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1.  Comparison of the sensitivity of the UKCAT and A Levels to sociodemographic characteristics: a national study 
Background
The UK Clinical Aptitude Test (UKCAT) was introduced to facilitate widening participation in medical and dental education in the UK by providing universities with a continuous variable to aid selection; one that might be less sensitive to the sociodemographic background of candidates compared to traditional measures of educational attainment. Initial research suggested that males, candidates from more advantaged socioeconomic backgrounds and those who attended independent or grammar schools performed better on the test. The introduction of the A* grade at A level permits more detailed analysis of the relationship between UKCAT scores, secondary educational attainment and sociodemographic variables. Thus, our aim was to further assess whether the UKCAT is likely to add incremental value over A level (predicted or actual) attainment in the selection process.
Methods
Data relating to UKCAT and A level performance from 8,180 candidates applying to medicine in 2009 who had complete information relating to six key sociodemographic variables were analysed. A series of regression analyses were conducted in order to evaluate the ability of sociodemographic status to predict performance on two outcome measures: A level ‘best of three’ tariff score; and the UKCAT scores.
Results
In this sample A level attainment was independently and positively predicted by four sociodemographic variables (independent/grammar schooling, White ethnicity, age and professional social class background). These variables also independently and positively predicted UKCAT scores. There was a suggestion that UKCAT scores were less sensitive to educational background compared to A level attainment. In contrast to A level attainment, UKCAT score was independently and positively predicted by having English as a first language and male sex.
Conclusions
Our findings are consistent with a previous report; most of the sociodemographic factors that predict A level attainment also predict UKCAT performance. However, compared to A levels, males and those speaking English as a first language perform better on UKCAT. Our findings suggest that UKCAT scores may be more influenced by sex and less sensitive to school type compared to A levels. These factors must be considered by institutions utilising the UKCAT as a component of the medical and dental school selection process.
doi:10.1186/1472-6920-14-7
PMCID: PMC3893425  PMID: 24400861
Medical student selection; Educational attainment; Aptitude tests; UKCAT; Socio-economic factors
2.  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
3.  The UKCAT-12 study: educational attainment, aptitude test performance, demographic and socio-economic contextual factors as predictors of first year outcome in a cross-sectional collaborative study of 12 UK medical schools 
BMC Medicine  2013;11:244.
Background
Most UK medical schools use aptitude tests during student selection, but large-scale studies of predictive validity are rare. This study assesses the United Kingdom Clinical Aptitude Test (UKCAT), and its four sub-scales, along with measures of educational attainment, individual and contextual socio-economic background factors, as predictors of performance in the first year of medical school training.
Methods
A prospective study of 4,811 students in 12 UK medical schools taking the UKCAT from 2006 to 2008 as a part of the medical school application, for whom first year medical school examination results were available in 2008 to 2010.
Results
UKCAT scores and educational attainment measures (General Certificate of Education (GCE): A-levels, and so on; or Scottish Qualifications Authority (SQA): Scottish Highers, and so on) were significant predictors of outcome. UKCAT predicted outcome better in female students than male students, and better in mature than non-mature students. Incremental validity of UKCAT taking educational attainment into account was significant, but small. Medical school performance was also affected by sex (male students performing less well), ethnicity (non-White students performing less well), and a contextual measure of secondary schooling, students from secondary schools with greater average attainment at A-level (irrespective of public or private sector) performing less well. Multilevel modeling showed no differences between medical schools in predictive ability of the various measures. UKCAT sub-scales predicted similarly, except that Verbal Reasoning correlated positively with performance on Theory examinations, but negatively with Skills assessments.
Conclusions
This collaborative study in 12 medical schools shows the power of large-scale studies of medical education for answering previously unanswerable but important questions about medical student selection, education and training. UKCAT has predictive validity as a predictor of medical school outcome, particularly in mature applicants to medical school. UKCAT offers small but significant incremental validity which is operationally valuable where medical schools are making selection decisions based on incomplete measures of educational attainment. The study confirms the validity of using all the existing measures of educational attainment in full at the time of selection decision-making. Contextual measures provide little additional predictive value, except that students from high attaining secondary schools perform less well, an effect previously shown for UK universities in general.
doi:10.1186/1741-7015-11-244
PMCID: PMC3827332  PMID: 24229380
Medical student selection; Educational attainment; Aptitude tests; UKCAT; Socio-economic factors; Contextual measures
4.  Widening access to UK medical education for under-represented socioeconomic groups: modelling the impact of the UKCAT in the 2009 cohort 
Objective To determine whether the use of the UK clinical aptitude test (UKCAT) in the medical schools admissions process reduces the relative disadvantage encountered by certain sociodemographic groups.
