical practice document, which describes what is required of all registered doctors in the UK
Information about the American Medical Student Association (AMSA) Just Medicine campaign (formerly the PharmFree campaign) and about the AMSA Scorecard is available
Information about the Institute on Medicine as a Profession (IMAP) and about its Conflicts of Interest Policy Database is also available
“Understanding and Responding to Pharmaceutical Promotion: A Practical Guide” is a manual prepared by Health Action International and the World Health Organization that medical schools can use to train students how to recognize and respond to pharmaceutical promotion
The US Institute of Medicine's report “Conflict of Interest in Medical Research, Education, and Practice” recommends steps to identify, limit, and manage conflicts of interest
The ALOSA Foundation provides evidence-based, non-industry-funded education about treating common conditions and using prescription drugs
doi:10.1371/journal.pmed.1001743
PMCID: PMC4196737  PMID: 25314155
6.  Role of students’ context in predicting academic performance at a medical school: a retrospective cohort study 
BMJ Open  2016;6(3):e010169.
Objectives
This study examines associations between medical students’ background characteristics (postcode-based measures of disadvantage, high school attended, sociodemographic characteristics), and academic achievement at a Russell Group University.
Design
Retrospective cohort analysis.
Setting
Applicants accepted at the University of Liverpool medical school between 2004 and 2006, finalising their studies between 2010 and 2011.
Participants
571 students (with an English home postcode) registered on the full-time Medicine and Surgery programme, who successfully completed their medical degree.
Main outcome measures
Final average at year 4 of the medical programme (represented as a percentage).
Results
Entry grades were positively associated with final attainment (p<0.001). Students from high-performing schools entered university with higher qualifications than students from low-performing schools (p<0.001), though these differences did not persist at university. Comprehensive school students entered university with higher grades than independent school students (p<0.01), and attained higher averages at university, though differences were not significant after controlling for multiple effects. Associations between school type and achievement differed between sexes. Females attained higher averages than males at university. Significant academic differences were observed between ethnic groups at entry level and university. Neither of the postcode-based measures of disadvantage predicted significant differences in attainment at school or university.
Conclusions
The findings of this study suggest that educational attainment at school is a good, albeit imperfect, predictor of academic attainment at medical school. Most attainment differences observed between students either decreased or disappeared during university. Unlike previous studies, independent school students did not enter university with the highest grades, but achieved the lowest attainment at university. Such variations depict how patterns may differ between subjects and higher-education institutions. Findings advocate for further evidence to help guide the implementation of changes in admissions processes and widen participation at medical schools fairly.
doi:10.1136/bmjopen-2015-010169
PMCID: PMC4800134  PMID: 26969642
Fair Access; Widening Participation; Admissions; Medical School; Contextual Data
7.  Weight, socio-demographics, and health behaviour related correlates of academic performance in first year university students 
Nutrition Journal  2013;12:162.
Background
This study aimed to examine differences in socio-demographics and health behaviour between Belgian first year university students who attended all final course exams and those who did not. Secondly, this study aimed to identify weight and health behaviour related correlates of academic performance in those students who attended all course exams.
Methods
Anthropometrics of 101 first year university students were measured at both the beginning of the first (T1) and second (T2) semester of the academic year. An on-line health behaviour questionnaire was filled out at T2. As a measure of academic performance student end-of-year Grade Point Averages (GPA) were obtained from the university’s registration office. Independent samples t-tests and chi 2 -tests were executed to compare students who attended all course exams during the first year of university and students who did not carry through. Uni- and multivariate linear regression analyses were conducted to identify correlates of academic performance in students who attended all course exams during the first year of university.
Results
Students who did not attend all course exams were predominantly male, showed higher increases in waist circumference during the first semester and consumed more French fries than those who attended all final course exams. Being male, lower secondary school grades, increases in weight, Body Mass Index and waist circumference over the first semester, more gaming on weekdays, being on a diet, eating at the student restaurant more frequently, higher soda and French fries consumption, and higher frequency of alcohol use predicted lower GPA’s in first year university students. When controlled for each other, being on a diet and higher frequency of alcohol use remained significant in the multivariate regression model, with frequency of alcohol use being the strongest correlate of GPA.
Conclusions
This study, conducted in Belgian first year university students, showed that academic performance is associated with a wide range of weight and health related behaviours. Future studies should investigate whether interventions aiming at promoting healthy behaviours among students could also have a positive impact on academic performance.
doi:10.1186/1475-2891-12-162
PMCID: PMC3878497  PMID: 24344995
Weight; Health behaviour; Correlates; Academic performance; First year university students
8.  Graduate entry to medicine: widening psychological diversity 
Background
At Nottingham University more than 95% of entrants to the traditional 5-year medical course are school leavers. Since 2003 we have admitted graduate entrants (GEM) to a shortened (4-year) course to 'widen access to students from more disadvantaged backgrounds'. We have recently shown that the GEM course widens academic and socio-demographic diversity of the medical student population. This study explored whether GEM students also bring psychological diversity and whether this could be beneficial.
