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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.

Objectives To determine whether the UK Clinical Aptitude Test (UKCAT) adds value to the selection process for school leaver applicants to medical and dental school, and in particular whether UKCAT can reduce the socioeconomic bias known to affect A levels.

Design Cohort study

Setting Applicants to 23 UK medical and dental schools in 2006.

Participants 9884 applicants who took the UKCAT in the UK and who achieved at least three passes at A level in their school leaving examinations (53% of all applicants).

Main outcome measures Independent predictors of obtaining at least AAB at A level and

UKCAT scores at or above the 30th centile for the cohort, for the subsections and the entire test.

Results Independent predictors of obtaining at least AAB at A level were white ethnicity (odds ratio 1.58, 95% confidence interval 1.41 to 1.77), professional or managerial background (1.39, 1.22 to 1.59), and independent or grammar schooling (2.26, 2.02 to 2.52) (all P<0.001). Independent predictors of achieving UKCAT scores at or above the 30th centile for the whole test were male sex (odd ratio 1.48, 1.32 to 1.66), white ethnicity (2.17, 1.94 to 2.43), professional or managerial background (1.34, 1.17 to 1.54), and independent or grammar schooling (1.91, 1.70 to 2.14) (all P<0.001). One major limitation of the study was that socioeconomic status was not volunteered by approximately 30% of the applicants. Those who withheld socioeconomic status data were significantly different from those who provided that information, which may have caused bias in the analysis.

Conclusions UKCAT was introduced with a high expectation of increasing the diversity and fairness in selection for UK medical and dental schools. This study of a major subgroup of applicants in the first year of operation suggests that it has an inherent favourable bias to men and students from a higher socioeconomic class or independent or grammar schools. However, it does provide a reasonable proxy for A levels in the selection process.

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

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.

Background

UK medical students and doctors from ethnic minorities underperform in undergraduate and postgraduate examinations. Although it is assumed that white (W) and non-white (NW) students enter medical school with similar qualifications, neither the qualifications of NW students, nor their educational background have been looked at in detail. This study uses two large-scale databases to examine the educational attainment of W and NW students.

Methods

Attainment at GCSE and A level, and selection for medical school in relation to ethnicity, were analysed in two separate databases. The 10th cohort of the Youth Cohort Study provided data on 13,698 students taking GCSEs in 1999 in England and Wales, and their subsequent progression to A level. UCAS provided data for 1,484,650 applicants applying for admission to UK universities and colleges in 2003, 2004 and 2005, of whom 52,557 applied to medical school, and 23,443 were accepted.

Results

NW students achieve lower grades at GCSE overall, although achievement at the highest grades was similar to that of W students. NW students have higher educational aspirations, being more likely to go on to take A levels, especially in science and particularly chemistry, despite relatively lower achievement at GCSE. As a result, NW students perform less well at A level than W students, and hence NW students applying to university also have lower A-level grades than W students, both generally, and for medical school applicants. NW medical school entrants have lower A level grades than W entrants, with an effect size of about -0.10.

Conclusion

The effect size for the difference between white and non-white medical school entrants is about B0.10, which would mean that for a typical medical school examination there might be about 5 NW failures for each 4 W failures. However, this effect can only explain a portion of the overall effect size found in undergraduate and postgraduate examinations of about -0.32.

Baylor College of Medicine has conducted a summer enrichment program for minority/disadvantaged premedical students since 1969. Follow-up data on medical school application and acceptance for participants from 1980 through 1984 were analyzed in relation to selected preprogram variables--cumulative college grade point average, total Scholastic Aptitude Test score, competitiveness of undergraduate college, sex, and ethnicity. Results of univariate and multivariate analyses indicated that: 1) females were significantly less likely to apply to medical school than males, 2) females had significantly lower mean MCAT scores (5.9 vs 7.2) even though their preprogram academic performance was comparable to that of the males, and 3) after controlling for MCAT scores, none of the preprogram variables were significant in predicting medical school acceptance. These findings suggest the need for research to explain the discrepancy between male and female MCAT performance and frequency of medical school application in summer program participants. The findings also have implications for the type of counseling provided to female participants in summer enrichment programs.

