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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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Objective

To test five hypotheses that non-Hispanic African Americans (AAs) and non-Hispanic whites (NHWs) differ in responsiveness to new dental symptoms by seeking dental care, and differ in certain predictors of dental care utilization.

Data Sources/Study Setting

Florida Dental Care Study, comprising AAs and NHWs 45 years old or older, who had at least one tooth, and who lived in north Florida.

Study Design

We used a prospective cohort design. The key outcome of interest was whether dental care was received in a given six-month period, after adjusting for the presence of certain time-varying and fixed characteristics.

Data Collection/Extraction Methods

In-person interviews were conducted at baseline and 24 months after baseline, with six-monthly telephone interviews in between.

Principal Findings

African Americans were less likely to seek dental care during follow-up, with or without adjusting for key predisposing, enabling, and oral health need characteristics. African Americans were more likely to be problem-oriented dental attenders, to be unable to pay an unexpected $500 dental bill, and to report postbaseline dental problems. However, the effect of certain postbaseline dental signs and symptoms on postbaseline dental care use differed between AAs and NHWs. Although financial circumstance was predictive for both groups, it was more salient for NHWs in separate NHW and AA regressions. Frustration with past dental care, propensity to use a homemade remedy, and dental insurance were significant predictors among AAs, but not among NHWs. The NHWs were much more likely to have sought care for preventive reasons.

Conclusions

Racial differences in responsiveness to new dental symptoms by seeking dental care were evident, as were differences in other predictors of dental care utilization. These differences may contribute to racial disparities in oral health.

Epidemiologic studies suggest an association between lead exposure and caries. Our objective was to establish whether children with a higher lead exposure as toddlers had more caries at school age than children with a lower lead exposure. We used a retrospective cohort design. A sample of children who attended second and fifth grades in the Rochester, New York, public schools during the 1995-1996 and 1996-1997 school years were examined for caries through a dental screening program. For each child we assessed the number of decayed, missing, or filled surfaces on permanent teeth (DMFS), and the number of decayed or filled surfaces on deciduous teeth (dfs); the number of surfaces at risk (SAR) was also recorded. Lead exposure was defined as the mean of all blood lead levels collected between 18 and 37 months of age by fingerstick [provided the blood lead level was [less than/equal to] 10 microg/dL)] or venipuncture. A total of 248 children (197 second graders and 51 fifth graders) were examined for caries and had a record of blood lead levels to define lead exposure. The mean dfs was 3.4 (range 0-29); the mean DMFS was 0.5 (range 0-8). Logistic regression was used to examine the association between the proportion of children with DMFS [Greater/equal to] 1, and the proportion with dfs [Greater/equal to] 1, and lead exposure [< 0.48 micromol/L vs. [Greater/equal to] 0.48 micromol/L (< 10 microg/dL vs. [Greater/equal to] 10 microg/dL)] while controlling for SAR, age at examination, and grade in school. For DMFS, the adjusted odds ratio was 0.95 [95% confidence interval (CI), 0.43-2.09; p = 0.89); for dfs, the odds ratio was 1.77 (95% CI, 0.97-3.24; p = 0.07). This study did not demonstrate that lead exposure > 10 microg/dL as a toddler was a strong predictor of caries among school-age children. However, the results should be interpreted cautiously because of limitations in the assessment of lead exposure and limited statistical power.

Background and aims

Recent progresses in preventive dentistry and their correct application in many developed coun-tries have remarkably decreased the rate of oro-dental diseases in children and teenagers, while the rate of oro-dental diseases is on the rise among the children in developing countries. The aim of this study was to evaluate the impact of educating school health care instructors by measuring their level of oral health knowledge and their opinions about the impact of oral health and preventive dentistry.

Materials and methods

This was a cross-sectional descriptive-analytical study. Questionnaires were administered before and after an educational lecture to school health care instructors in Hamadan, Iran. Data were analyzed using paired t-test.

Results

In this study, 31 school health care instructors took part. The percentage of instructors in poor knowledge level was 22.6% before the educational lecture (education), which decreased to 0 percent after the education (P < 0.05). The percentage of instructors with good knowledge level was 3.2%, which increased to 80.6% after the education (P < 0.05).

Conclusion

Close cooperation between universities and the Ministry of Health and Medical Education will lead to im-provements in the level of knowledge and awareness of school health care instructors.