Methods
We studied: a) 217 and 96 applicants to the Nottingham 5- and 4-year courses respectively, applying in the 2002-3 UCAS cycle, and, b) 246 school leavers starting the 5-year course and 39 graduate entrants to the 4-year course in October 2003. The psychological profiles of the two groups of applicants and two groups of entrants were compared using their performance in the Goldberg 'Big 5' Personality test, the Personal Qualities Assessment (PQA; measuring interpersonal traits and interpersonal values), and the Lovibond and Lovibond measure of depression, anxiety and stress. For the comparison of the Entrants we excluded the 33 school leavers and seven graduates who took the tests as Applicants.
Statistical analyses were undertaken using SPSS software (version 16.0).
Results
Graduate applicants compared to school leaver applicants were significantly more conscientious, more confident, more self controlled, more communitarian in moral orientation and less anxious. Only one of these differences was preserved in the entrants with graduates being less anxious. However, the graduate entrants were significantly less empathetic and conscientious than the school leavers.
Conclusion
This study has shown that school leaver and graduate entrants to medical school differ in some psychological characteristics. However, if confirmed in other studies and if they were manifest in the extreme, not all the traits brought by graduates would be desirable for someone aiming for a medical career.
doi:10.1186/1472-6920-9-67
PMCID: PMC2784445  PMID: 19912642
9.  Medical School Attrition-Beyond the Statistics A Ten Year Retrospective Study 
BMC Medical Education  2013;13:13.
Background
Medical school attrition is important - securing a place in medical school is difficult and a high attrition rate can affect the academic reputation of a medical school and staff morale. More important, however, are the personal consequences of dropout for the student. The aims of our study were to examine factors associated with attrition over a ten-year period (2001–2011) and to study the personal effects of dropout on individual students.
Methods
The study included quantitative analysis of completed cohorts and qualitative analysis of ten-year data. Data were collected from individual student files, examination and admission records, exit interviews and staff interviews. Statistical analysis was carried out on five successive completed cohorts. Qualitative data from student files was transcribed and independently analysed by three authors. Data was coded and categorized and key themes were identified.
Results
Overall attrition rate was 5.7% (45/779) in 6 completed cohorts when students who transferred to other medical courses were excluded. Students from Kuwait and United Arab Emirates had the highest dropout rate (RR = 5.70, 95% Confidence Intervals 2.65 to 12.27;p < 0.0001) compared to Irish and EU students combined. North American students had a higher dropout rate than Irish and EU students; RR = 2.68 (1.09 to 6.58;p = 0.027) but this was not significant when transfers were excluded (RR = 1.32(0.38, 4.62);p = 0.75). Male students were more likely to dropout than females (RR 1.70, .93 to 3.11) but this was not significant (p = 0.079).
Absenteeism was documented in 30% of students, academic difficulty in 55.7%, social isolation in 20%, and psychological morbidity in 40% (higher than other studies). Qualitative analysis revealed recurrent themes of isolation, failure, and despair. Student Welfare services were only accessed by one-third of dropout students.
Conclusions
While dropout is often multifactorial, certain red flag signals may alert us to risk of dropout including non-EU origin, academic struggling, absenteeism, social isolation, depression and leave of absence. Psychological morbidity amongst dropout students is high and Student Welfare services should be actively promoted. Absenteeism should prompt early intervention. Behind every dropout statistic lies a personal story. All medical schools have a duty of care to support students who leave the medical programme.
doi:10.1186/1472-6920-13-13
PMCID: PMC3565981  PMID: 23363547
Medical school attrition; Dropout; Exit interviews; Student welfare services; Academic difficulty; Absenteeism
10.  Should applicants to Nottingham University Medical School study a non-science A-level? A cohort study 
Background
It has been suggested that studying non-science subjects at A-level should be compulsory for medical students. Our admissions criteria specify only Biology, Chemistry and one or more additional subjects. This study aimed to determine whether studying a non-science subject for A-level is an independent predictor of achievement on the undergraduate medical course.
Methods
The subjects of this retrospective cohort study were 164 students from one entry-year group (October 2000), who progressed normally on the 5-year undergraduate medical course at Nottingham. Pre-admission academic and socio-demographic data and undergraduate course marks were obtained. T-test and hierarchical multiple linear regression analyses were undertaken to identify independent predictors of five course outcomes at different stages throughout the course.
Results
There was no evidence that the choice of science or non-science as the third or fourth A-level subject had any influence on course performance. Demographic variables (age group, sex, and fee status) had some predictive value but ethnicity did not. Pre-clinical course performance was the strongest predictor in the clinical phases (pre-clinical Themes A&B (knowledge) predicted Clinical Knowledge, p < 0.001, and pre-clinical Themes C&D (skills) predicted Clinical Skills, p = < 0.01).
Conclusion
This study of one year group at Nottingham Medical School provided no evidence that the admissions policy on A-level requirements should specify the choice of third or fourth subject.
doi:10.1186/1472-6920-9-5
PMCID: PMC2650695  PMID: 19159444
11.  Addition by Subtraction: The Relation Between Dropout Rates and School-Level Academic Achievement 
Teachers College record (1970)  2012;114(8):1-26.
Background/Context
Efforts to improve student achievement should increase graduation rates. However, work investigating the effects of student-level accountability has consistently demonstrated that increases in the standards for high school graduation are correlated with increases in dropout rates. The most favored explanation for this finding is that high-stakes testing policies that mandate grade repetition and high school exit exams may be the tipping point for students who are already struggling academically. These extra demands may, in fact, push students out of school.