All applicants and those who subsequently enrolled for the 1964-65 session in the Western medical schools were studied with the hope that it would encourage a national registration of applicants. Seven hundred and sixty-four applicants completed 865 applications for 288 places in four schools. Although the principal factor in selecting medical students in all Western schools is pre-medical performance, 49 “good-quality” (academically of good standing and under 30 years of age) resident applicants were not accepted in their own provincial school, and 49 places were filled with “poor-quality” students.

The loss of good applicants to the Western medical schools and the 20% overlap of each school's applicant pool with that of other schools suggests that objective standards of quality must be developed, and that a regular annual national assessment of applicants should be conducted by the Association of Canadian Medical Colleges.

ABSTRACT

BACKGROUND

Diversity improves all students’ academic experiences and their abilities to work with patients from differing backgrounds. Little is known about what makes minority students select one medical school over another.

PURPOSE

To measure the impact of the existence of a health disparities course in the medical school curriculum on recruitment of underrepresented minority (URM) college students to the University of Chicago Pritzker School of Medicine.

METHODS

All medical school applicants interviewed in academic years 2007 and 2008 at the University of Chicago Pritzker School of Medicine (PSOM) attended an orientation that detailed a required health care disparities curriculum introduced in 2006. Matriculants completed a precourse survey measuring the impact of the existence of the course on their decision to attend PSOM. URM was defined by the American Association of Medical Colleges as Black, American Indian/Alaskan Native, Native Hawaiian, Mexican American, and Mainland Puerto Rican.

RESULTS

Precourse survey responses were 100% and 96% for entering classes of 2007 and 2008, respectively. Among those students reporting knowledge of the course (128/210, 61%), URM students (27/37, 73%) were more likely than non-URM students (38/91, 42%) to report that knowledge of the existence of the course influenced their decision to attend PSOM (p = 0.002). Analysis of qualitative responses revealed that students felt that the curriculum gave the school a reputation for placing importance on health disparities and social justice issues. URM student enrollment at PSOM, which had remained stable from years 2005 and 2006 at 12% and 11% of the total incoming classes, respectively, increased to 22% of the total class size in 2007 (p = 0.03) and 19 percent in 2008.

CONCLUSION

The required health disparities course may have contributed to the increased enrollment of URM students at PSOM in 2007 and 2008.

A national survey of medical school admissions administrators was used to assess the acceptability of applicants' qualifications that included degrees earned partly online, partly in a community college, or in a traditional program. A questionnaire was sent from The Florida State University in 2007 to admissions administrators in the 125 accredited allopathic medical schools in the United States. In each of three situations, the respondents were asked to select one of two hypothetical applicants to invite for an interview. The applicants with their coursework taken in a traditional-residential setting were overwhelmingly preferred over the applicant holding the degree earned partly online. Further analysis indicated that online courses were perceived as not presenting sufficient opportunity for students to develop important social skills through interaction with other students and mentors.

The methods employed in the selection of medical students for the 1964-65 class of freshmen at the four Western medical schools are described and recommendations are made for improving the procedure. The structure and functions of the various selection committees varied from school to school but their prime purpose was the same—the selection of “good students” who would later become “good physicians”. Not surprisingly, academic achievement and confidence in estimating this ranked highest in importance, and while non-intellectual characteristics ranked almost as high, committee members had no confidence that they could evaluate these qualities.

It is suggested that the ideal selection committee would be a “high-priority” committee consisting of six to eight members who would meet at least twice a year, have tenure of at least four years, be trained in interviewing applicants, consider Medical College Admission Test scores, review applications before each meeting, and establish research committees to investigate the students they choose.

Background

Knowledge in natural sciences generally predicts study performance in the first two years of the medical curriculum. In order to reduce delay and dropout in the preclinical years, Hamburg Medical School decided to develop a natural science test (HAM-Nat) for student selection. In the present study, two different approaches to scale construction are presented: a unidimensional scale and a scale composed of three subject specific dimensions. Their psychometric properties and relations to academic success are compared.

