Compellingly negative: Bayesian analysis shows handedness and dementia are not associated.

This scientific commentary refers to "The role of hand preference in cognition and neuropsychiatric symptoms in neurodegenerative diseases" by Saari & Vuoksimaa (https://doi.org/10.1093/braincomms/fcad137).

Institutional choice among medical applicants: a profile paper for The United Kingdom Medical Applicant Cohort Study (UKMACS) prospective longitudinal cohort study.

PURPOSE: To generate a large cohort of those in 2019 seriously considering applying to study Medicine, collecting data on a range of socioeconomic and other demographic factors that influence choice of medical schools and to link to other datasets to form a longitudinal study of progress through medical school and careers in medicine. DESIGN: Cross-sectional questionnaire studies, part of the longitudinal UK Medical Applicant Cohort Study (UKMACS). SETTING: UK medical school admissions in 2020. PARTICIPANTS: UK residents aged 16+ and seriously considering applying to study Medicine. The cohort was primarily drawn from those registering in 2019 for the U(K)CAT (University Clinical Aptitude Test (formerly the UK Clinical Aptitude Test)) with additional potential applicants responding to an open call. Participants consented to their data being linked within the UK Medical Education Database. FINDINGS TO DATE: UKMACS Wave 1 questionnaire respondents consisted of 6391 consenting respondents from across the UK. In 2019, 14 980 of the 17 470 UK-domiciled medicine applicants were first-time applicants. The questionnaires show that many of these applicants have a need for more help and guidance to make informed choices, with less advantaged groups reporting themselves as being at a disadvantage when applying due to limited understanding of information and limited access to guidance to enable informed and effective decision-making. FUTURE PLANS: To link the cohort with successive Universities and Colleges Admissions Service and other datasets to analyse outcomes of applications and establish national longitudinal evidence to understand how medical choices are made and how they impact on educational, career and workforce outcomes.

Can achievement at medical admission tests predict future performance in postgraduate clinical assessments? A UK-based national cohort study.

OBJECTIVE: To determine whether scores on two undergraduate admissions tests (BioMedical Admissions Test (BMAT) and University Clinical Aptitude Test (UCAT)) predict performance on the postgraduate Membership of the Royal Colleges of Physicians (MRCP) examination, including the clinical examination Practical Assessment of Clinical Examination Skills (PACES). DESIGN: National cohort study. SETTING: Doctors who graduated medical school between 2006 and 2018. PARTICIPANTS: 3045 doctors who had sat BMAT, UCAT and the MRCP. PRIMARY OUTCOME MEASURES: Passing each section of the MRCP at the first attempt, including the clinical assessment PACES. RESULTS: Several BMAT and UCAT subtest scores displayed incremental predictive validity for performance on the first two (written) parts of the MRCP. Only aptitude and skills on BMAT (OR 1.34, 1.08 to 1.67, p=0.01) and verbal reasoning on UCAT (OR 1.34, 1.04 to 1.71, p=0.02) incrementally predicted passing PACES at the first attempt. CONCLUSIONS: Our results imply that the abilities assessed by aptitude and skills and verbal reasoning may be the most important cognitive attributes, of those routinely assessed at selection, for predicting future clinical performance. Selectors may wish to consider placing particular weight on scales assessing these attributes if they wish to select applicants likely to become more competent clinicians. These results are potentially relevant in an international context too, since many admission tests used globally, such as the Medical College Admission Test, assess similar abilities.

Predictive validity of A-level grades and teacher-predicted grades in UK medical school applicants: a retrospective analysis of administrative data in a time of COVID-19.