To study the involvement of cytokines and their corresponding autoantibodies (Aabs) in inflammatory mechanisms in patients with lower respiratory tract infections, blood samples were taken from patients at the time of admission to the hospital and before treatment. Cell-released capturing enzyme-linked immunosorbent assay was used to measure the levels of gamma interferon (IFN-γ) and interleukin-4 (IL-4) produced spontaneously by peripheral mononuclear cells (PMNC). ELISA was used to measure Aabs to these cytokines in sera. The levels of both cytokines were inversely related to the levels of their corresponding Aabs. While a high level of IFN-γ was observed together with a low level of anti-IFN-γ Aab, decreased IL-4 levels were observed with increased levels of Aabs to IL-4. Immunoglobulins were purified, digested to obtain Fab fragments, and tested for specificity and cross-reactivity. The Aabs and their Fab fragments were tested in cytokine biological assays and showed neutralizing effects. Our data demonstrated increased levels of the proinflammatory cytokine IFN-γ and decreased release of the anti-inflammatory cytokine IL-4 during early presentation of lower respiratory tract infection. The levels of these cytokines were inversely related to the levels of their corresponding Aabs that exhibited regulatory effects on the cytokine biological function in vitro.

To investigate the present status of nutrition education for dentists and physicians in Canada, we conducted a survey of the nutrition education programs in 10 Canadian dental and 16 medical schools in the academic year 1982-83. Seven of the dental schools and seven of the medical schools had a separate course in nutrition. The average duration of these courses was 22 hours for the dental schools and 26 hours for the medical schools. Nutrition education was integrated with another discipline in 4 of the dental schools and 11 of the medical schools. The average duration of this type of instruction was 14 hours for the dental schools and 18 hours for the medical schools. Six of the dental schools and eight of the medical schools employed a nutritionist/dietitian to provide instruction in nutrition. We recommend that courses in basic and applied clinical nutrition be incorporated throughout the curricula of Canadian dental and medical schools, and that personnel trained in clinical nutrition be employed to provide instruction in this area.

ABSTRACT

OBJECTIVE

To compare international medical graduates (IMGs) with Canadian medical school graduates in a family practice residency program.

DESIGN

Analysis of the results of the in-training evaluation reports (ITERs) and the Certification in Family Medicine (CCFP) examination results for 2 cohorts of IMGs and Canadian-trained graduates between the years 2006 and 2008.

SETTING

St Paul’s Hospital (SPH) in Vancouver, BC, a training site of the University of British Columbia (UBC) Family Practice Residency Program.

PARTICIPANTS

In-training evaluation reports were examined for 12 first-year and 9 second-year Canadian-trained residents at the SPH site, and 12 first-year and 12 second-year IMG residents at the IMG site at SPH; CCFP examination results were reviewed for all UBC family practice residents who took the May 2008 examination and disclosed their results.

MAIN OUTCOME MEASURES

Pass or fail rates on the CCFP examination; proportions of evaluations in each group of residents given each of the following designations: exceeds expectations, meets expectations, or needs improvement. The May 2008 CCFP examination results were reviewed.

RESULTS

Compared with the second-year IMGs, the second-year SPH Canadian-trained residents had a greater proportion of exceeds expectations designations than the IMGs. For the first-year residents, both the SPH Canadian graduates and IMGs had similar results in all 3 categories. Combining the results of the 2 cohorts, the Canadian-trained residents had 310 (99%) ITERs that were designated as either exceeds expectations or meets expectations, and only 3 (1%) ITERs were in the needs improvement category. The IMG results were 362 (97.6%) ITERs in the exceeds expectations or meets expectations categories; 9 (2%) were in the needs improvement category. Statistically these are not significant differences. Seven of the 12 (58%) IMG candidates passed the CCFP examination compared with 59 of 62 (95%) of the UBC family practice residents.

CONCLUSION

The IMG residents compared favourably with their Canadian-trained colleagues when comparing ITERs but not in passing the CCFP examination. Further research is needed to elucidate these results.

Background

Providing after school activities is a community level approach for reducing the decline in physical activity of girls as they reach early adolescence.

Purpose

The purpose of this study was to examine psychosocial, environmental, and behavioral factors as potential mediators of after school physical activity in adolescent girls.

Methods

We assessed objectively measured levels of physical activity occurring outside of school and potential predictors and mediators of activity in girls participating in the Trial of Activity in Adolescent Girls (TAAG).

Results

We found that the TAAG intervention had a statistically significant and positive effect on out of school activity in the 2006 cohort. Self-efficacy, friends’ social support, total social support, and difficulty getting to and from community activities mediated the level of moderate to vigorous physical activity in girls.

Conclusions

Parents, communities, and schools should provide and enhance opportunities outside of the school day for adolescents to be active. Reducing transportation barriers and enlisting social support appear to be key.

Background

The study presents a geographical analysis of dental trauma in a population of 12 and 15 year-old school-children, in the city of Curitiba, Brazil (n = 1581), using a database obtained in the period 2005-2006. The main focus is to analyze dental trauma using a geographic information system as a tool for integrating social, environmental and epidemiological data.

