Article Text

Download PDFPDF

The relationship between school type and academic performance at medical school: a national, multi-cohort study
  1. Ben Kumwenda1,
  2. Jennifer A Cleland1,
  3. Kim Walker2,
  4. Amanda J Lee3,
  5. Rachel Greatrix4
  1. 1 Institute of Education for Medical and Dental Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
  2. 2 NHS Education for Scotland and UK Foundation Programme, Aberdeen, UK
  3. 3 Medical Statistics Team, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
  4. 4 UK Clinical Aptitude Test (UKCAT) Foundation, University of Nottingham, Nottingham, UK
  1. Correspondence to Ben Kumwenda; r01bk15{at}


Objectives Differential attainment in school examinations is one of the barriers to increasing student diversity in medicine. However, studies on the predictive validity of prior academic achievement and educational performance at medical school are contradictory, possibly due to single-site studies or studies which focus only on early years’ performance. To address these gaps, we examined the relationship between sociodemographic factors, including school type and average educational performance throughout medical school across a large number of diverse medical programmes.

Methods This retrospective study analysed data from students who graduated from 33 UK medical schools between 2012 and 2013. We included candidates’ demographics, pre-entry grades (adjusted Universities and Colleges Admissions Service tariff scores) preadmission test scores (UK Clinical Aptitude Test (UKCAT) and Graduate Medical School Admissions Test (GAMSAT)) and used the UK Foundation Programme’s educational performance measure (EPM) decile as an outcome measure. Logistic regression was used to assess the independent relationship between students’ background characteristics and EPM ranking.

Results Students from independent schools had significantly higher mean UKCAT scores (2535.1, SD=209.6) than students from state-funded schools (2506.1, SD=224.0, p<0.001). Similarly, students from independent schools came into medical school with significantly higher mean GAMSAT scores (63.9, SD=6.9) than students from state-funded schools (60.8, SD=7.1, p<0.001). However, students from state-funded schools were almost twice as likely (OR=2.01, 95% CI 1.49 to 2.73) to finish in the highest rank of the EPM ranking than those who attended independent schools.

Conclusions This is the first large-scale study to examine directly the relationship between school type and overall performance at medical school. Our findings provide modest supportive evidence that, when students from independent and state schools enter with similar pre-entry grades, once in medical school, students from state-funded schools are likely to outperform students from independent schools. This evidence contributes to discussions around contextualising medical admission.

  • medical education
  • admissions
  • performance
  • widening access
  • predictive validity

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors JAC led the funding bid which was co-written by AJL and reviewed by KW and BK. KW and JAC advised on the nature of the data. BK managed the data and carried out the data analysis under the supervision of the other authors. AJL advised on all the statistical analysis. JAC guided the first draft of the introduction and discussion sections of this paper. BK and AJL wrote the first drafts of the methods and results sections. JC edited the drafts. All authors reviewed and agreed on the final draft of the paper.

  • Funding This study is part of Ben Kumwenda’s doctoral programme of research funded by the UKCAT Research Panel, of which JC and RG are members.

  • Competing interests KW is the Special Advisor (Recruitment) for the UK’s Foundation Programme (UKFPO).

  • Patient consent Obtained.

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

  • Data sharing statement No additional data available as datasets held in safe haven.

Linked Articles