Design Prospective cohort study.
Setting Applicants to 22 UK medical schools in 2009 that were members of the consortium of institutions utilising the UKCAT as a component of their admissions process.
Participants 8459 applicants (24 844 applications) to UKCAT consortium member medical schools where data were available on advanced qualifications and socioeconomic background.
Main outcome measures The probability of an application resulting in an offer of a place on a medicine course according to seven educational and sociodemographic variables depending on how the UKCAT was used by the medical school (in borderline cases, as a factor in admissions, or as a threshold).
Results On univariate analysis all educational and sociodemographic variables were significantly associated with the relative odds of an application being successful. The multilevel multiple logistic regression models, however, varied between medical schools according to the way that the UKCAT was used. For example, a candidate from a non-professional background was much less likely to receive a conditional offer of a place compared with an applicant from a higher social class when applying to an institution using the test only in borderline cases (odds ratio 0.51, 95% confidence interval 0.45 to 0.60). No such effect was observed for such candidates applying to medical schools using the threshold approach (1.27, 0.84 to 1.91). These differences were generally reflected in the interactions observed when the analysis was repeated, pooling the data. Notably, candidates from several under-represented groups applying to medical schools that used a threshold approach to the UKCAT were less disadvantaged than those applying to the other institutions in the consortium. These effects were partially reflected in significant differences in the absolute proportion of such candidates finally taking up places in the different types of medical schools; stronger use of the test score (as a factor or threshold) was associated with a significantly increased odds of entrants being male (1.74, 1.25 to 2.41) and from a low socioeconomic background (3.57, 1.03 to 12.39). There was a non-significant trend towards entrants being from a state (non-grammar) school (1.60, 0.97 to 2.62) where a stronger use of the test was employed. Use of the test only in borderline cases was associated with increased odds of entrants having relatively low academic attainment (5.19, 2.02 to 13.33) and English as a second language (2.15, 1.03 to 4.48).
Conclusions The use of the UKCAT may lead to more equitable provision of offers to those applying to medical school from under-represented sociodemographic groups. This may translate into higher numbers of some, but not all, relatively disadvantaged students entering the UK medical profession.
doi:10.1136/bmj.e1805
PMCID: PMC3328544  PMID: 22511300
5.  Can personal qualities of medical students predict in-course examination success and professional behaviour? An exploratory prospective cohort study 
BMC Medical Education  2012;12:69.
Background
Over two-thirds of UK medical schools are augmenting their selection procedures for medical students by using the United Kingdom Clinical Aptitude Test (UKCAT), which employs tests of cognitive and non-cognitive personal qualities, but clear evidence of the tests’ predictive validity is lacking. This study explores whether academic performance and professional behaviours that are important in a health professional context can be predicted by these measures, when taken before or very early in the medical course.
Methods
This prospective cohort study follows the progress of the entire student cohort who entered Hull York Medical School in September 2007, having taken the UKCAT cognitive tests in 2006 and the non-cognitive tests a year later. This paper reports on the students’ first and second academic years of study. The main outcome measures were regular, repeated tutor assessment of individual students’ interpersonal skills and professional behaviour, and annual examination performance in the three domains of recall and application of knowledge, evaluation of data, and communication and practical clinical skills. The relationships between non-cognitive test scores, cognitive test scores, tutor assessments and examination results were explored using the Pearson product–moment correlations for each group of data; the data for students obtaining the top and bottom 20% of the summative examination results were compared using Analysis of Variance.
Results
Personal qualities measured by non-cognitive tests showed a number of statistically significant relationships with ratings of behaviour made by tutors, with performance in each year’s objective structured clinical examinations (OSCEs), and with themed written summative examination marks in each year. Cognitive ability scores were also significantly related to each year’s examination results, but seldom to professional behaviours. The top 20% of examination achievers could be differentiated from the bottom 20% on both non-cognitive and cognitive measures.
Conclusions
This study shows numerous significant relationships between both cognitive and non-cognitive test scores, academic examination scores and indicators of professional behaviours in medical students. This suggests that measurement of non-cognitive personal qualities in applicants to medical school could make a useful contribution to selection and admission decisions. Further research is required in larger representative groups, and with more refined predictor measures and behavioural assessment methods, to establish beyond doubt the incremental validity of such measures over conventional cognitive assessments.
doi:10.1186/1472-6920-12-69
PMCID: PMC3473297  PMID: 22873571
6.  Use of UKCAT scores in student selection by UK medical schools, 2006-2010 
BMC Medical Education  2011;11:98.