Purpose/Objective/Focus
This article examines two hypotheses regarding the relation between school-level accountability and dropout rates. The first posits that improvements in school performance lead to improved success for everyone. If school-level accountability systems improve a school for all students, then the proportion of students performing at grade level increases, and the dropout rate decreases. The second hypothesis posits that schools facing pressure to improve their overall accountability score may pursue this increase at the cost of other student outcomes, including dropout rate.
Research Design
Our approach focuses on the dynamic relation between school-level academic achievement and dropout rates over time—that is, between one year’s achievement and the subsequent year’s dropout rate, and vice versa. This article employs longitudinal data of records on all students in North Carolina public schools over an 8-year period. Analyses employ fixed-effects models clustering schools and districts within years and controls each year for school size, percentage of students who were free/reduced-price lunch eligible, percentage of students who are ethnic minorities, and locale.
Findings/Results
This study finds partial evidence that improvements in school-level academic performance will lead to improvements (i.e., decreases) in school-level dropout rates. Schools with improved performance saw decreased dropout rates following these successes. However, we find more evidence of a negative side of the quest for improved academic performance. When dropout rates increase, the performance composites in subsequent years increase.
Conclusions/recommendations
Accountability systems need to remove any indirect benefit a school may receive from increasing its dropout rate. Schools should be held accountable for those who drop out of school. Given the personal and social costs of dropping out, accountability systems need to place more emphasis on dropout prevention. Such an emphasis could encompass increasing the dropout age and having the school’s performance composite include scores of zero on end-of-grade tests for those who leave school.
PMCID: PMC3763746  PMID: 24013958
12.  Algebra for All: California’s Eighth-Grade Algebra Initiative as Constrained Curricula 
Teachers College record (1970)  2014;116(8):1-32.
Background/Context
Across the United States, secondary school curricula are intensifying as a growing proportion of students enroll in high-level academic math courses. In many districts, this intensification process occurs as early as eighth grade, where schools are effectively constraining their mathematics curricula by restricting course offerings and placing more students into Algebra I. This paper provides a quantitative single-case research study of policy-driven curricular intensification in one California school district.
Research Questions
(1a) What effect did 8th eighth grade curricular intensification have on mathematics course enrollment patterns in Towering Pines Unified schools? (2b) How did the distribution of prior achievement in Towering Pines math classrooms change as the district constrained the curriculum by universalizing 8th eighth grade Algebra? (3c) Did 8th eighth grade curricular intensification improve students’ mathematics achievement?
Setting
Towering Pines is an immigrant enclave in the inner-ring suburbs of a major metropolitan area. The district’s 10 middle schools together enroll approximately 4,000 eighth graders each year. The districts’ students are ethnically diverse and largely economically disadvantaged. The study draws upon administrative data describing 8th eighth graders in the district in the 2004–20-05 through 2007–20-08 school years.
Intervention/Program/Practice
During the study period, Towering Pines dramatically intensified middle school students’ math curricula: In the 2004–20-05 school year 32% of the district’s 8th eighth graders enrolled in Algebra or a higher- level mathematics course; by the 2007–20-08 school year that proportion had increased to 84%.
Research Design
We use an interrupted time-series design, comparing students’ 8th eighth grade math course enrollments, 10th grade math course enrollments, and 10th grade math test scores across the four cohorts, controlling for demographics and prior achievement.
Findings/Results
We find that students’ odds of taking higher level mathematics courses increased as this district implemented the state’s Algebra mandate. However, even as the district implemented a constrained curriculum strategy, mathematics achievement growth between 6th sixth and 10th grade slowed and the achievement advantages associated with 8th eighth grade Algebra declined.
Conclusions/Recommendations
Our analyses suggest that curricular intensification increased the inclusiveness and decreased the selectivity of the mathematics tracking regime in Towering Pines middle schools. However, the findings suggest that this constrained curriculum strategy may have may have unintended negative consequences for student achievement.
PMCID: PMC4479347  PMID: 26120219
13.  A comparison of course-related stressors in undergraduate problem-based learning (PBL) versus non-PBL medical programmes 
Background
Medical students report high levels of stress related to their medical training as well as to other personal and financial factors. The aim of this study is to investigate whether there are differences in course-related stressors reported by medical students on undergraduate problem-based learning (PBL) and non-PBL programmes in the UK.
Method
A cross-sectional study of second-year medical students in two UK medical schools (one PBL and one non-PBL programme) was conducted. A 16-question self-report questionnaire, derived from the Perceived Medical Student Stress Scale and the Higher Education Stress Inventory, was used to measure course-related stressors. Following univariate analysis of each stressor between groups, multivariate logistic regression was used to determine which stressors were the best predictors of each course type, while controlling for socio-demographic differences between the groups.
