Predictive power of UKCAT and other pre-admission measures for performance in a medical school in Glasgow: a cohort study.

BACKGROUND: The UK Clinical Aptitude Test (UKCAT) and its four subtests are currently used by 24 Medical and Dental Schools in the UK for admissions. This longitudinal study examines the predictive validity of UKCAT for final performance in the undergraduate medical degree programme at one Medical School and compares this with the predictive validity of the selection measures available pre-UKCAT. METHODS: This was a retrospective observational study of one cohort of students, admitted to Glasgow Medical School in 2007. We examined the associations which UKCAT scores, school science grades and pre-admissions interview scores had with performance indicators, particularly final composite scores that determine students' postgraduate training opportunities and overall ranking (Educational Performance Measure - EPM, and Honours and Commendation - H&C). Analyses were conducted both with and without adjustment for potential socio-demographic confounders (gender, age, ethnicity and area deprivation). RESULTS: Despite its predictive value declining as students progress through the course, UKCAT was associated with the final composite scores. In mutually adjusted analyses (also adjusted for socio-demographic confounders), only UKCAT total showed independent relationships with both EPM (p = 0.005) and H&C (p = 0.004), school science achievements predicted EPM (p = 0.009), and pre-admissions interview score predicted neither. UKCAT showed less socio-demographic variation than did TSS. CONCLUSION: UKCAT has a modest predictive power for overall course performance at the University of Glasgow Medical School over and above that of school science achievements or pre-admission interview score and we conclude that UKCAT is the most useful predictor of final ranking.

Increasing Collaborative Discussion in Case-Based Learning Improves Student Engagement and Knowledge Acquisition.

Background: In the transition from academic to clinical learning, the development of clinical reasoning skills and teamwork is essential, but not easily achieved by didactic teaching only. Case-based learning (CBL) was designed to stimulate discussions of genuine clinical cases and diagnoses but in our initial format (CBL'10) remained predominantly tutor-driven rather than student-directed. However, interactive teaching methods stimulate deep learning and consolidate taught material, and we therefore introduced a more collaborative CBL (cCBL), featuring a structured format with discussions in small breakout groups. This aimed to increase student participation and improve learning outcomes. Method: A survey with open and closed questions was distributed among 149 students and 36 tutors that had participated in sessions of both CBL formats. A statistical analysis compared exam scores of topics taught via CBL'10 and cCBL. Results: Students and tutors both evaluated the switch to cCBL positively, reporting that it increased student participation and enhanced consolidation and integration of the wider subject area. They also reported that the cCBL sessions increased constructive discussion and stimulated deep learning. Moreover, tutors found the more structured cCBL sessions easier to facilitate. Analysis of exam results showed that summative assessment scores of subjects switched to cCBL significantly increased compared to previous years, whereas scores of subjects that remained taught as CBL'10 did not change. Conclusions: Compared to our initial, tutor-led CBL format, cCBL resulted in improved educational outcomes, leading to increased participation, confidence, discussion and higher exam scores.

Barriers to access, transition and progression of Widening Participation students in UK Medical Schools: The students' perspective.

This article was migrated. The article was marked as recommended. Much attention is being given to the implementation of fair selection criteria for access to Medical Schools in the UK, in order to address an imbalance in social class representation in the medical professions. Largely overlooked however, are the disadvantages faced by potential applicants both before and after selection by the Medical Schools. Here, we explore the nature of the barriers - both real and perceived - to accessing, transitioning and progressing in the medical education system as experienced by 125 current students at three UK Medical Schools. An online survey was conducted and responses to open and closed questions were categorised on the basis of the number of Widening Participation (WP) flags (e.g. index of multiple-deprivation, parental education and school Higher Education participation rate). The results show that differences in economic, social and cultural capital that students acquire through their background impact on their chances of admission to medical schools, highlighting issues such as access to finance and privileged knowledge, with school support and work experience opportunities being less available to WP students. Equally, these students found the transition to Medical School harder, and highlighted a lack of peers from similar backgrounds, a perception of being less well prepared academically and generally finding it difficult to fit in. Money worries and having to work for extra income, exacerbated the feeling of not fitting in, by losing out on key extracurricular activities. The data presented stress the importance of early support of (potential) WP students in secondary schools, and of a strong support network throughout their medical education.

Agonist occupancy of a single monomeric element is sufficient to cause internalization of the dimeric beta2-adrenoceptor.