OBJECTIVES: To compare in UK medical students the predictive validity of attained A-level grades and teacher-predicted A levels for undergraduate and postgraduate outcomes. Teacher-predicted A-level grades are a plausible proxy for the teacher-estimated grades that replaced UK examinations in 2020 as a result of the COVID-19 pandemic. The study also models the likely future consequences for UK medical schools of replacing public A-level examination grades with teacher-predicted grades. DESIGN: Longitudinal observational study using UK Medical Education Database data. SETTING: UK medical education and training. PARTICIPANTS: Dataset 1: 81 202 medical school applicants in 2010-2018 with predicted and attained A-level grades. Dataset 2: 22 150 18-year-old medical school applicants in 2010-2014 with predicted and attained A-level grades, of whom 12 600 had medical school assessment outcomes and 1340 had postgraduate outcomes available. OUTCOME MEASURES: Undergraduate and postgraduate medical examination results in relation to attained and teacher-predicted A-level results. RESULTS: Dataset 1: teacher-predicted grades were accurate for 48.8% of A levels, overpredicted in 44.7% of cases and underpredicted in 6.5% of cases. Dataset 2: undergraduate and postgraduate outcomes correlated significantly better with attained than with teacher-predicted A-level grades. Modelling suggests that using teacher-estimated grades instead of attained grades will mean that 2020 entrants are more likely to underattain compared with previous years, 13% more gaining the equivalent of the lowest performance decile and 16% fewer reaching the equivalent of the current top decile, with knock-on effects for postgraduate training. CONCLUSIONS: The replacement of attained A-level examination grades with teacher-estimated grades as a result of the COVID-19 pandemic may result in 2020 medical school entrants having somewhat lower academic performance compared with previous years. Medical schools may need to consider additional teaching for entrants who are struggling or who might need extra support for missed aspects of A-level teaching.

Exploring UK medical school differences: the MedDifs study of selection, teaching, student and F1 perceptions, postgraduate outcomes and fitness to practise.

BACKGROUND: Medical schools differ, particularly in their teaching, but it is unclear whether such differences matter, although influential claims are often made. The Medical School Differences (MedDifs) study brings together a wide range of measures of UK medical schools, including postgraduate performance, fitness to practise issues, specialty choice, preparedness, satisfaction, teaching styles, entry criteria and institutional factors. METHOD: Aggregated data were collected for 50 measures across 29 UK medical schools. Data include institutional history (e.g. rate of production of hospital and GP specialists in the past), curricular influences (e.g. PBL schools, spend per student, staff-student ratio), selection measures (e.g. entry grades), teaching and assessment (e.g. traditional vs PBL, specialty teaching, self-regulated learning), student satisfaction, Foundation selection scores, Foundation satisfaction, postgraduate examination performance and fitness to practise (postgraduate progression, GMC sanctions). Six specialties (General Practice, Psychiatry, Anaesthetics, Obstetrics and Gynaecology, Internal Medicine, Surgery) were examined in more detail. RESULTS: Medical school differences are stable across time (median alpha = 0.835). The 50 measures were highly correlated, 395 (32.2%) of 1225 correlations being significant with p < 0.05, and 201 (16.4%) reached a Tukey-adjusted criterion of p < 0.0025. Problem-based learning (PBL) schools differ on many measures, including lower performance on postgraduate assessments. While these are in part explained by lower entry grades, a surprising finding is that schools such as PBL schools which reported greater student satisfaction with feedback also showed lower performance at postgraduate examinations. More medical school teaching of psychiatry, surgery and anaesthetics did not result in more specialist trainees. Schools that taught more general practice did have more graduates entering GP training, but those graduates performed less well in MRCGP examinations, the negative correlation resulting from numbers of GP trainees and exam outcomes being affected both by non-traditional teaching and by greater historical production of GPs. Postgraduate exam outcomes were also higher in schools with more self-regulated learning, but lower in larger medical schools. A path model for 29 measures found a complex causal nexus, most measures causing or being caused by other measures. Postgraduate exam performance was influenced by earlier attainment, at entry to Foundation and entry to medical school (the so-called academic backbone), and by self-regulated learning. Foundation measures of satisfaction, including preparedness, had no subsequent influence on outcomes. Fitness to practise issues were more frequent in schools producing more male graduates and more GPs. CONCLUSIONS: Medical schools differ in large numbers of ways that are causally interconnected. Differences between schools in postgraduate examination performance, training problems and GMC sanctions have important implications for the quality of patient care and patient safety.

'Best friends forever'? Friendship stability across school transition and associations with mental health and educational attainment.