Background
The United Kingdom Clinical Aptitude Test (UKCAT) is a set of cognitive tests introduced in 2006, taken annually before application to medical school. The UKCAT is a test of aptitude and not acquired knowledge and as such the results give medical schools a standardised and objective tool that all schools could use to assist their decision making in selection, and so provide a fairer means of choosing future medical students.
Selection of students for UK medical schools is usually in three stages: assessment of academic qualifications, assessment of further qualities from the application form submitted via UCAS (Universities and Colleges Admissions Service) leading to invitation to interview, and then selection for offer of a place. Medical schools were informed of the psychometric qualities of the UKCAT subtests and given some guidance regarding the interpretation of results. Each school then decided how to use the results within its own selection system.
Methods
Annual retrospective key informant telephone interviews were conducted with every UKCAT Consortium medical school, using a pre-circulated structured questionnaire. The key points of the interview were transcribed, 'member checked' and a content analysis was undertaken.
Results
Four equally popular ways of using the test results have emerged, described as Borderline, Factor, Threshold and Rescue methods. Many schools use more than one method, at different stages in their selection process. Schools have used the scores in ways that have sought to improve the fairness of selection and support widening participation. Initially great care was taken not to exclude any applicant on the basis of low UKCAT scores alone but it has been used more as confidence has grown.
Conclusions
There is considerable variation in how medical schools use UKCAT, so it is important that they clearly inform applicants how the test will be used so they can make best use of their limited number of applications.
doi:10.1186/1472-6920-11-98
PMCID: PMC3248371  PMID: 22114935
7.  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
8.  Construct-level predictive validity of educational attainment and intellectual aptitude tests in medical student selection: meta-regression of six UK longitudinal studies 
BMC Medicine  2013;11:243.
Background
Measures used for medical student selection should predict future performance during training. A problem for any selection study is that predictor-outcome correlations are known only in those who have been selected, whereas selectors need to know how measures would predict in the entire pool of applicants. That problem of interpretation can be solved by calculating construct-level predictive validity, an estimate of true predictor-outcome correlation across the range of applicant abilities.
Methods
Construct-level predictive validities were calculated in six cohort studies of medical student selection and training (student entry, 1972 to 2009) for a range of predictors, including A-levels, General Certificates of Secondary Education (GCSEs)/O-levels, and aptitude tests (AH5 and UK Clinical Aptitude Test (UKCAT)). Outcomes included undergraduate basic medical science and finals assessments, as well as postgraduate measures of Membership of the Royal Colleges of Physicians of the United Kingdom (MRCP(UK)) performance and entry in the Specialist Register. Construct-level predictive validity was calculated with the method of Hunter, Schmidt and Le (2006), adapted to correct for right-censorship of examination results due to grade inflation.
Results
Meta-regression analyzed 57 separate predictor-outcome correlations (POCs) and construct-level predictive validities (CLPVs). Mean CLPVs are substantially higher (.450) than mean POCs (.171). Mean CLPVs for first-year examinations, were high for A-levels (.809; CI: .501 to .935), and lower for GCSEs/O-levels (.332; CI: .024 to .583) and UKCAT (mean = .245; CI: .207 to .276). A-levels had higher CLPVs for all undergraduate and postgraduate assessments than did GCSEs/O-levels and intellectual aptitude tests. CLPVs of educational attainment measures decline somewhat during training, but continue to predict postgraduate performance. Intellectual aptitude tests have lower CLPVs than A-levels or GCSEs/O-levels.
Conclusions
Educational attainment has strong CLPVs for undergraduate and postgraduate performance, accounting for perhaps 65% of true variance in first year performance. Such CLPVs justify the use of educational attainment measure in selection, but also raise a key theoretical question concerning the remaining 35% of variance (and measurement error, range restriction and right-censorship have been taken into account). Just as in astrophysics, ‘dark matter’ and ‘dark energy’ are posited to balance various theoretical equations, so medical student selection must also have its ‘dark variance’, whose nature is not yet properly characterized, but explains a third of the variation in performance during training. Some variance probably relates to factors which are unpredictable at selection, such as illness or other life events, but some is probably also associated with factors such as personality, motivation or study skills.
doi:10.1186/1741-7015-11-243
PMCID: PMC3827328  PMID: 24229353
Medical student selection; Undergraduate performance; Postgraduate performance; Educational attainment; Aptitude tests; Criterion-related construct validity; Range restriction; Right censorship; Grade inflation; Markov Chain Monte Carlo algorithm
9.  Selecting the right medical student 
BMC Medicine  2013;11:245.