Methods

334 first year medical students of the 2006 cohort responded to 52 multiple choice items from biology, physics, and chemistry. For the construction of scales we generated two random subsamples, one for development and one for validation. In the development sample, unidimensional item sets were extracted from the item pool by means of weighted least squares (WLS) factor analysis, and subsequently fitted to the Rasch model. In the validation sample, the scales were subjected to confirmatory factor analysis and, again, Rasch modelling. The outcome measure was academic success after two years.

Results

Although the correlational structure within the item set is weak, a unidimensional scale could be fitted to the Rasch model. However, psychometric properties of this scale deteriorated in the validation sample. A model with three highly correlated subject specific factors performed better. All summary scales predicted academic success with an odds ratio of about 2.0. Prediction was independent of high school grades and there was a slight tendency for prediction to be better in females than in males.

Conclusions

A model separating biology, physics, and chemistry into different Rasch scales seems to be more suitable for item bank development than a unidimensional model, even when these scales are highly correlated and enter into a global score. When such a combination scale is used to select the upper quartile of applicants, the proportion of successful completion of the curriculum after two years is expected to rise substantially.

Background

More and more medical school applicants in England and Wales are gaining the maximum grade at A level of AAA, and the UK Government has now agreed to pilot the introduction of a new A* grade. This study assessed the likely utility of additional grades of A* or of A**.

Methods

Statistical analysis of university selection data collected by the Universities and Colleges Admissions Service (UCAS), consisting of data from 1,484,650 applicants to UCAS for the years 2003, 2004 and 2005, of whom 23,628 were medical school applicants, and of these 14,510 were medical school entrants from the UK, aged under 21, and with three or four A level results. The main outcome measure was the number of points scored by applicants in their best three A level subjects.

Results

Censored normal distributions showed a good fit to the data using maximum likelihood modelling. If it were the case that A* grades had already been introduced, then at present about 11% of medical school applicants and 18% of entrants would achieve the maximum score of 3 A*s. Projections for the years 2010, 2015 and 2020 suggest that about 26%, 35% and 46% of medical school entrants would have 3 A* grades.

Conclusion

Although A* grades at A level will help in medical student selection, within a decade, a third of medical students will gain maximum grades. While revising the A level system there is a strong argument, as proposed in the Tomlinson Report, for introducing an A** grade.

Introduction: In 2006, the Association of American Medical Colleges (AAMC) issued a recommendation that medical schools increase the supply of physicians by 30% to meet the patient needs of the new millennium.

Objective: To provide financial analysis of the cost of increasing class size.

Methods: To determine the financial consequences of increasing medical student enrollment and in the absence of nationally published cost data for medical schools, adjusted secondary revenue data was analyzed using AAMC and Liaison Committee on Medical Education (LCME) financial data from 2009. Linear regression analysis was used to determine average fixed costs and variable cost per student in USD.

Results: In USD, $62,877 represents the best point estimate of the annual variable cost of educating a medical student.

Conclusion: Comparing this cost to current tuitions and fees of LCME-accredited medical schools suggests that revenues other than tuition are needed to cover increases in class size. Tuition and fees revenue from increasing enrollment will not increase overall revenue to medical schools.

Objective To study medical students' views about the quality of the teaching they receive during their undergraduate training, especially in terms of the hidden curriculum.

Design Semistructured interviews with individual students.

Setting One medical school in the United Kingdom.

Participants 36 undergraduate medical students, across all stages of their training, selected by random and quota sampling, stratified by sex and ethnicity, with the whole medical school population as a sampling frame.

Main outcome measures Medical students' experiences and perceptions of the quality of teaching received during their undergraduate training.

Results Students reported many examples of positive role models and effective, approachable teachers, with valued characteristics perceived according to traditional gendered stereotypes. They also described a hierarchical and competitive atmosphere in the medical school, in which haphazard instruction and teaching by humiliation occur, especially during the clinical training years.

Conclusions Following on from the recent reforms of the manifest curriculum, the hidden curriculum now needs attention to produce the necessary fundamental changes in the culture of undergraduate medical education.

