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Open Access Research article

The Academic Backbone: longitudinal continuities in educational achievement from secondary school and medical school to MRCP(UK) and the specialist register in UK medical students and doctors

IC McManus12*, Katherine Woolf1, Jane Dacre1, Elisabeth Paice3 and Chris Dewberry4

Author Affiliations

1 UCL Medical School, University College London, Gower Street, London WC1E 6BT, UK

2 Research Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, Gower Street, London WC1E 6BT, UK

3 142 Cromwell Tower Barbican, London EC2Y 8DD, UK

4 Department of Organizational Psychology, Birkbeck, University of London, Malet Street, Bloomsbury, London WC1E 7HX, UK

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BMC Medicine 2013, 11:242  doi:10.1186/1741-7015-11-242

Published: 14 November 2013

Abstract

Background

Selection of medical students in the UK is still largely based on prior academic achievement, although doubts have been expressed as to whether performance in earlier life is predictive of outcomes later in medical school or post-graduate education. This study analyses data from five longitudinal studies of UK medical students and doctors from the early 1970s until the early 2000s. Two of the studies used the AH5, a group test of general intelligence (that is, intellectual aptitude). Sex and ethnic differences were also analyzed in light of the changing demographics of medical students over the past decades.

Methods

Data from five cohort studies were available: the Westminster Study (began clinical studies from 1975 to 1982), the 1980, 1985, and 1990 cohort studies (entered medical school in 1981, 1986, and 1991), and the University College London Medical School (UCLMS) Cohort Study (entered clinical studies in 2005 and 2006). Different studies had different outcome measures, but most had performance on basic medical sciences and clinical examinations at medical school, performance in Membership of the Royal Colleges of Physicians (MRCP(UK)) examinations, and being on the General Medical Council Specialist Register.

Results

Correlation matrices and path analyses are presented. There were robust correlations across different years at medical school, and medical school performance also predicted MRCP(UK) performance and being on the GMC Specialist Register. A-levels correlated somewhat less with undergraduate and post-graduate performance, but there was restriction of range in entrants. General Certificate of Secondary Education (GCSE)/O-level results also predicted undergraduate and post-graduate outcomes, but less so than did A-level results, but there may be incremental validity for clinical and post-graduate performance. The AH5 had some significant correlations with outcome, but they were inconsistent. Sex and ethnicity also had predictive effects on measures of educational attainment, undergraduate, and post-graduate performance. Women performed better in assessments but were less likely to be on the Specialist Register. Non-white participants generally underperformed in undergraduate and post-graduate assessments, but were equally likely to be on the Specialist Register. There was a suggestion of smaller ethnicity effects in earlier studies.

Conclusions

The existence of the Academic Backbone concept is strongly supported, with attainment at secondary school predicting performance in undergraduate and post-graduate medical assessments, and the effects spanning many years. The Academic Backbone is conceptualized in terms of the development of more sophisticated underlying structures of knowledge ('cognitive capital’ and 'medical capital’). The Academic Backbone provides strong support for using measures of educational attainment, particularly A-levels, in student selection.

Keywords:
Academic Backbone; Secondary school attainment; Undergraduate medical education; Post-graduate medical education; Longitudinal analyses; Continuities; Medical student selection; Cognitive capital; Medical capital; Aptitude tests