Medical student selection is an important but difficult task. Three recent papers by McManus et al. in BMC Medicine have re-examined the role of tests of attainment of learning (A’ levels, GCSEs, SQA) and of aptitude (AH5, UKCAT), but on a much larger scale than previously attempted. They conclude that A’ levels are still the best predictor of future success at medical school and beyond. However, A’ levels account for only 65% of the variance in performance that is found. Therefore, more work is needed to establish relevant assessment of the other 35%.
Please see related research articles http://www.biomedcentral.com/1741-7015/11/242, http://www.biomedcentral.com/1741-7015/11/243 and http://www.biomedcentral.com/1741-7015/11/244.
doi:10.1186/1741-7015-11-245
PMCID: PMC3827327  PMID: 24229397
Medical School Admission; Predictors of performance; Aptitude testing
10.  A Comparison of Applicants and Applications to Canadian Medical and Dental Schools, 1965-66 
A collation and analysis of the applications and applicants to Canadian medical and dental schools for 1965-66 showed that the ratio of applications to the number of places available was 5.3 to 1 for medical schools, and 4.7 to 1 for dental schools.
Sixty-seven per cent of the Canadians who applied to a dental school did not find a place, in contrast to the 47% of those who applied to a medical school and were not successful.
One hundred and forty-one applicants (4.3% of the total applicants to medical schools and 10.9% of total applicants to dental schools) had applied to both medical and dental schools. Almost 50% of these “dual applicants” were not accepted by either a medical or dental school. Thirty-five applicants were accepted at both dental and medical schools and all but three of these elected to enrol at a medical school.
PMCID: PMC1935627  PMID: 5937202
11.  Prospective survey of performance of medical students during preclinical years. 
The performance during the preclinical course of 517 students who had applied to this medical school for admission in 1981 and who had been accepted by the school or by another British medical school was analysed in relation to variables measured at the time of application to find factors that predicted success in the preclinical course, whether students chose to take an intercalated degree, and the class achieved in the intercalated degree. Thirty one of the 507 students who entered medical school withdrew from the course or failed their examinations; these students were particularly likely not to have an A level in a biological science. O level grades were of minimal predictive value for performance during the preclinical course. A level grades discriminated between successful and unsuccessful students but had too low a specificity or sensitivity to be of use in individual prediction. Mature entrants performed better overall than school leavers. Background variables accounted for only 14.2% of the variance in performance, implying that motivation and personality may be more important in determining performance. The 80 students who chose to take an intercalated degree were more likely to be men and not to be mature entrants; for a further 50 students intercalated degrees were obligatory. Performance in the intercalated degree related to performance during the preclinical course and to assessments made at the selection interview but not to achievement at O or A level.
PMCID: PMC1340851  PMID: 3089415
12.  Medical school applicants from ethnic minority groups: identifying if and when they are disadvantaged. 
BMJ : British Medical Journal  1995;310(6978):496-500.
OBJECTIVE--To assess whether people from ethnic minority groups are less likely to be accepted at British medical schools, and to explore the mechanisms of disadvantage. DESIGN--Prospective study of a national cohort of medical school applicants. SETTING--All 28 medical schools in the United Kingdom. SUBJECTS--6901 subjects who had applied through the Universities' Central Council on Admissions in 1990 to study medicine. MAIN OUTCOME MEASURES--Offers and acceptance at medical school by ethnic group. RESULTS--Applicants from ethnic minority groups constituted 26.3% of those applying to medical school. They were less likely to be accepted, partly because they were less well qualified and applied later. Nevertheless, taking educational and some other predictors into account, applicants from ethnic minority groups were 1.46 times (95% confidence interval 1.19 to 1.74) less likely to be accepted. Having a European surname predicted acceptance better than ethnic origin itself, implying direct discrimination rather than disadvantage secondary to other possible differences between white and non-white applicants. Applicants from ethnic minority groups fared significantly less well in 12 of the 28 British medical schools. Analysis of the selection process suggests that medical schools make fewer offers to such applicants than to others with equivalent estimated A level grades. CONCLUSIONS--People from ethnic minority groups applying to medical school are disadvantaged, principally because ethnic origin is assessed from a candidate's surname; the disadvantage has diminished since 1986. For subjects applying before A level the mechanism is that less credit is given to referees' estimates of A level grades. Selection would be fairer if (a) application forms were anonymous; (b) forms did not include estimates of A level grades; and (c) selection took place after A level results are known.