Background

To evaluate the scientific reasoning in basic science among undergraduate medical students, we established the National Medical Science Olympiad in Iran. In this Olympiad, the drawing of a concept map was used to evaluate a student's knowledge framework; students' ability in hypothesis generation and testing were also evaluated in four different steps. All medical students were invited to participate in this program. Finally, 133 undergraduate medical students with average grades ≥ 16/20 from 45 different medical schools in Iran were selected. The program took the form of four exams: drawing a concept map (Exam I), hypothesis generation (Exam II), choosing variables based on the hypothesis (Exam III), measuring scientific thought (Exam IV). The examinees were asked to complete all examination items in their own time without using textbooks, websites, or personal consultations. Data were presented as mean ± SE of each parameter. The correlation coefficient between students' scores in each exam with the total final score and average grade was calculated using the Spearman test.

Results

Out of a possible score of 200, the mean ± SE of each exam were as follows: 183.88 ± 5.590 for Exam I; 78.68 ± 9.168 for Exam II; 92.04 ± 2.503 for exam III; 106.13 ± 2.345 for Exam IV. The correlation of each exam score with the total final score was calculated, and there was a significant correlation between them (p < 0.001). The scatter plot of the data showed a linear correlation between the score for each exam and the total final score. This meant that students with a higher final score were able to perform better in each exam through having drawn up a meaningful concept map.

The average grade was significantly correlated with the total final score (R = 0.770), (p < 0.001). There was also a significant correlation between each exam score and the average grade (p < 0.001). The highest correlation was observed between Exam I (R = 0.7708) and the average grade. This means students with higher average grades had better grades in each exam, especially in drawing the concept map.

Conclusions

We hope that this competition will encourage medical schools to integrate theory and practice, analyze data, and read research articles. Our findings relate to a selected population, and our data may not be applicable to all medical students. Therefore, further studies are required to validate our results.

Background

In 1998, a new selection process which utilised an aptitude test and an interview in addition to previous academic achievement was introduced into an Australian undergraduate medical course.

Aims

To test the outcomes of the selection criteria over an 11-year period.

Methods

1174 students who entered the course from secondary school and who enrolled in the MBBS from 1999 through 2009 were studied in relation to specific course outcomes. Regression analyses using entry scores, sex and age as independent variables were tested for their relative value in predicting subsequent academic performance in the 6-year course. The main outcome measures were assessed by weighted average mark for each academic year level; together with results in specific units, defined as either ‘knowledge'-based or ‘clinically’ based.

Results

Previous academic performance and female sex were the major independent positive predictors of performance in the course. The interview score showed positive predictive power during the latter years of the course and in a range of ‘clinically' based units. This relationship was mediated predominantly by the score for communication skills.

Conclusions

Results support combining prior academic achievement with the assessment of communication skills in a structured interview as selection criteria into this undergraduate medical course.

Objective To assess the relation between a range of measures and the likelihood of applicants to medical schools in the United Kingdom being offered a place overall and at each medical school, with particular emphasis on ethnic minority applicants.

Design Data provided by the Universities and Colleges Admissions Service on 92 676 applications to medical schools from 18 943 candidates for admission in 1996 and 1997. Statistical analysis was by multiple logistic regression.

Main outcome measures Receipt of a conditional or unconditional offer of a place at medical school.

Results Eighteen separate measures were independently associated with the overall likelihood of receiving an offer. Applicants from ethnic minority groups were disadvantaged, as were male applicants, applicants applying late in the selection season, applicants making non-medical (so called insurance) choices, applicants requesting deferred entry (so called gap year), and applicants at further or higher education or sixth form colleges. Analysis at individual medical schools showed different patterns of measures that predicted offers. Not all schools disadvantaged applicants from ethnic minority groups and the effect was stable across the two years, suggesting structural differences in the process of selection. The degree of disadvantage did not relate to the proportion of applicants from ethnic minority groups.

Conclusions The data released by the Council of Heads of Medical Schools allow a detailed analysis of the selection process at individual medical schools. The results suggest several areas in which some candidates are disadvantaged, in particular those from ethnic minority groups. Similar data in the future will allow monitoring of changes in selection processes.