Results
A total of 280 students responded. Compared to the non-PBL students (N = 197), the PBL students (N = 83) were significantly more likely to agree that: they did not know what the faculty expected of them (Odds Ratio (OR) = 0.38, p = 0.03); there were too many small group sessions facilitated only by students resulting in an unclear curriculum (OR = 0.04, p < 0.0001); and that there was a lack of opportunity to explore academic subjects of interest (OR = 0.40, p = 0.02). They were significantly more likely to disagree that: there was a lack of encouragement from teachers (OR = 3.11, p = 0.02); and that the medical course fostered a sense of anonymity and feelings of isolation amongst students (OR = 3.42, p = 0.008).
Conclusion
There are significant differences in the perceived course-related stressors affecting medical students on PBL and non-PBL programmes. Course designers and student support services should therefore tailor their work to minimise, or help students cope with, the specific stressors on each course type to ensure optimum learning and wellbeing among our future doctors.
doi:10.1186/1472-6920-9-60
PMCID: PMC2759915  PMID: 19747400
14.  A holistic review of the medical school admission process: examining correlates of academic underperformance 
Medical Education Online  2014;19:10.3402/meo.v19.22919.
Background
Despite medical school admission committees’ best efforts, a handful of seemingly capable students invariably struggle during their first year of study. Yet, even as entrance criteria continue to broaden beyond cognitive qualifications, attention inevitably reverts back to such factors when seeking to understand these phenomena. Using a host of applicant, admission, and post-admission variables, the purpose of this inductive study, then, was to identify a constellation of student characteristics that, taken collectively, would be predictive of students at-risk of underperforming during the first year of medical school. In it, we hypothesize that a wider range of factors than previously recognized could conceivably play roles in understanding why students experience academic problems early in the medical educational continuum.
Methods
The study sample consisted of the five most recent matriculant cohorts from a large, southeastern medical school (n=537). Independent variables reflected: 1) the personal demographics of applicants (e.g., age, gender); 2) academic criteria (e.g., undergraduate grade point averages [GPA], medical college admission test); 3) selection processes (e.g., entrance track, interview scores, committee votes); and 4) other indicators of personality and professionalism (e.g., Mayer-Salovey-Caruso Emotional Intelligence Test™ emotional intelligence scores, NEO PI-R™ personality profiles, and appearances before the Professional Code Committee [PCC]). The dependent variable, first-year underperformance, was defined as ANY action (repeat, conditionally advance, or dismiss) by the college's Student Progress and Promotions Committee (SPPC) in response to predefined academic criteria. This study protocol was approved by the local medical institutional review board (IRB).
Results
Of the 537 students comprising the study sample, 61 (11.4%) met the specified criterion for academic underperformance. Significantly increased academic risks were identified among students who 1) had lower mean undergraduate science GPAs (OR=0.24, p=0.001); 2) entered medical school via an accelerated BS/MD track (OR=16.15, p=0.002); 3) were 31 years of age or older (OR=14.76, p=0.005); and 4) were non-unanimous admission committee admits (OR=0.53, p=0.042). Two dimensions of the NEO PI-R™ personality inventory, openness (+) and conscientiousness (−), were modestly but significantly correlated with academic underperformance. Only for the latter, however, were mean scores found to differ significantly between academic performers and underperformers. Finally, appearing before the college's PCC (OR=4.21, p=0.056) fell just short of statistical significance.
Conclusions
Our review of various correlates across the matriculation process highlights the heterogeneity of factors underlying students’ underperformance during the first year of medical school and challenges medical educators to understand the complexity of predicting who, among admitted matriculants, may be at future academic risk.
doi:10.3402/meo.v19.22919
PMCID: PMC3974177  PMID: 24695362
admissions; underperformance; selection; at-risk students
15.  The UK clinical aptitude test and clinical course performance at Nottingham: a prospective cohort study 
BMC Medical Education  2013;13:32.
Background
The UK Clinical Aptitude Test (UKCAT) was introduced in 2006 as an additional tool for the selection of medical students. It tests mental ability in four distinct domains (Verbal Reasoning, Quantitative Reasoning, Abstract Reasoning, and Decision Analysis), and the results are available to students and admission panels in advance of the selection process. Our first study showed little evidence of any predictive validity for performance in the first two years of the Nottingham undergraduate course.
The study objective was to determine whether the UKCAT scores had any predictive value for the later parts of the course, largely delivered via clinical placements.
Methods
Students entering the course in 2007 and who had taken the UKCAT were asked for permission to use their anonymised data in research. The UKCAT scores were incorporated into a database with routine pre-admission socio-demographics and subsequent course performance data. Correlation analysis was followed by hierarchical multivariate linear regression.
Results
The original study group comprised 204/254 (80%) of the full entry cohort. With attrition over the five years of the course this fell to 185 (73%) by Year 5. The Verbal Reasoning score and the UKCAT Total score both demonstrated some univariate correlations with clinical knowledge marks, and slightly less with clinical skills. No parts of the UKCAT proved to be an independent predictor of clinical course marks, whereas prior attainment was a highly significant predictor (p <0.001).
Conclusions
This study of one cohort of Nottingham medical students showed that UKCAT scores at admission did not independently predict subsequent performance on the course. Whilst the test adds another dimension to the selection process, its fairness and validity in selecting promising students remains unproven, and requires wider investigation and debate by other schools.
doi:10.1186/1472-6920-13-32
PMCID: PMC3621812  PMID: 23442227
16.  The value of the UK Clinical Aptitude Test in predicting pre-clinical performance: a prospective cohort study at Nottingham Medical School 
BMC Medical Education  2010;10:55.