PMCID: PMC2548873  PMID: 7888888
13.  Who gets into medical school? 
Canadian Family Physician  2005;51(9):1241.
OBJECTIVE
Being of rural origin is one of the few predictors of whether medical students choose either family or rural practice as a career. This study investigates what proportion of applicants are of rural origin, what their grades are, and whether they are accepted.
DESIGN
Mailed survey using the postal codes of Ontario medical school applicants’ residences when they attended secondary school to link them to communities. Applicants of rural origin were defined as having attended secondary school while residing in communities with core populations of fewer than 10 000 people.
SETTING
Province of Ontario, its six medical schools, and its 1 500 000 rural citizens (13% of the total population).
PARTICIPANTS
All 4948 applicants to Ontario medical schools in 2002 and 2003 who had gone to high school in Ontario.
MAIN OUTCOME MEASURES
Proportion of rural applicants among all applicants in the given years. Mean grade point averages (GPA) and Medical College Admission Test (MCAT) scores attained by applicants of both urban and rural origin. Proportion of rural students among all students admitted to medical schools.
RESULTS
While 13% of the Ontario population is rural, only 7.3% of Ontario applicants to medical school were of rural origin (P < .001). On average, the GPAs of applicants of rural and urban origin were identical at 3.42 (P = .995 not significant [NS]). The MCAT scores averaged 8.9 for applicants of rural origin and 9.0 for applicants of urban origin (P = .36 NS). Applicants of rural origin were admitted to medical school as frequently as applicants of urban origin (1:5.6 vs 1:4.7, P = .139 NS).
CONCLUSION
Although students of rural origin in Ontario apply to medical school less frequently than students of urban origin do, those that do apply have similar grades to those of urban applicants and are equally likely to be accepted.
PMCID: PMC1479467  PMID: 16926938
14.  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
15.  The validity of Iran’s national university entrance examination (Konkoor) for predicting medical students’ academic performance 
BMC Medical Education  2012;12:60.
Background
In Iran, admission to medical school is based solely on the results of the highly competitive, nationwide Konkoor examination. This paper examines the predictive validity of Konkoor scores, alone and in combination with high school grade point averages (hsGPAs), for the academic performance of public medical school students in Iran.
Methods
This study followed the cohort of 2003 matriculants at public medical schools in Iran from entrance through internship. The predictor variables were Konkoor total and subsection scores and hsGPAs. The outcome variables were (1) Comprehensive Basic Sciences Exam (CBSE) scores; (2) Comprehensive Pre-Internship Exam (CPIE) scores; and (3) medical school grade point averages (msGPAs) for the courses taken before internship. Pearson correlation and regression analyses were used to assess the relationships between the selection criteria and academic performance.
Results
There were 2126 matriculants (1374 women and 752 men) in 2003. Among the outcome variables, the CBSE had the strongest association with the Konkoor total score (r = 0.473), followed by msGPA (r = 0.339) and the CPIE (r = 0.326). While adding hsGPAs to the Konkoor total score almost doubled the power to predict msGPAs (R2 = 0.225), it did not have a substantial effect on CBSE or CPIE prediction.
Conclusions
The Konkoor alone, and even in combination with hsGPA, is a relatively poor predictor of medical students’ academic performance, and its predictive validity declines over the academic years of medical school. Care should be taken to develop comprehensive admissions criteria, covering both cognitive and non-cognitive factors, to identify the best applicants to become "good doctors" in the future. The findings of this study can be helpful for policy makers in the medical education field.
doi:10.1186/1472-6920-12-60
PMCID: PMC3461424  PMID: 22840211
16.  Independent Validation of an Existing Model Enables Prediction of Hearing Loss after Childhood Bacterial Meningitis 
PLoS ONE  2013;8(3):e58707.
Objective
This study aimed external validation of a formerly developed prediction model identifying children at risk for hearing loss after bacterial meningitis (BM). Independent risk factors included in the model are: duration of symptoms prior to admission, petechiae, cerebral spinal fluid (CSF) glucose level, Streptococcus pneumoniae and ataxia. Validation helps to evaluate whether the model has potential in clinical practice.