Key messagesThe Council of Heads of Medical Schools has made publicly available, on the website of the Universities and Colleges Admissions Service, detailed data on individual applications for medical school in 1996 and 1997These data allow analysis of factors influencing selection at individual medical schools in the United Kingdom, although some important measures such as GCSE grades, estimated A level grades, and assessments of personal attributes are not availableIn 1996-7 certain groups, in particular ethnic minority groups and male applicants, were disadvantaged during selectionThe disadvantage of applicants from ethnic minority groups seems stable across years, with some schools consistently showing no evidence of disadvantageProvision of similar data in the future will allow continued monitoring of selection and of the proposals for change made by the council

This paper describes the use of CASIP, an authoring language for CAI materials with unrestricted natural language input, to produce brief tests that assess in an objective and standardized manner a variety of aptitudes in medical students, residents or applicants to medical school. These aptitudes include decisiveness, methodical thinking, ethical values, crisis management ability, persistence, combativeness, and ease of frustration.

BACKGROUND

School safety and quality affect student learning and success. This study examined the effects of a comprehensive elementary school-wide social-emotional and character education program, Positive Action, on teacher, parent, and student perceptions of school safety and quality utilizing a matched-pair, cluster-randomized, controlled design. The Positive Action Hawai’i trial included 20 racially/ethnically diverse schools and was conducted from 2002–2003 through 2005–2006.

METHODS

School-level archival data, collected by the Hawai’i Department of Education, were used to examine program effects at 1-year post-trial. Teacher, parent, and student data were analyzed to examine indicators of school quality such as student safety and well-being, involvement, and satisfaction, as well as overall school quality. Matched-paired t-tests were used for the primary analysis, and sensitivity analyses included permutation tests and random-intercept growth curve models.

RESULTS

Analyses comparing change from baseline to 1-year post-trial revealed that intervention schools demonstrated significantly improved school quality compared to control schools, with 21%, 13%, and 16% better overall school quality scores as reported by teachers, parents, and students, respectively. Teacher, parent, and student reports on individual school-quality indicators showed improvement in student safety and well-being, involvement, satisfaction, quality student support, focused and sustained action, standards-based learning, professionalism and system capacity, and coordinated team work. Teacher reports also showed an improvement in the responsiveness of the system.

CONCLUSIONS

School quality was substantially improved, providing evidence that a school-wide social-emotional and character education program can enhance school quality and facilitate whole-school change.

Relying solely on measures of intellectual aptitude and academic performance in university admissions can be disadvantageous to underprivileged students. The Fiji School of Medicine primarily uses such measures to evaluate and select student applicants, and the introduction of supplementary assessments could provide better access for students from disadvantaged backgrounds. This study examined the need for supplementary assessments in the admission process, types of additional assessments needed, and stakeholders’ views on a multi-entry multi-exit strategy currently in use at the Fiji School of Medicine. A survey of the key stakeholders was conducted in February and March 2012 using closed and open ended questionnaire. One hundred and twenty-two validated questionnaires were self-administered by key stakeholders from the College of Medicine, Nursing and Health Sciences (CMNHS) and Fiji Ministries of Education and Health, with a response rate of 61%. Returned questionnaires were analysed quantitatively and qualitatively. Sixty-five percent of respondents supported the introduction of supplementary assessments, 49% favoured admissions test, and 16% preferred assessing non-academic factors. Many respondents supported the School’s multi-entry multi-exit strategy as a ‘good policy’ that provided ‘flexibility’ and opportunity for students, but should be better regulated. These findings demonstrate the need for supplementary assessments in the selection process and for continued support for the use of multi-entry multi-exit strategy at the school.

Although several studies have examined the relationship between minority students' admissions profiles and performance in the preclinical curriculum, there is a dearth of information about the ability of admissions variables to predict performance in the clerkships and on National Boards, Part II. Consistent with other research, a study of 59 minority students at the Albert Einstein College of Medicine found that the Medical College Aptitude Test (MCAT) chemistry score is the most consistent predictor of performance on internal examinations in years 1 and 2, and on National Boards, Part I. On the Part II examination, however, the only significant correlation is with the MCAT reading score, while the MCAT quantitative score and the recommendation of the premedical advisor are the best predictors of clerkship grades. Since students' mean MCATs and grade point averages (GPAs) are similar to those of all minority students accepted to medical schools in 1982, these findings may be generalized to that larger population.