A range of studies have indicated that many rhodopsin-like, family A G protein-coupled receptors, including the beta(2)-adrenoceptor, exist and probably function as dimers. It is less clear if receptors internalize as dimers and if agonist occupancy of only one element of a dimer is sufficient to cause internalization of a receptor dimer into the cell. We have used a chemogenomic approach to demonstrate that this is the case. Following expression of the wild type beta(2)-adrenoceptor, isoprenaline but not 1-(3''4'-dihydroxyphenyl)-3-methyl-1-butanone, which does not have significant affinity for the wild type receptor, caused receptor internalization. By contrast, 1-(3'4'-dihydroxyphenyl)-3-methyl-1-butanone, but not isoprenaline that does not have high affinity for the mutated receptor, caused internalization of Asp(113)Serbeta(2)-adrenoceptor. Following co-expression of wild type and Asp(113)Serbeta(2)-adrenoceptors each of isoprenaline and 1-(3'4'-dihydroxyphenyl)-3-methyl-1-butanone caused the co-internalization of both of these two forms of the receptor. Co-expressed wild type and Asp(113)Serbeta(2)-adrenoceptors were able to be co-immunoprecipitated and 1-(3'4'-dihydroxyphenyl)-3-methyl-1-butanone produced internalization of the wild type receptor that was not prevented by the beta-adrenoceptor antagonist propranolol that binds with high affinity only to the wild type receptor. These results demonstrate that agonist occupancy of either single binding site of the beta(2)-adrenoceptor dimer is sufficient to cause internalization of the dimer and that antagonist occupation of one of the two ligand binding sites is unable to prevent agonist-mediated internalization.

The challenges of widening access to the medical profession: how to facilitate medical careers for those at a genuine disadvantage.

This article was migrated. The article was marked as recommended. Widening Participation (WP) for medical school entry has been politically encouraged to ensure access and participation for underrepresented groups that are rarely able to gain access to this high demand profession. Those who reside in the 20% most deprived postcodes in Scotland (SIMD20, Scottish Index of Multiple Deprivation) are much less likely to apply for medical school entry and even less likely to succeed. The National outreach programme of Scotland (Reach) aims to rectify the existing situation by encouraging and supporting students from working class backgrounds to apply to high demand courses, including medicine, and has achieved great success in helping pupils from low progression secondary schools to gain a place in Glasgow Medical School. However, some of the Reach students have similar demographics as the rest of the medical school class and arguably do not genuinely belong in the target group. To address this, a second flag, based on SIMD20/40 residence, was employed. Applying more than one WP flag however - while substantially improving the accurate targeting of this programme and helping those who truly are multiply deprived - reduces the Reach-eligible applicant pool to the point of undermining the high WP targets imposed on Universities. But using only a single criterion of SIMD20/40 residence or school progression rate would inappropriately benefit some pupils that are actually not genuinely disadvantaged. Ideally, individualised indicators such as eligibility for Free School Meals, receipt of an Educational Maintenance Allowance and/or a UKCAT bursary, would complement residential data and school progression rates. This paper reflects on the evolution of the admissions practices at Glasgow Medical School that are designed to meet the targets and create a medical workforce reflecting the population it serves.

Concerted stimulation and deactivation of pertussis toxin-sensitive G proteins by chimeric G protein-coupled receptor-regulator of G protein signaling 4 fusion proteins: analysis of the contribution of palmitoylated cysteine residues to the GAP activity of RGS4.

Agonists stimulated high-affinity GTPase activity in membranes of HEK293 cells following coexpression of the alpha 2A-adrenoceptor and a pertussis toxin-resistant mutant of Go1 alpha. Enzyme kinetic analysis of Vmax and Km failed to detect regulation of the effect of agonist by a GTPase activating protein. This did occur, however, when cells were also transfected to express RGS4. Both elements of a fusion protein in which the N-terminus of RGS4 was linked to the C-terminal tail of the alpha 2A-adrenoceptor were functional, as it was able to provide concerted stimulation and deactivation of the G protein. By contrast, the alpha 2A-adrenoceptor-RGS4 fusion protein stimulated but did not enhance deactivation of a form of Go1 alpha that is resistant to the effects of regulator of G protein signaling (RGS) proteins. Employing this model system, mutation of Asn128 but not Asn88 eliminated detectable GTPase activating protein activity of RGS4 against Go1 alpha. Mutation of all three cysteine residues that are sites of post-translational acylation in RGS4 also eliminated GTPase activating protein activity but this was not achieved by less concerted mutation of these sites. These studies demonstrate that a fusion protein between a G protein-coupled receptor and an RGS protein is fully functional in providing both enhanced guanine nucleotide exchange and GTP hydrolysis of a coexpressed G protein. They also provide a direct means to assess, in mammalian cells, the effects of mutation of the RGS protein on function in circumstances in which the spatial relationship and orientation of the RGS to its target G protein is defined and maintained.