Study design
116 Dutch school-age BM survivors were included in the validation cohort and screened for sensorineural hearing loss (>25 dB). Risk factors were obtained from medical records. The model was applied to the validation cohort and its performance was compared with the development cohort. Validation was performed by application of the model on the validation cohort and by assessment of discrimination and goodness of fit. Calibration was evaluated by testing deviations in intercept and slope. Multiple imputation techniques were used to deal with missing values.
Results
Risk factors were distributed equally between both cohorts. Discriminative ability (Area Under the Curve, AUC) of the model was 0.84 in the development and 0.78 in the validation cohort. Hosmer-Lemeshow test for goodness of fit was not significant in the validation cohort, implying good fit concerning the similarity of expected and observed cases. There were no significant differences in calibration slope and intercept. Sensitivity and negative predicted value were high, while specificity and positive predicted value were low which is comparable with findings in the development cohort.
Conclusions
Performance of the model remained good in the validation cohort. This prediction model might be used as a screening tool and can help to identify those children that need special attention and a long follow-up period or more frequent auditory testing.
doi:10.1371/journal.pone.0058707
PMCID: PMC3594173  PMID: 23536814
17.  Effectiveness of Educational Poster on Knowledge of Emergency Management of Dental Trauma–Part 1. Cluster Randomised Controlled Trial for Primary and Secondary School Teachers 
PLoS ONE  2013;8(9):e74833.
Objective
To investigate the effectiveness of educational posters in improving the knowledge level of primary and secondary school teachers regarding emergency management of dental trauma.
Methods
A cluster randomised controlled trial was conducted. 32 schools with a total of 515 teachers were randomised into intervention (poster) and control groups at the school level. Teachers’ baseline levels of knowledge about dental trauma were obtained by using a questionnaire. Posters containing information on dental trauma management were displayed in the school medical room, the common room used by staff, and on a notice board for 2 weeks in each school of the intervention group; in the control group, no posters were displayed. Teachers in both groups completed the questionnaire after 2 weeks.
Results
The teachers in the intervention schools (where posters were displayed for 2 weeks) showed statistically significant improvement in scores in cases where they had not previously learned about dental emergencies from sources other than first aid training, with an average score increase of 2.6656 (score range of questionnaire, −13 to 9; p-value <0.0001).
Conclusion
Educational posters on the management of dental trauma can significantly improve the level of knowledge of primary and secondary school teachers in Hong Kong.
KClinicalTrials.com HKCTR-1307
ClinicalTrials.gov: NCT01707355
doi:10.1371/journal.pone.0074833
PMCID: PMC3797909  PMID: 24147154
18.  Education and Cognitive Change over 15 Years: The Atherosclerosis Risk in Communities Study 
OBJECTIVES
To evaluate whether education level is associated with change in cognitive performance.
DESIGN
Prospective cohort study.
SETTING
The Atherosclerosis Risk in Communities (ARIC) Study, a community-based cohort.
PARTICIPANTS
Nine thousand two hundred sixty-eight ARIC participants who underwent cognitive evaluation at least twice over a 15-year period.
MEASUREMENTS
Education was evaluated as a predictor of change in word recall, the Digit Symbol Substitution Test (DSST), and word fluency. A random-effects linear regression model, and a time by educational level interaction was used.
RESULTS
Educational level was highly associated with cognitive performance. The effect on performance of a less than high school education (vs more than high school) was equivalent to the effect of as much as 22 years of cognitive aging, but educational level was not associated with change in cognitive performance in whites or blacks, with the exception of the DSST for whites, in whom those with lower levels of education had less decline in scores.
CONCLUSION
Educational level was not associated with change in cognitive performance, although the higher baseline cognitive performance of individuals with more education might explain lower rates of dementia in more-educated individuals, because more decline would have to take place between baseline higher performance and time at which dementia was diagnosed in more-educated individuals.
doi:10.1111/j.1532-5415.2012.04164.x
PMCID: PMC3662980  PMID: 23013064
education; cognition; cognitive reserve
19.  What Motivates Talented Medical Students to Study Simultaneously at Master of Public Health (MPH)? 
Iranian Journal of Public Health  2013;42(4):402-409.
Background
Nearly three decades ago, the Master of Public Health (MPH) academic degree was introduced to Tehran University of Medical Sciences’ School of Public Health, Tehran, Iran. A new program for simultaneous education of medical, pharmaceutical and dental students was initiated in 2006. Talented students had the opportunity to study MPH simultaneously. There were some concerns about this kind of admission; as to whether these students who were not familiar with the health system had the appropriate attitude and background for this field of education. And with the present rate of brain drain, is this just a step towards their immigration without the fulfillment of public health?