Methods

Geostatistical analysis of the database and thematic maps were generated showing the distribution of dental trauma cases according to Curitiba's Health Districts and other variables of interest. Dental trauma spatial variation was assessed using a generalized additive model in order to identify and control the individual risk-factors and thus determine whether spatial variation is constant or not throughout the Health Districts and the place of residence of individuals. In addition, an analysis was made of the coverage of dental trauma cases taking the spatial distribution of Curitiba's primary healthcare centres.

Results

The overall prevalence of dental trauma was 37.1%, with 53.1% in males and 46.7% in females. The spatial analysis confirms the hypothesis that there is significant variation in the occurrence of dental trauma, considering the place of residence in the population studied (Monte Carlo test, p = 0,006). Furthermore, 28.7% of cases had no coverage by the primary healthcare centres.

Conclusions

The effect of the place of residence was highly significant in relation to the response variable. The delimitation of areas, as a basis for case density, enables the qualification of geographical territories where actions can be planned based on priority criteria. Promotion, control and rehabilitation actions, applied in regions of higher prevalence of dental trauma, can be more effective and efficient, thus providing healthcare refinement.

Purpose

To compare the streams of expenses and revenues associated with investment in a cohort of basic science investigators at the University of Rochester School of Medicine & Dentistry over seven years.

Method

The authors evaluated a medical school's financial investment in 25 basic science faculty who were hired between 1999 and 2004 to expand basic science research. The authors compared direct and indirect costs with the extramural grant support generated by these investigators through 2006. To facilitate a comparison of investments made and grants generated, the authors calculated present value (in 2006 dollars) of revenues and expenses using the school's approximate cost of capital.

Results

Of the 25 faculty members hired, 24 (96%) remained at the school through 2006. From 1999 to 2006, the school invested a total of $69.0 million ($33.1 million in start-up costs and $35.9 million in indirect costs) to support the faculty members. Through 2006, these faculty members generated $99.7 million in extramural grant revenue ($70.7 million in direct grant revenue and $29.1 million in indirect grant revenue). While the faculty generated $1.45 in total grant revenue per dollar invested, start-up expenses and incomplete recovery of indirect costs required the school to add 40 cents to every grant dollar generated to achieve financial equilibrium.

Conclusions

Investments in basic science research, even when successful, may require significant financial subsidies from academic health centers.

An examination of applicants to Canadian medical schools for 1965-66 revealed that 4660 applications were received by the 12 schools for approximately 900 places available; 2852 of these were from Canadians, but because many applicants applied to more than one school, these 2852 applications represented only 1767 individuals. Evaluations made by the schools concerning the acceptability of these applicants showed that only 36 persons rated as “acceptable” by one or more schools failed to gain admission to any Canadian school for 1965-66. Furthermore, 66 “marginal” applicants were accepted, as were 130 multiple applicants who were rated as “acceptable” by one school but “marginal” and/or “unacceptable” by one or more other schools. Of the 464 multiple applicants, only 40% received the same evaluation from all schools to which they applied. If those multiple applicants who were rated as acceptable by all schools to which they applied are added to single applicants rated as acceptable, the pool of these clearly acceptable candidates (40% of all Canadian applicants) is sufficient only to fill 78% of places available. It was thus concluded that it is erroneous to speak of a surplus of well-qualified Canadian applicants at the present time.

Background

Corruption pervades educational and other institutions worldwide and medical schools are not exempt. Empirical evidence about levels and types of corruption in medical schools is sparse. We conducted surveys in 2000 and 2007 in the medical school of the Autonomous University of Guerrero in Mexico to document student perceptions and experience of corruption and to support the medical school to take actions to tackle corruption.

Methods

In both 2000 and 2007 medical students completed a self-administered questionnaire in the classroom without the teacher present. The questionnaire asked about unofficial payments for admission to medical school, for passing an examination and for administrative procedures. We examined factors related to the experience of corruption in multivariate analysis. Focus groups of students discussed the quantitative findings.

Results

In 2000, 6% of 725 responding students had paid unofficially to obtain entry into the medical school; this proportion fell to 1.6% of the 436 respondents in 2007. In 2000, 15% of students reported having paid a bribe to pass an examination, not significantly different from the 18% who reported this in 2007. In 2007, students were significantly more likely to have bribed a teacher to pass an examination if they were in the fourth year, if they had been subjected to sexual harassment or political pressure, and if they had been in the university for five years or more. Students resented the need to make unofficial payments and suggested tackling the problem by disciplining corrupt teachers. The university administration made several changes to the system of admissions and examinations in the medical school, based on the findings of the 2000 survey.

Conclusion

The fall in the rate of bribery to enter the medical school was probably the result of the new admissions system instituted after the first survey. Further actions will be necessary to tackle the continuing presence of bribery to pass examinations and for administrative procedures. The social audit helped to draw attention to corruption and to stimulate actions to tackle it.