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What is the effect of secondary (high) schooling on subsequent medical school performance? A national, UK-based, cohort study
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  • Published on:
    Authors' response to: "UK medical schools are not academically equal"
    • Paul A Tiffin, Reader in Psychometric Epidemiology/Honorary Consultant Psychiatrist University of York

    We agree that variation exists across UK medical schools as highlighted by the cited paper by McManus et al. (2008). It was partly this that we had in mind when we state, in the limitation section of our discussion:

    “In terms of the outcome measures, the categorisation of undergraduate examinations into skills and knowledge was not operationalised and therefore rely on the participating medical schools to categorise the evaluations. Thus, their definition may vary across medical schools. While some of this variation was handled by the use of multilevel modelling, a more robust definition of undergraduate ‘skills’-based assessments may have been helpful in predicting clinically orientated performance, which may have been a more faithful proxy for later medical practice. In this regard, a methodology has been proposed to achieve this through the ‘nationalisation’ of ‘local’ measures of undergraduate medical school performance for fair comparisons of graduating medical doctors.” [page 10, paragraph 3].

    Indeed, we recognise the use of ‘local educational measures’ as a particular challenge in UK-based Medical Education Research and are shortly to evaluate whether our approach to adjusting for this using ‘Peer Competition Rescaling’ (applied in the report by Tiffin & Paton, 2017) is valid in these circumstances. Thus, it is true to state that at present we cannot rule out the potential selection effect that Dr Banerjee highlights as a possibility. Only emerging...

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    Conflict of Interest:
    None declared.
  • Published on:
    UK medical schools are not academically equal
    • Anjan K Banerjee, Hon. Consultant Colorectal Surgeon Queen Alexandra Hospital, Portsmouth

    Whilst the study addresses an important problem there appears to be no correction for the relative competitiveness within different UK medical schools. Whilst all UK medical schools meet high international standards and meet stringent GMC criteria for approval, there are differences in the academic rigour between medical courses, and also the academic standards achieved, demonstrated by the speed and success rate of acquisition of skills and knowledge based higher qualifications such as MRCP [ McManus et al., 2008]. If the lower performing students at A level gravitate towards the lower academically schools, they may be placed higher in ranking of skills based assessment in those medical schools. Paradoxically the higher performing grade students , by getting places in the most academically rigorous schools ( such as Oxford and Cambridge), might sit lower in the academic rankings of their respective medical school. An alternative hypothesis would be that state school students with weaker A levels are more likely to attend less academically competitive medical schools, where individually they will be higher in the skills ranking. It would be more meaningful if the A level correlations were extended to success rates in a common medical qualifying exam and postgraduate qualifications, prior to changing medical school selection policy.


    McManus IC, Elder AT, Champlain A, Dacre JE, Mollon J , Chis L
    Graduates of different UK medical schools sh...

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    Conflict of Interest:
    None declared.