BACKGROUND: Friendships have been linked to mental health and school attainment in children. The effects of friendlessness and friendship quality have been well researched, but less is known about the role of friendship stability (i.e., maintaining the same friend over time), an aspect of friendship which is often interrupted by the transition between phases of schooling. Many children report concerns about the secondary school transition which introduces a number of new social and academic challenges for children. AIMS: To explore rates of friendship stability and whether maintaining a stable best friend across the primary to secondary school transition provided benefits to children's adjustment during this period. SAMPLE: Data were from 593 children (M age = 11 years 2 months). METHODS: This study used longitudinal data from children transitioning into 10 UK secondary schools and explored the association between self-reported friendship stability and three outcomes: academic attainment, emotional problems and conduct problems. Analyses controlled for friendship quality and pre-transition psychological adjustment or attainment as appropriate. RESULTS: Rates of friendship stability were relatively low during this period. Children who kept the same best friend had higher academic attainment and lower levels of conduct problems. Exploratory analyses indicated that secondary school policies that group children based on friendships may support friendship stability. CONCLUSIONS: Helping maintain children's best friendships during the transition to secondary school may contribute to higher academic performance and better mental health.

Fitness to practise sanctions in UK doctors are predicted by poor performance at MRCGP and MRCP(UK) assessments: data linkage study.

BACKGROUND: The predictive validity of postgraduate examinations, such as MRCGP and MRCP(UK) in the UK, is hard to assess, particularly for clinically relevant outcomes. The sanctions imposed on doctors by the UK's General Medical Council (GMC), including erasure from the Medical Register, are indicators of serious problems with fitness to practise (FtP) that threaten patient safety or wellbeing. This data linkage study combined data on GMC sanctions with data on postgraduate examination performance. METHODS: Examination results were obtained for UK registered doctors taking the MRCGP Applied Knowledge Test (AKT; n = 27,561) or Clinical Skills Assessment (CSA; n = 17,365) at first attempt between 2010 and 2016 or taking MRCP(UK) Part 1 (MCQ; n = 37,358), Part 2 (MCQ; n = 28,285) or Practical Assessment of Clinical Examination Skills (PACES; n = 27,040) at first attempt between 2001 and 2016. Exam data were linked with GMC actions on a doctor's registration from September 2008 to January 2017, sanctions including Erasure, Suspension, Conditions on Practice, Undertakings or Warnings (ESCUW). Examination results were only considered at first attempts. Multiple logistic regression assessed the odds ratio for ESCUW in relation to examination results. Multiple imputation was used for structurally missing values. RESULTS: Doctors sanctioned by the GMC performed substantially less well on MRCGP and MRCP(UK), with a mean Cohen's d across the five exams of - 0.68. Doctors on the 2.5th percentile of exam performance were about 12 times more likely to have FtP problems than those on the 97.5th percentile. Knowledge assessments and clinical assessments were independent predictors of future sanctions, with clinical assessments predicting ESCUW significantly better. The log odds of an FtP sanction were linearly related to examination marks over the entire range of performance, additional performance increments lowering the risk of FtP sanctions at all performance levels. CONCLUSIONS: MRCGP and MRCP(UK) performance are valid predictors of professionally important outcomes that transcend simple knowledge or skills and the GMC puts under the headings of conduct and trust. Postgraduate examinations may predict FtP sanctions because the psychological processes involved in successfully studying, understanding and practising medicine at a high level share similar mechanisms to those underlying conduct and trust.

Impact of accelerated, graduate-entry medicine courses: a comparison of profile, success, and specialty destination between graduate entrants to accelerated or standard medicine courses in UK.

BACKGROUND: Little research has compared the profile, success, or specialty destinations of graduates entering UK medical schools via accelerated, 4-yr, standard 5-yr and 6-yr programmes. Four research questions directed this investigation:- What are the success rates for graduates entering graduate-entry vs. undergraduate medicine courses? How does the sociodemographic and educational profile differ between these two groups? Is success - in medical school and foundation training - dependent on prior degree, demographic factors, or aptitude test performance at selection? What specialty do graduate entry medicine students subsequently enter? METHODS: The data from two cohorts of graduates entering medical school in 2007 and 2008 (n = 2761) in the UKMED (UK Medical Education Database) database were studied: 1445 taking 4-yr and 1150 taking 5-yr medicine courses, with smaller numbers following other programmes. RESULTS: Completion rates for degree programmes were high at 95%, with no significant difference between programme types. 4-yr entrants were older, less likely to be from Asian communities, had lower HESA (Higher Education Statistics Agency) tariff scores, but higher UKCAT (UK Clinical Aptitude Test) and GAMSAT (Graduate Medical School Admissions Test) scores, than 5-yr entrants. Higher GAMSAT scores, black or minority ethnicity (BME), and younger age were independent predictors of successful completion of medical school. Foundation Programme (FPAS) selection measures (EPM - educational performance measure; SJT - situational judgment test) were positively associated with female sex, but negatively with black or minority ethnicity. Higher aptitude test scores were associated with EPM and SJT, GAMSAT with EPM, UKCAT with SJT. Prior degree subject, class of degree, HESA tariff, and type of medicine programme were not related to success. CONCLUSIONS: The type of medicine programme has little effect on graduate entrant completion, or EPM or SJT scores, despite differences in student profile. Aptitude test score has some predictive validity, as do sex, age and BME, but not prior degree subject or class. Further research is needed to disentangle the influences of BME.

