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Original research
‘10% of your medical students will cause 90% of your problems’: a prospective correlational study
  1. Marina Sawdon1,
  2. JC McLachlan2
  1. 1School of Medicine, University of Sunderland, Sunderland, UK
  2. 2School of Medicine, University of Central Lancashire, Preston, UK
  1. Correspondence to Dr Marina Sawdon; marina.sawdon{at}


Objectives Our aim was to explore the relationship between medical student Conscientiousness Index scores and indicators of later clinical performance held in the UK Medical Education Database (UKMED). Objectives were to determine whether conscientiousness in first-year and second-year medical students predicts later performance in medical school and in early practice. Policy implications would permit targeted remediation where necessary or aid in selection.

Design A prospective correlational study.

Setting A single UK medical school and early years of practice, 2005–2018.

Participants The data were obtained from the UKMED on 858 students. Full outcome data was available for variable numbers of participants, as described in the text.

Main outcome measures Scores on the UK Foundation Programme Office’s Situational Judgement Test (SJT) and Educational Performance Measure (EPM), the Prescribing Safety Assessment (PSA) and Annual Review of Competency Progression (ARCP) outcomes.

Results Linear regression analysis shows Conscientiousness Index scores significantly correlate with pregraduate and postgraduate performance variables: SJT scores (R=0.373, R2=0.139, B=0.066, p<0.001, n=539); PSA scores (R=0.249, R2=0.062, B=0.343, p<0.001, n=462); EPM decile scores for the first (lowest) decile are significantly lower than the remaining 90% (p=0.003, n=539), as are PSA scores (p<0.001, n=463), and ARCP year 2 scores (p=0.019, n=517). The OR that students in the first decile fail to achieve the optimum ARCP outcome is 1.6126 (CI: 1.1400 to 2.2809, p=0.0069, n=618).

Conclusions Conscientiousness Index scores in years 1 and 2 of medical school have predictive value for later performance in knowledge, skills and clinical practice. This trait could be used either for selection or for targeted remediation to avoid potential problems in the future.

  • medical education & training
  • education & training (see medical education & training)
  • quality in health care

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  • Contributors JCML designed the original study. MS collated the data. Both MS and JCML contributed equally to the analysis and interpretation of the data, the drafting of the manuscript, the revision of the manuscript, approved the final version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was granted ethical clearance by the Ethics Committee of a UK Medical School, approval reference ESC2/2017/PP02. All UK Medical Education Database (UKMED) projects that use solely UKMED-held data have a blanket exemption from ethics application. This exemption has been confirmed by Queen Mary University of London Research Ethics Committee, on behalf of all UK medical schools.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available. Upon reasonable request in writing, the authors are willing to share the Contentiousness Index data; however, as the outcome data was analysed in a safe haven, authors no longer have access to this data from the UK Medical Education Database (UKMED). Requests for this data must be made to the UKMED research subgroup.

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