Background
The UK Clinical Aptitude Test (UKCAT) was introduced in 2006 as an additional tool for the selection of medical students. It tests mental ability in four distinct domains (Quantitative Reasoning, Verbal Reasoning, Abstract Reasoning, and Decision Analysis), and the results are available to students and admissions panels in advance of the selection process. As yet the predictive validity of the test against course performance is largely unknown.
The study objective was to determine whether UKCAT scores predict performance during the first two years of the 5-year undergraduate medical course at Nottingham.
Methods
We studied a single cohort of students, who entered Nottingham Medical School in October 2007 and had taken the UKCAT. We used linear regression analysis to identify independent predictors of marks for different parts of the 2-year preclinical course.
Results
Data were available for 204/260 (78%) of the entry cohort. The UKCAT total score had little predictive value. Quantitative Reasoning was a significant independent predictor of course marks in Theme A ('The Cell'), (p = 0.005), and Verbal Reasoning predicted Theme C ('The Community') (p < 0.001), but otherwise the effects were slight or non-existent.
Conclusion
This limited study from a single entry cohort at one medical school suggests that the predictive value of the UKCAT, particularly the total score, is low. Section scores may predict success in specific types of course assessment.
The ultimate test of validity will not be available for some years, when current cohorts of students graduate. However, if this test of mental ability does not predict preclinical performance, it is arguably less likely to predict the outcome in the clinical years. Further research from medical schools with different types of curriculum and assessment is needed, with longitudinal studies throughout the course.
doi:10.1186/1472-6920-10-55
PMCID: PMC2922293  PMID: 20667093
17.  Embedding a Learning Management System Into an Undergraduate Medical Informatics Course in Saudi Arabia: Lessons Learned 
Medicine 2.0  2013;2(2):e13.
Background
Public universities in Saudi Arabia today are making substantial investments in e-learning as part of their educational system, especially in the implementation of learning management systems (LMS). To our knowledge, this is the first study conducted in Saudi Arabia exploring medical students’ experience with an LMS, particularly as part of a medical informatics course.
Objective
This study investigates students’ use of various features of the LMS embedded in a recently implemented medical informatics course.
Methods
A mixed methodology approach was employed. Survey questionnaires were distributed to all third year medical informatics students at the end of the course. In addition, two focus group sessions were conducted with twelve students. A thematic analysis of the focus group was performed.
Results
A total of 265 third year medical student surveys (167/265, 63% male and 98/265, 37% female) were completed and analyzed. Overall, 50.6% (134/265) of the students agreed that the course was well planned and up-to-date, had clearly stated objectives and clear evaluation methods, appropriate course assignment, and that the LMS offered easy navigation. Most of the students rated the course as good/fair overall. In general, females were 10.4% more likely to prefer the LMS, as revealed by higher odd ratios (odds ratio [OR] 1.104, 95% CI 0.86-1.42) compared to males. Survey results showed that students’ use of LMS tools increased after taking the course compared to before taking the course. The full model containing all items were statistically significant (χ2 25=69.52, P<.001, n=243), indicating that the model was able to distinguish between students who had positive attitudes towards LMS and those who did not. The focus group, however, revealed that the students used social networking for general use rather than learning purposes, but they were using other Internet resources and mobile devices for learning. Male students showed a higher preference for using technology in general to enhance learning activities. Overall, medical student attitudes towards the LMS were generally positive. Students also wanted a reminder and notification tool to help them stay updated with course events. Interestingly, a subset of students had been running a parallel LMS of their own that has features worth exploring and could be integrated with an official LMS in the future.
Conclusions
To our knowledge, this was the first time that an LMS was used in a medical informatics course. Students showed interest in adapting various LMS tools to enhance their learning and gained more knowledge through familiarity with the tool. Researching an official LMS also revealed the existence of a parallel student-created LMS. This could allow teacher-led and student-led platforms to be integrated in the future for an enhanced student-centered experience.
doi:10.2196/med20.2735
PMCID: PMC4085123  PMID: 25075236
medical education; medical informatics; learning management systems (LMS)
18.  Widening access to medical education for under-represented socioeconomic groups: population based cross sectional analysis of UK data, 2002-6 
Objective To determine whether new programmes developed to widen access to medicine in the United Kingdom have produced more diverse student populations.
Design Population based cross sectional analysis.
Setting 31 UK universities that offer medical degrees.
Participants 34 407 UK medical students admitted to university in 2002-6.
Main outcome measures Age, sex, socioeconomic status, and ethnicity of students admitted to traditional courses and newer courses (graduate entry courses (GEC) and foundation) designed to widen access and increase diversity.
Results The demographics of students admitted to foundation courses were markedly different from traditional, graduate entry, and pre-medical courses. They were less likely to be white and to define their background as higher managerial and professional. Students on the graduate entry programme were older than students on traditional courses (25.5 v 19.2 years) and more likely to be white (odds ratio 3.74, 95% confidence interval 3.27 to 4.28; P<0.001) than those on traditional courses, but there was no difference in the ratio of men. Students on traditional courses at newer schools were significantly older by an average of 2.53 (2.41 to 2.65; P<0.001) years, more likely to be white (1.55, 1.41 to 1.71; P<0.001), and significantly less likely to have higher managerial and professional backgrounds than those at established schools (0.67, 0.61 to 0.73; P<0.001). There were marked differences in demographics across individual established schools offering both graduate entry and traditional courses.