Meta-analytic findings reveal lower means but higher variances in visuospatial ability in dyslexia.

Conflicting empirical and theoretical accounts suggest that dyslexia is associated with either average, enhanced, or impoverished high-level visuospatial processing relative to controls. Such heterogeneous results could be due to the presence of wider variability in dyslexic samples, which is unlikely to be identified at the single study level, due to lack of power. To address this, this study reports a meta-analysis of means and variances in high-level visuospatial ability in 909 non-dyslexic and 956 dyslexic individuals. The findings suggest that dyslexia is associated not only with a lower mean performance on visuospatial tasks but also with greater variability in performance. Through novel meta-analytic techniques, we demonstrate a negative effect size for mean differences (-.457), but a positive effect size for SD differences (+.118; SD ratio = 1.107). In doing so, this is the first study to demonstrate impoverished visuospatial processing of the majority of individuals with dyslexia in addition to greater variance in performance in this group. The findings advocate for further consideration of both the presence of, and reasons for, increased variance in perception, attention, and memory across neurodevelopmental disorders.

Would changing the selection process for GP trainees stem the workforce crisis? A cohort study using multiple-imputation and simulation.

BACKGROUND: There is currently a shortage of qualified GPs in the UK and not all of the training posts available each year are filled. Changing the way in which GP trainees are selected could help increase the training post fill rate and the number of new entrants to the GP Register. The aim of this study was to model the impact of changing the selection process for GP training on the number of trainees obtaining GP Registration, either with or without extensions. METHOD: This was a cohort study using UK applications for GP training in 2011-14. Application data were linked using GMC numbers to training outcome data where available, and imputed using multiple imputation where missing. The number of trainees appointed and GP Registrations within three and five years' full-time-equivalent were estimated for four different selection processes. RESULTS: The cut scores used in the actual 2015 selection process makes it impossible to fill all training posts. Random selection is the worst option, but the difference between this and other processes modelled falls as more trainees are selected. There are large marginal effects on outcomes: those with the highest selection scores are more likely to obtain GP Registration than those with the lowest scores. CONCLUSIONS: Changing the selection process alone would have a small impact on the number of GP Registrations; reducing/removing cut scores would have a much larger impact. This would also increase the number of trainees requiring extensions and being released from training which would have adverse consequences for the profession.

Using differential item functioning to evaluate potential bias in a high stakes postgraduate knowledge based assessment.

BACKGROUND: Fairness is a critical component of defensible assessment. Candidates should perform according to ability without influence from background characteristics such as ethnicity or sex. However, performance differs by candidate background in many assessment environments. Many potential causes of such differences exist, and examinations must be routinely analysed to ensure they do not present inappropriate progression barriers for any candidate group. By analysing the individual questions of an examination through techniques such as Differential Item Functioning (DIF), we can test whether a subset of unfair questions explains group-level differences. Such items can then be revised or removed. METHODS: We used DIF to investigate fairness for 13,694 candidates sitting a major international summative postgraduate examination in internal medicine. We compared (a) ethnically white UK graduates against ethnically non-white UK graduates and (b) male UK graduates against female UK graduates. DIF was used to test 2773 questions across 14 sittings. RESULTS: Across 2773 questions eight (0.29%) showed notable DIF after correcting for multiple comparisons: seven medium effects and one large effect. Blinded analysis of these questions by a panel of clinician assessors identified no plausible explanations for the differences. These questions were removed from the question bank and we present them here to share knowledge of questions with DIF. These questions did not significantly impact the overall performance of the cohort. Group-level differences in performance between the groups we studied in this examination cannot be explained by a subset of unfair questions. CONCLUSIONS: DIF helps explore fairness in assessment at the question level. This is especially important in high-stakes assessment where a small number of unfair questions may adversely impact the passing rates of some groups. However, very few questions exhibited notable DIF so differences in passing rates for the groups we studied cannot be explained by unfairness at the question level.