Methods:
This qualitative study was conducted in 2012 where 26 students took part in focused group discussions and individual interviews. The students were questioned about their motivation and the program’s impact on their future career. The participants’ statements were analyzed using thematic analysis.
Results:
The primary motivations of students who entered this program were: learning health knowledge related issues, gaining a perspective beyond clinical practice, obtaining a degree to strengthen their academic résumé, immigration, learning academic research methods and preparing for the management of health systems in the future.
Conclusion:
Apparently, there was no considerable difference between the motivation of students and the program planners. The students’ main motivation for studying MPH was a combination of various interests in research and health sciences issues. Therefore, considering the potential of this group of students, effective academic investment on MPH can have positive impact.
PMCID: PMC3684727  PMID: 23785680
Curriculum; Graduate; Administration; Public health; Education; Iran
20.  Clinical experience, performance in final examinations, and learning style in medical students: prospective study. 
BMJ : British Medical Journal  1998;316(7128):345-350.
OBJECTIVE: To assess whether the clinical experience of undergraduate medical students relates to their performance in final examinations and whether learning styles relate either to final examination performance or to the extent of clinical experience. DESIGN: Prospective, longitudinal study of two cohorts of medical students assessed by questionnaire at time of application to medical school and by questionnaire and university examination at the end of their final clinical year. SUBJECTS: Two cohorts of students who had applied to St Mary's Hospital Medical School during 1980 (n = 1478) and 1985 (n = 2399) for admission in 1981 and 1986 respectively. Students in these cohorts who entered any medical school in the United Kingdom were followed up in their final clinical year in 1986-7 and 1991-2. MAIN OUTCOME MEASURES: Student's clinical experience of a range of acute medical conditions, surgical operations, and practical procedures as assessed by questionnaire in the final year, and final examination results for the students taking their examinations at the University of London. RESULTS: Success in the final examination was not related to a student's clinical experiences. The amount of knowledge gained from clinical experience was, however, related to strategic and deep learning styles both in the final year and also at the time of application, five or six years earlier. Grades in A level examinations did not relate either to study habits or to clinical experience. Success in the final examination was also related to a strategic or deep learning style in the final year (although not at time of entry to medical school). CONCLUSIONS: The lack of correlation between examination performance and clinical experience calls into question the validity of final examinations. How much knowledge is gained from clinical experience as a student is able to be predicted from measures of study habits made at the time of application to medical school, some six years earlier, although not from results of A level examinations. Medical schools wishing to select students who will gain the most knowledge from clinical experience cannot use the results of A level examinations alone but could assess a student's learning style.
PMCID: PMC2665541  PMID: 9487168
21.  So few medical schools, so many clerk rating systems! 
Objective:
To determine the methods used to rate medical clerks at Canadian medical schools and to investigate whether there is any uniformity across the country.
Design:
Survey by means of questionnaire mailed to the chairpeople of the departments of medicine at the 16 Canadian medical schools.
Outcome measures:
From the 15 schools that responded information was gathered on the descriptor, letter and numeric grades or rankings used to evaluate clinical clerks. A breakdown of the levels of descriptor grades was obtained along with the distribution of student scores according to these levels.
Results:
Descriptor grades were used at 10 (66.6%) of the 15 schools, letter grades at 1 (6.6%) and numeric grades at 4 (26.6%). In schools whose descriptor grades included more levels than “Pass” or “Fail” an average of 11% of students received the highest-level grade, 28% the second-level grade and 58% the grade for “acceptable” performance. There was wide variability in all these measures from school to school.
Conclusion:
There is a lack of consistency in the criteria used for rating clinical clerks at Canadian medical schools.
PMCID: PMC1492266  PMID: 1611572
22.  Entry Characteristics and Academic Performance of Students in a Master of Pharmacy Degree Program in the United Kingdom 
Objective. To evaluate the characteristics of a cohort of master of pharmacy (MPharm) students upon entry into the program and examine associations between entry qualifications, type of secondary school attended, socioeconomic status, age, and academic performance in the MPharm program.
Methods. A retrospective cohort analysis was conducted of student data for graduates of the Aston University MPharm program during the 5-year period 2005-2006 through 2009-2010 (n=644).
Results. MPharm entrants were disproportionately drawn from socioeconomically deprived areas and independent (private) schools. Achievement prior to admission was related to the type of school attended but not to socioeconomic status. Performance in the program was not related to type of school or socioeconomic status but was strongly correlated with prior academic achievement.