OBJECTIVES: To determine prevalence and risk factors of Chlamydia trachomatis among female secondary school students and to develop potential selective screening strategies. METHODS: A cross sectional survey was conducted in the 17 school medical centres in Antwerp municipality, Belgium. All female students of forms 5 or 6, who were due for their medical check up during the school year 1996-7, were invited to participate. A self administered questionnaire on general and sexual behaviour, and a first void urine sample were collected. The urine specimen was tested for C trachomatis with ligase chain reaction assay, and positive tests were confirmed with polymerase chain reaction assays. RESULTS: 2784 female students participated in the study. Their median age was 17, and 52% of them reported having sexual intercourse at least once. The prevalence of C trachomatis among sexually active women was 1.4%. Factors significantly associated with infection in multivariate analysis were number of lifetime partners, genital complaints of partner, type of secondary school, and a history of pregnancy. Selective screening of those women who are at highest risk for infection would have detected 90% of all infections, and require testing of 14% to 18% of the population. CONCLUSIONS: The prevalence of C trachomatis was relatively low among female secondary school students in Antwerp, but unsafe sex practices were evident because of the high number of unplanned pregnancies. Selective screening strategies with a high sensitivity can be proposed, but should be assessed for acceptability, feasibility, and cost. 




Background

Prior to 1999 students entering our MBBS course were selected on academic performance alone. We have now evaluated the impact on the demographics of subsequent cohorts of our standard entry students (those entering directly from high school) of the addition to the selection process of an aptitude test (UMAT), a highly structured interview and a rural incentive program.

Methods

Students entering from 1985 to 1998, selected on academic performance alone (N = 1402), were compared to those from 1999 to 2011, selected on the basis of a combination of academic performance, interview score, and UMAT score together with the progressive introduction of a rural special entry pathway (N = 1437).

Results

Males decreased from 57% to 45% of the cohort, students of NE or SE Asian origin decreased from 30% to 13%, students born in Oceania increased from 52% to 69%, students of rural origin from 5% to 21% and those from independent high schools from 56% to 66%. The proportion of students from high schools with relative socio-educational disadvantage remained unchanged at approximately 10%. The changes reflect in part increasing numbers of female and independent high school applicants and the increasing rural quota. However, they were also associated with higher interview scores in females vs males and lower interview scores in those of NE and SE Asian origin compared to those born in Oceania or the UK. Total UMAT scores were unrelated to gender or region of origin.

Conclusions

The revised selection processes had no impact on student representation from schools with relative socio-educational disadvantage. However, the introduction of special entry quotas for students of rural origin and a structured interview, but not an aptitude test, were associated with a change in gender balance and ethnicity of students in an Australian undergraduate MBBS course.

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

Studies on school students are indicating that somatic complaints and pain have increased during the past decades. Throughout this period there has been a change in methodology from proxy reports by parents to having the students themselves act as the respondents, possible explaining some of the increase in prevalence. The aim of this study was to compare the agreement of answers from students with answers given by their parents regarding the students' medical background and subjective rating of perceived health with specific focus on frequency of headache, musculoskeletal pain and tiredness.

Methods

The participating students came from eleven different schools in Sweden. The schools were a sub sample of randomly selected schools originally participating in a larger multidisciplinary base study. Those 8th grade students present at school on the test date became the subjects of the investigation. A total of 232 students answered, assisted by the test leader, a specially designed self-complete questionnaire at school. Their parents were, at the same time, contacted and 200 answered a similar mailed-out questionnaire. One hundred and eighty-six (186) corresponding student-same parent questionnaires were registered for which comparisons of answers could be made and analysis conducted.

Results

When a child is in good health, in absence of diseases, pain and injuries, his or her assessment matches up with their parent. Children and parents also showed agreement in cases of severe injuries and frequent (daily) complaints of knee pain. Less frequent headaches, back- and musculoskeletal pain and other complaints of minor injuries and less wellbeing, such as students' tiredness, were all under-reported and under-rated by their parents.

Conclusion

When assessing the perceived health and wellbeing of students, their own expressions should be the basis for the data collection and analysis rather than relying entirely on parental reports.