Maternal depressive symptoms and adolescent academic attainment: Testing pathways via parenting and self-control.

Maternal depression is associated with reduced academic attainment in children, however, it is not clear how this association comes about. Depressive symptoms are associated with impairment in social roles including parenting. Children's self-control is an important contributor to academic attainment and is influenced by parenting. We therefore hypothesised that impaired parenting and children's self-control may mediate links between maternal depression and children's academic attainment. Data were from a brief longitudinal study (3 waves) of UK children aged 11-12 years and their mothers. Higher maternal depressive symptoms at baseline were associated with lower academic attainment in children assessed one year later. There was evidence to support an indirect effect of maternal depressive symptoms on children's academic attainment through the mother-child and the father-child relationship which, in turn, reduced children's self-control. These influences were independent of socio-economic deprivation. A direct effect of maternal depression on children's academic attainment was also observed.

Faking handedness: Individual differences in ability to fake handedness, social cognitions of the handedness of others, and a forensic application using Bayes' theorem.

People usually describe their handedness honestly, but that need not necessarily be the case. A legal case is described of a murder said by the pathologist to be committed by a left-hander but the defendant claimed to be right-handed, and the first author assessed the defendant's handedness as an expert witness. We know of no previous work on faking handedness, and so we tested 30 right-handers and 25 left-handers on various handedness tasks, and then asked the participants to repeat the tasks while faking being of opposite handedness. Social cognitions of handedness were assessed from participants' knowledge of how other right- and left-handers would answer handedness questionnaires. Fake handedness was best differentiated using cursive lower-case sentence writing, upper-case written letters being less good at distinguishing, as also were simple motor tasks. Participants differed in social cognitions of handedness, and those with more accurate social cognitions were better able to fake. Personality measures did not predict faking ability. For forensic purposes a Bayesian analysis was carried out to evaluate the likelihood of right and left hand performance being true rather than faked, and the cursive lower-case writing provided strong posterior odds that, as claimed, the particular defendant was a true right-hander.

A longitudinal study of self-control at the transition to secondary school: Considering the role of pubertal status and parenting.

Higher self-control in children and adolescents is associated with a range of positive outcomes in adulthood. However, little is known about the naturalistic development of self-control during early adolescence and the factors that affect this. We examined the role of puberty and parenting style as theoretically important influences on stability and change in self-control. A longitudinal (3 waves), multiple-informant dataset of children entering early adolescence (M = 11 years) was used to explore longitudinal change in self-control using latent growth curve modelling. Children's self-control declined during the one-year study period and declines were associated with children's behavioural and social functioning. Associations with self-control were found for pubertal status and parental warmth and hostility, but not for parental discipline. The findings suggest that during early adolescence, when children make the transition to secondary school, self-control declines. This is particularly the case for those experiencing puberty earlier than their peers. Parent warmth influences the trajectory of self-control during this period.

The Tapley and Bryden test of performance differences between the hands: The original data, newer data, and the relation to pegboard and other tasks.

Tapley and Bryden (T&B)'s 1985 circle-marking task is a group-administered task assessing performance differences between the hands. The bimodal distribution clearly separates self-described right- and left-handers. Using Phil's original datafiles we analyse the test in more detail, providing raw scores for each hands which are useful forensically, and we provide reliability estimates. Van Horn's unpublished 1992 PhD thesis studied T&B tasks and Annett pegboards varying in difficulty. A striking finding, that Phil Bryden called "the Van Horn problem," was that hand differences (R - L) were unrelated to task difficulty. That result was the starting point for Pamela Bryden's 1998 thesis, firstly replicating Van Horn, but then showing that task difficulty did relate to hand differences for Grooved pegboards. Pamela Bryden's model for those effects is presented here. Comparing across tasks, the T&B and pegboard tasks showed almost complete consistency for direction of handedness. Likewise, within each task, degree of handedness intercorrelated strongly across variants. In strong contrast, degree of handedness for T&B tasks showed minimal correlation with degree of handedness for pegboards. At the highest level, therefore, direction of handedness is consistent within individuals (conventional right and left handedness), but there are separable processes determining dominant-non-dominant hands differences for each particular task.