Conclusions. Prior academic achievement was the most important predictor of performance in the MPharm program; however, the superior prior achievement of students who attended independent secondary schools was not seen at the point of graduation. These findings may have implications for admissions policies.
doi:10.5688/ajpe767126
PMCID: PMC3448464  PMID: 23049098
master of pharmacy degree; performance; pharmacy; graduate program
23.  A levels and intelligence as predictors of medical careers in UK doctors: 20 year prospective study 
BMJ : British Medical Journal  2003;327(7407):139-142.
Objective To assess whether A level grades (achievement) and intelligence (ability) predict doctors' careers.
Design Prospective cohort study with follow up after 20 years by postal questionnaire.
Setting A UK medical school in London.
Participants 511 doctors who had entered Westminster Medical School as clinical students between 1975 and 1982 were followed up in January 2002.
Main outcome measures Time taken to reach different career grades in hospital or general practice, postgraduate qualifications obtained (membership/fellowships, diplomas, higher academic degrees), number of research publications, and measures of stress and burnout related to A level grades and intelligence (result of AH5 intelligence test) at entry to clinical school. General health questionnaire, Maslach burnout inventory, and questionnaire on satisfaction with career at follow up.
Results 47 (9%) doctors were no longer on the Medical Register. They had lower A level grades than those who were still on the register (P < 0.001). A levels also predicted performance in undergraduate training, performance in postregistration house officer posts, and time to achieve membership qualifications (Cox regression, P < 0.001; b=0.376, SE=0.098, exp(b)=1.457). Intelligence did not independently predict dropping off the register, career outcome, or other measures. A levels did not predict diploma or higher academic qualifications, research publications, or stress or burnout. Diplomas, higher academic degrees, and research publications did, however, significantly correlate with personality measures.
Conclusions Results of achievement tests, in this case A level grades, which are particularly used for selection of students in the United Kingdom, have long term predictive validity for undergraduate and postgraduate careers. In contrast, a test of ability or aptitude (AH5) was of little predictive validity for subsequent medical careers.
PMCID: PMC165701  PMID: 12869457
24.  The Hamburg Selection Procedure for Dental Students – Introduction of the HAM-Nat as subject-specific test for study aptitude  
Introduction: The present study examines the question whether the selection of dental students should be based solely on average school-leaving grades (GPA) or whether it could be improved by using a subject-specific aptitude test.
Methods: The HAM-Nat Natural Sciences Test was piloted with freshmen during their first study week in 2006 and 2007. In 2009 and 2010 it was used in the dental student selection process. The sample size in the regression models varies between 32 and 55 students.
Results: Used as a supplement to the German GPA, the HAM-Nat test explained up to 12% of the variance in preclinical examination performance. We confirmed the prognostic validity of GPA reported in earlier studies in some, but not all of the individual preclinical examination results.
Conclusion: The HAM-Nat test is a reliable selection tool for dental students. Use of the HAM-Nat yielded a significant improvement in prediction of preclinical academic success in dentistry.
PMCID: PMC3839074  PMID: 24282449
student selection dentistry; prediction of study success; admission test
25.  Determining the Relative Burden of Childhood Asthma at the Local Level by Surveying School Nurses 
Schools are effective venues for providing pediatric asthma education programs. Resources are limited, however, so ideally, these programs should be provided to schools with the highest prevalence. National and state asthma surveillance data cannot be extrapolated to local geographic areas. The objective of this study was to survey local schools on Long Island to obtain this information. Survey forms were mailed to the school nurses at every school in Nassau and Suffolk Counties, New York, in 2004, 2006, 2008, and 2010 asking for the number of children with asthma and the number who had permission to access rescue medication in the school. School nurses completed and returned the forms. We analyzed data from elementary and high schools separately, as high-school students often carry their medications with them without obtaining permission. Of the 3,327 surveys sent, 2,060 (61.9%) were returned and 1,807 (54.3%) could be included in the analyses. Overall, asthma prevalence increased from 7.6% in 2004 to 8.7% in 2010. This mirrored the New York State and national trends, although the rates we found were generally lower. The rate of asthmatic children with permission to access rescue medication in school was about the same throughout the study period (39.7% in 2004 and only 42.3% in 2010). Both rates were lower in elementary schools in low socioeconomic areas. These methods allowed us to compare the burden of childhood asthma in individual responder schools in a relatively large geographic area.
doi:10.1089/ped.2013.0231
PMCID: PMC3678585  PMID: 23781394

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