Conclusions The graduate entry programmes do not seem to have led to significant changes to the socioeconomic profile of the UK medical student population. Foundation programmes have increased the proportion of students from under-represented groups but numbers entering these courses are small.
doi:10.1136/bmj.d918
PMCID: PMC3043108  PMID: 21343208
19.  Educational and Career Outcomes of an Internal Medicine Preceptorship for First-Year Medical Students 
OBJECTIVE
Medical educators have attempted in recent years to provide quality clinical experiences for medical students early in their medical training. We questioned whether participating in a preceptorship in internal medicine (PIM) resulted in better performances on subsequent clinical rotations and increased interest in internal medicine.
PARTICIPANTS
Fifty-four students have participated in the PIM to date, with control groups consisting of students who applied for it but were not selected (n = 36), students participating in a preceptorship in family medicine (n = 168), and the remaining students (n = 330).
DESIGN
Prospective cohort study.
SETTING
University medical center and community practices.
INTERVENTION
A 2-month, clinical preceptorship following the first year of medical school.
MEASUREMENTS AND MAIN RESULTS
The following outcomes were assessed: scores in the introduction to clinical medicine course; grades in the medical ethics course; scores from the internal medicine clerkship; and choosing a career in internal medicine. In their second year, PIM students scored higher in both semesters of the introduction to clinical medicine course (87% and 86% vs 84% and 84%, p’s < .01) and were more likely to receive honors in ethics (50% vs 29%, p < .01) than non-PIM students. During the internal medicine clerkship, PIM students’ scores were significantly higher on an objective structured clinical examination (79% vs 76%, p = .05), ambulatory clinical evaluations (80% vs 76%, p < .01), and overall clerkship scores (78% vs 75%, p = .03) but not on inpatient clinical evaluations or on the National Board of Medical Examiners Subject Examination. Preceptorship students were more likely to receive honors grades in the medicine clerkship (33% vs 10%, p < .01), and they were more likely to match into internal medicine residencies than control students (54% vs 27%, p < .01).
CONCLUSIONS
The PIM course is an intervention, early in students’ careers, which appears to benefit them academically and increase their interest in internal medicine as a career.
doi:10.1046/j.1525-1497.1999.00352.x
PMCID: PMC1496599  PMID: 10354253
medical students; clinical competence; curriculum
20.  Predictors of self-reported academic performance among undergraduate medical students of Hawassa University, Ethiopia 
Background
This study was conducted to identify predictors of self-reported academic performance in undergraduate medical students at Hawassa University.
Methods
An analytical cross-sectional study involving 592 undergraduate medical students was conducted in November 2012. The academic performance of the study subjects was measured by self-reported cumulative grade point average (GPA) using a self-administered questionnaire. Data were entered and analyzed using Statistical Package for the Social Sciences version 16 software. Pearson’s bivariate correlations, multiple linear regression, and multiple logistic regression were used to identify predictors of academic performance.
Results
The self-reported academic performance of students had been decreasing as the academic years progressed, with the highest and lowest performance being in the premedicine (mean GPA 3.47) and clinical I (mean GPA 2.71) years, respectively. One hundred and fifty-eight (26.7%) of the participants had ever been delayed, 37 (6.2%) had ever re-sat for examination, and two (0.3%) had ever been warned due to academic failure. The overall variation in self-reported academic performance of the students was 32.8%. Participant age alone explained 21.9% of the variation. On the other hand, university entrance examination results, substance use at university, and medicine as first choice by students were identified as predictors of variation in self-reported academic performance, accounting for 6.9%, 2.7%, and <1% of the variation, respectively. Students who had never used tobacco, alcohol, or khat after starting university were twice as likely to score a self-reported cumulative GPA above 3.0 (adjusted odds ratio 1.95, 95% confidence interval 1.25–3.02) and less likely to be delayed, have to re-sit an examination, or be warned (adjusted odds ratio 0.47, 95% confidence interval 0.29–0.77).
Conclusion
Only 32.8% of the variation in self-reported academic performance was explained by the studied variables. Hence, efficacious mechanisms should be designed to combat the intervenable determinants of self-reported academic performance, like substance use and a low medical school entrance examination result. Further studies should also be undertaken to gain a better understanding of other unstudied determinants, like personality, learning style, cognitive ability, and the system used for academic evaluation.
doi:10.2147/AMEP.S78604
PMCID: PMC4399784  PMID: 25914564
predictors; academic performance; medical students; Ethiopia
21.  Temporal Structure of First-year Courses and Success at Course Exams: Comparison of Traditional Continual and Block Delivery of Anatomy and Chemistry Courses 
Croatian Medical Journal  2009;50(1):61-68.
Aim
To evaluate students’ academic success at the Anatomy and Chemistry courses delivered in a traditional continual course, spread over the two semesters, or in alternating course blocks, in which 1 group of students attended first the Anatomy and then the Chemistry course and vice versa.