Higher cognitive ability buffers stress-related depressive symptoms in adolescent girls.

Stress has been shown to have a causal effect on risk for depression. We investigated the role of cognitive ability as a moderator of the effect of stressful life events on depressive symptoms and whether this varied by gender. Data were analyzed in two adolescent data sets: one representative community sample aged 11-12 years (n = 460) and one at increased familial risk of depression aged 9-17 years (n = 335). In both data sets, a three-way interaction was found whereby for girls, but not boys, higher cognitive ability buffered the association between stress and greater depressive symptoms. The interaction was replicated when the outcome was a diagnosis of major depressive disorder. This buffering effect in girls was not attributable to coping efficacy. However, a small proportion of the variance was accounted for by sensitivity to environmental stressors. Results suggest that this moderating effect of cognitive ability in girls is largely attributable to greater available resources for cognitive operations that offer protection against stress-induced reductions in cognitive processing and cognitive control which in turn reduces the likelihood of depressive symptomatology.

Doctor, builder, soldier, lawyer, teacher, dancer, shopkeeper, vet: exploratory study of which eleven-year olds would like to become a doctor.

BACKGROUND: Very little is known about the extent to which eleven-year olds might consider a career in medicine. This exploratory study therefore asked children and their parents about medicine as a possible career, looking also at the relationship to a range of background measures. METHODS: A longitudinal, three-wave, questionnaire study of students transferring from primary to secondary school (STARS), with data collection at primary school (wave 1; mean age 11.3 yrs), in the first months of secondary school (wave 2; mean age 11.7 yrs) and at the end of the first year of secondary school (wave 3; mean age 12.3 yrs). Parents/carers also completed questionnaires. Children were entering ten large comprehensive secondary schools in the south-east of England; 46.3 % were female, 15.6 % receiving free-school meals, 39.8 % were Black or Minority Ethnic and 28.8 % had a first language which was not English. Of 2287 children in the study, 1936 children (84.5 %) completed at least one questionnaire of the three waves (waves 1, 2 and 3). The main outcome measures were an open-ended question in each wave, "What job would you like to do when you grow up?", and a more detailed questionnaire in wave 3 asking about 33 different jobs. RESULTS: 9.9 % of children spontaneously mentioned medicine as a career on at least one occasion. For the specific jobs, would-be doctors particularly preferred Hospital Medicine, followed by Surgery, General Practice and then Psychiatry. Would-be doctors were also more interested in careers such as Nurse, Archaeologist, Lawyer and Teacher, and less interested in careers such as Shopkeeper, Sportsperson, or Actor/dancer/singer/musician. Would-be doctors were less Neurotic, more Open to Experience, more Conscientious, and preferred higher prestige occupations. Those interested in medicine did not score more highly on Key Stage 2 attainment tests or Cognitive Abilities Test, did not have a higher family income or greater parental/carer education, and did not have more experience of illness or deaths among family and friends. CONCLUSIONS: An interest in a medical career, unlike high prestige jobs in general, is not associated with higher educational attainment or cognitive ability, and it is likely that only one in ten of the children interested in medical careers will have sufficient educational attainment at GCSE or A-level to be able to enter medical school.

Assessment at UK medical schools varies substantially in volume, type and intensity and correlates with postgraduate attainment.

