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Does the UKCAT predict performance on exit from medical school? A national cohort study
  1. R K MacKenzie1,
  2. J A Cleland1,
  3. D Ayansina2,
  4. S Nicholson3
  1. 1Institute of Education for Medical and Dental Sciences, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK
  2. 2Department of Medical Statistics, College of Life Sciences and Medicine, University of Aberdeen, Aberdeen, UK
  3. 3Centre for Medical Education, Institute of Health Sciences Education, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
  1. Correspondence to Dr RK MacKenzie; r.k.mackenzie{at}


Objectives Most UK medical programmes use aptitude tests during student selection, but large-scale studies of predictive validity are rare. This study assesses the UK Clinical Aptitude Test (UKCAT:, and 4 of its subscales, along with individual and contextual socioeconomic background factors, as predictors of performance during, and on exit from, medical school.

Methods This was an observational study of 6294 medical students from 30 UK medical programmes who took the UKCAT from 2006 to 2008, for whom selection data from the UK Foundation Programme (UKFPO), the next stage of UK medical education training, were available in 2013. We included candidate demographics, UKCAT (cognitive domains; total scores), UKFPO Educational Performance Measure (EPM) and national exit situational judgement test (SJT). Multilevel modelling was used to assess relationships between variables, adjusting for confounders.

Results The UKCAT—as a total score and in terms of the subtest scores—has significant predictive validity for performance on the UKFPO EPM and SJT. UKFPO performance was also affected positively by female gender, maturity, white ethnicity and coming from a higher social class area at the time of application to medical school An inverse pattern was seen for a contextual measure of school, with those attending fee-paying schools performing significantly more weakly on the EPM decile, the EPM total and the total UKFPO score, but not the SJT, than those attending other types of school.

Conclusions This large-scale study, the first to link 2 national databases—UKCAT and UKFPO, has shown that UKCAT is a predictor of medical school outcome. The data provide modest supportive evidence for the UKCAT's role in student selection. The conflicting relationships of socioeconomic contextual measures (area and school) with outcome adds to wider debates about the limitations of these measures, and indicates the need for further research.

  • EDUCATION & TRAINING (see Medical Education & Training)

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  • Contributors JAC and RKM wrote the funding bid. SN advised on the nature of the data. RKM managed the data and carried out the preliminary data analysis under the supervision of DA. DA advised on all the statistical analysis and carried out the multivariate analysis. JAC wrote the first draft of the Introduction and Methods sections of this paper. RKM and DA wrote the first draft of the Results section, RKM and SN wrote the first draft of the Discussion and Conclusions sections. JAC edited the drafts. All authors reviewed and agreed the final draft of the paper.

  • Funding United Kingdom Clinical Aptitude Test Consortium (grant number RG10984-10).

  • Competing interests This study addressed a research question posed and funded by UKCAT, of which SN was Chair. JAC is a member of the UKCAT Research Committee.

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

  • Data sharing statement No additional data are available.

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