Method
We analyzed the data on exam grades for Anatomy and Chemistry courses in the first year of the curriculum for academic year 2001/02, with the traditional continual delivery of the courses (n = 253 for chemistry and n = 243 for anatomy course), and academic year 2003/04, with block delivery of the courses (n = 255 for chemistry and n = 260 for anatomy course). The content of the courses and the teachers were similar in both academic years. Grades from the final examination were analyzed only for students who sat the exam at the first available exam term and passed the course. For the Anatomy block course, grades at 2 interim written tests and 2 parts of the final exam (practical stage exam and oral exam) in each block were analyzed for students who passed all interim tests and the final exam.
Results
There were no differences between the two types of course delivery in the number of students passing the final examination at first attempt. There was a decrease in passing percentage for the two Anatomy block course student groups in 2003/04 (56% passing students in block 1 vs 40% in block 2, P = 0.014). There were no differences in the final examination grade between the 2 blocks for both the Anatomy and Chemistry course, but there was an increase in the average grades from 2001/02 to 2003/04 academic year due to an increase in Chemistry grades (F1,399 = 18.4, P < 0.001, 2 × 2 ANOVA). Grades in Chemistry were significantly lower than grades in Anatomy when courses were delivered in a continual but not in a block format (F1,399 = 35.1, P < 0.001, 2 × 2 ANOVA). When both courses were delivered in a block format there was no effect of the sequence of their delivery (F1,206 = 1.8, P = 0.182, 2 × 2 ANOVA). There was also a significant difference in grades on interim assessments of Anatomy when it was delivered in the block format (F3,85 = 28.8, P < 0.001, between-within subjects 2 × 4 ANOVA) with grades from practical test and oral exam being significantly lower than grades on 2 interim tests that came at the beginning of the block (P < 0.001 for all pair-wise comparisons).
Conclusions
The type of course delivery was not associated with significant differences in student academic success in Anatomy and Chemistry courses in the medical curriculum. Students can successfully pass these courses when they are delivered either in a continual, whole year format or in a condensed time format of a course block, regardless of the number and type of courses preceding the block course.
doi:10.3325/cmj.2009.50.61
PMCID: PMC2657569  PMID: 19260146
22.  Perceptions of pre-clerkship medical students and academic advisors about sleep deprivation and its relationship to academic performance: a cross-sectional perspective from Saudi Arabia 
BMC Research Notes  2015;8:740.
Background
The medical student population is believed to be at an increased risk for sleep deprivation. Little is known about students’ perceptions towards sleep deprivation and its relationship to academic performance. The aim of study is to explore the perceptions of medical students and their academic advisors about sleep deprivation and its relationship to academic performance.
Methods
The study took place at Alfaisal University, College of Medicine, Riyadh, Saudi Arabia. An online, anonymous, cross-sectional, self-rating survey was administered to first-, third-year students and their academic advisors. Two-tailed Mann–Whitney U test was used to compare the mean 5-point Likert scale responses between students according to gender, academic year and cumulative grade point average (cGPA).
Results
A total of 259 students and 21 academic advisors participated in the survey (response rates: 70.6 and 84 %, respectively). The vast majority of students agreed that sleep deprivation negatively affects academic performance (78.8 %) and mood (78.4 %). Around 62.2 and 73.7 % of students agreed that the demanding medical curriculum and stress of final exams lead to sleep deprivation, respectively. While 36.7 % of students voiced the need for incorporation of curricular separate courses about healthy sleep patterns into medical curriculum, a much greater proportion of students (45.9 %) expressed interest in extracurricular activities about healthy sleep patterns. Interestingly, only 13.5 % of students affirmed that they were counselled about sleep patterns and academic performance by their academic advisors. There were several statistically significant differences of means of students’ perceptions according to gender, academic year and cGPA. Despite almost all academic advisors (95.5 %) asserted the importance of sleep patterns to academic performance, none (0 %) inquired about sleep patterns when counselling students. Nineteen academic advisors (90.5 %) recommended incorporation of sleep patterns related learning into medical curricula; among those, only 1 (n = 1/19; 5.3 %) recommended learning as a separate course whereas the majority (n = 18/19; 94.7 %) recommended learning in forms of extracurricular activities and integration into relevant ongoing courses.
Conclusions
Our results showed that students had correct conceptions about the negative impact of sleep deprivation on academic performance and mood. Also, our results highlighted the need for curricular/extracurricular education and counseling about healthy sleep patterns.
doi:10.1186/s13104-015-1755-y
PMCID: PMC4666159  PMID: 26626289
Sleep; Sleep duration; Perceptions; Medical students; Academic performance; Saudi Arabia
23.  Examination performance of graduate entry medical students compared with mainstream students 
Summary
Objectives
To assess whether medical students on graduate entry/fast- track programmes perform as well as students on standard courses.
Design
Retrospective cohort study.
Setting
University of Birmingham Medical School.
Participants
Medical students on graduate entry/fast-track course and standard (5-year) course (‘mainstream’).
Main outcome measures
Examination marks from all assessments taken simultaneously by graduate entry course (GEC) and mainstream course students once the cohorts have combined: i.e. for the final three years of the programme. Honours awards for 2007 and 2008 graduates.