BACKGROUND: In the United Kingdom (UK), medical schools are free to develop local systems and policies that govern student assessment and progression. Successful completion of an undergraduate medical degree results in the automatic award of a provisional licence to practice medicine by the General Medical Council (GMC). Such a licensing process relies heavily on the assumption that individual schools develop similarly rigorous assessment policies. Little work has evaluated variability of undergraduate medical assessment between medical schools. That absence is important in the light of the GMC's recent announcement of the introduction of the UKMLA (UK Medical Licensing Assessment) for all doctors who wish to practise in the UK. The present study aimed to quantify and compare the volume, type and intensity of summative assessment across medicine (A100) courses in the United Kingdom, and to assess whether intensity of assessment correlates with the postgraduate attainment of doctors from these schools. METHODS: Locally knowledgeable students in each school were approached to take part in guided-questionnaire interviews via telephone or Skype(TM). Their understanding of assessment at their medical school was probed, and later validated with the assessment department of the respective medical school. We gathered data for 25 of 27 A100 programmes in the UK and compared volume, type and intensity of assessment between schools. We then correlated these data with the mean first-attempt score of graduates sitting MRCGP and MRCP(UK), as well as with UKFPO selection measures. RESULTS: The median written assessment volume across all schools was 2000 min (mean = 2027, SD = 586, LQ = 1500, UQ = 2500, range = 1000-3200) and 1400 marks (mean = 1555, SD = 463, LQ = 1200, UQ = 1800, range = 1100-2800). The median practical assessment volume was 400 min (mean = 472, SD = 207, LQ = 400, UQ = 600, range = 200-1000). The median intensity (minutes per mark ratio) of summative written assessment was 1.24 min per mark (mean = 1.28, SD = 0.30, LQ = 1.11, UQ = 1.37, range = 0.85-2.08). An exploratory analysis suggested a significant correlation of total assessment time with mean first-attempt score on both the knowledge and the clinical assessments of MRCGP and of MRCP(UK). CONCLUSIONS: There are substantial differences in the volume, format and intensity of undergraduate assessment between UK medical schools. These findings suggest a potential for differences in the reliability of detecting poorly performing students, or differences in identifying and stratifying academically equivalent students for ranking in the Foundation Programme Application System (FPAS). Furthermore, these differences appear to directly correlate with performance in postgraduate examinations. Taken together, our findings highlight highly variable local assessment procedures that warrant further investigation to establish their potential impact on students.

Cross-comparison of MRCGP & MRCP(UK) in a database linkage study of 2,284 candidates taking both examinations: assessment of validity and differential performance by ethnicity.

BACKGROUND: MRCGP and MRCP(UK) are the main entry qualifications for UK doctors entering general [family] practice or hospital [internal] medicine. The performance of MRCP(UK) candidates who subsequently take MRCGP allows validation of each assessment. In the UK, underperformance of ethnic minority doctors taking MRCGP has had a high political profile, with a Judicial Review in the High Court in April 2014 for alleged racial discrimination. Although the legal challenge was dismissed, substantial performance differences between white and BME (Black and Minority Ethnic) doctors undoubtedly exist. Understanding ethnic differences can be helped by comparing the performance of doctors who take both MRCGP and MRCP(UK). METHODS: We identified 2,284 candidates who had taken one or more parts of both assessments, MRCP(UK) typically being taken 3.7 years before MRCGP. We analyzed performance on knowledge-based MCQs (MRCP(UK) Parts 1 and 2 and MRCGP Applied Knowledge Test (AKT)) and clinical examinations (MRCGP Clinical Skills Assessment (CSA) and MRCP(UK) Practical Assessment of Clinical Skills (PACES)). RESULTS: Correlations between MRCGP and MRCP(UK) were high, disattenuated correlations for MRCGP AKT with MRCP(UK) Parts 1 and 2 being 0.748 and 0.698, and for CSA and PACES being 0.636. BME candidates performed less well on all five assessments (P < .001). Correlations disaggregated by ethnicity were complex, MRCGP AKT showing similar correlations with Part1/Part2/PACES in White and BME candidates, but CSA showing stronger correlations with Part1/Part2/PACES in BME candidates than in White candidates. CSA changed its scoring method during the study; multiple regression showed the newer CSA was better predicted by PACES than the previous CSA. CONCLUSIONS: High correlations between MRCGP and MRCP(UK) support the validity of each, suggesting they assess knowledge cognate to both assessments. Detailed analyses by candidate ethnicity show that although White candidates out-perform BME candidates, the differences are largely mirrored across the two examinations. Whilst the reason for the differential performance is unclear, the similarity of the effects in independent knowledge and clinical examinations suggests the differences are unlikely to result from specific features of either assessment and most likely represent true differences in ability.