Results
In total 19,263 examination results were analysed from 1547 students. Of these 161 were GEC students and 1386 were mainstream medical students. On average mainstream students, male students, overseas students and students of South Asian ethnicity obtained lower examination marks than graduate entry students, female students, home or EU students and students of non-South Asian ethnicity, respectively. Graduate entry students were significantly more likely to achieve honours degrees than mainstream students.
Conclusion
On average the academic performance of Graduate Entry medical students at the University of Birmingham is better than mainstream medical students.
doi:10.1258/jrsm.2009.090121
PMCID: PMC2755335  PMID: 19797600
24.  The educational background and qualifications of UK medical students from ethnic minorities 
Background
UK medical students and doctors from ethnic minorities underperform in undergraduate and postgraduate examinations. Although it is assumed that white (W) and non-white (NW) students enter medical school with similar qualifications, neither the qualifications of NW students, nor their educational background have been looked at in detail. This study uses two large-scale databases to examine the educational attainment of W and NW students.
Methods
Attainment at GCSE and A level, and selection for medical school in relation to ethnicity, were analysed in two separate databases. The 10th cohort of the Youth Cohort Study provided data on 13,698 students taking GCSEs in 1999 in England and Wales, and their subsequent progression to A level. UCAS provided data for 1,484,650 applicants applying for admission to UK universities and colleges in 2003, 2004 and 2005, of whom 52,557 applied to medical school, and 23,443 were accepted.
Results
NW students achieve lower grades at GCSE overall, although achievement at the highest grades was similar to that of W students. NW students have higher educational aspirations, being more likely to go on to take A levels, especially in science and particularly chemistry, despite relatively lower achievement at GCSE. As a result, NW students perform less well at A level than W students, and hence NW students applying to university also have lower A-level grades than W students, both generally, and for medical school applicants. NW medical school entrants have lower A level grades than W entrants, with an effect size of about -0.10.
Conclusion
The effect size for the difference between white and non-white medical school entrants is about B0.10, which would mean that for a typical medical school examination there might be about 5 NW failures for each 4 W failures. However, this effect can only explain a portion of the overall effect size found in undergraduate and postgraduate examinations of about -0.32.
doi:10.1186/1472-6920-8-21
PMCID: PMC2359745  PMID: 18416818
25.  Second report on the organization of pharmacology in Great Britain 
British Journal of Pharmacology  1974;50(2):163-175.
1 A questionnaire was sent to 150 departments employing pharmacologists including all those academic departments teaching pharmacology, in Great Britain and Northern Ireland, and all industrial firms and research institutes engaged in pharmacological (27) and toxicological (38) work. All questionnaires were completed. The returns refer to the situation on 1st January 1972.
2 There were 1,104 pharmacologists, of whom 652 were established staff, 383 were research staff and students, and 29 visiting workers. Of the staff in established posts, 192 were in medical schools, 81 in other university departments, 75 in other non-university departments and 28 in toxicology departments. Forty pharmacologists were established in other research units.
3 Since 1964, 11 B.Sc. (Pharmacology) courses have been started. In 1971-72 there were 69 students in the final year of all B.Sc. Pharmacology courses. By 1974-75, 134 students are expected in the final year of these courses.
4 Of 413 students specializing in pharmacology who graduated in 1971, 74% had taken a pharmacy qualification. Overall, 26% continued in academic courses, 11% went into industry, 56% into hospital or retail pharmacy. Only 1% were unemployed.
5 Of 68 students completing postgraduate courses in pharmacology in 1971, 20% went into university teaching, 26% into industry and only 1% were unemployed. At present there are 260 students in postgraduate training in pharmacology departments.
6 During 1970 and 1971 appointments exceeded losses in all sections giving an overall annual gain of 58.5. The total demand was estimated at 73 per year over this time. The predicted size of pharmacology departments in 1974-75 could lead to a maximum annual demand of 95 per year for these next three years.
7 Up to January 1972, the supply of, and demand for pharmacologists seems to have been near balance from the unemployment and vacancy rates reported.
However, in 1971, the supply of pharmacologists exceeded significantly the identifiable demand from pharmacology and toxicology departments. Thus there was a considerable demand from unknown employers. In the future there will be a considerable increase in the supply of specialist pharmacologists. We cannot predict if this will be balanced by demand in the absence of information about the growth in demand from the unknown employers.
8 Taking the number of professors as an index of academic status, pharmacology has improved its standing, especially in the non-medical school departments. Now there are 40 professors in 51 departments compared with 25 in 42 departments in 1964.
9 Overall, the composition of departments has not changed much since 1964. Academic departments still draw on each other for their pharmacologists whereas industrial departments draw equally from other industrial departments and academic departments. The total proportion of medically qualified pharmacologists has fallen to 14% (from 25% in 1964) and these pharmacologists are still concentrated heavily in medical school departments. In industrial departments, only 3% have a medical qualification.
10From the replies of 94 out of 410 recent graduates specializing in pharmacology, the courses are in general interesting and effective. However, both students and employers considered that not enough statistics and mathematics as applied to pharmacology were taught. Of the respondents, 84% also wanted more teaching on the clinical use of drugs.
PMCID: PMC1776630  PMID: 4425759

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