Exploring UK medical school differences: the MedDifs study of selection, teaching, student and F1 perceptions, postgraduate outcomes and fitness to practise

I. C. McManus, Andrew Christopher Harborne, Hugo Layard Horsfall, Tobin Joseph, Daniel T. Smith, Tess Marshall-Andon, Ryan Samuels, Joshua William Kearsley, Nadine Abbas, Hassan Baig, Joseph Beecham, Natasha Benons, Charlie Caird, Ryan Clark, Thomas Cope, James Coultas, Luke Debenham, Sarah Douglas, Jack Eldridge, Thomas Hughes-GoodingAgnieszka Jakubowska, Oliver Jones, Eve Lancaster, Calum MacMillan, Ross McAllister, Wassim Merzougui, Ben Phillips, Simon Phillips, Omar Risk, Adam Sage, Aisha Sooltangos, Robert Spencer, Roxanne Tajbakhsh, Oluseyi Adesalu, Ivan Aganin, Ammar Ahmed, Katherine Aiken, Alimatu Sadia Akeredolu, Ibrahim Alam, Aamna Ali, Richard Anderson, Jia Jun Ang, Fady Sameh Anis, Sonam Aojula, Catherine Arthur, Alena Ashby, Ahmed Ashraf, Emma Aspinall, Mark Awad, Abdul Muiz Azri Yahaya, Shreya Badhrinarayanan, Soham Bandyopadhyay, Sam Barnes, Daisy Bassey-Duke, Charlotte Boreham, Rebecca Braine, Joseph Brandreth, Zoe Carrington, Zoe Cashin, Shaunak Chatterjee, Mehar Chawla, Chung Shen Chean, Chris Clements, Richard Clough, Jessica Coulthurst, Liam Curry, Vinnie Christine Daniels, Simon Davies, Rebecca Davis, Hanelie De Waal, Nasreen Desai, Hannah Douglas, James Druce, Lady Namera Ejamike, Meron Esere, Alex Eyre, Ibrahim Talal Fazmin, Sophia Fitzgerald-Smith, Verity Ford, Sarah Freeston, Katherine Garnett, Whitney General, Helen Gilbert, Zein Gowie, Ciaran Grafton-Clarke, Keshni Gudka, Leher Gumber, Rishi Gupta, Chris Harlow, Amy Harrington, Adele Heaney, Wing Hang Serene Ho, Lucy Holloway, Christina Hood, Eleanor Houghton, Saba Houshangi, Emma Howard, Benjamin Human, Harriet Hunter, Ifrah Hussain, Sami Hussain, Richard Thomas Jackson-Taylor, Bronwen Jacob-Ramsdale, Ryan Janjuha, Saleh Jawad, Muzzamil Jelani, David Johnston, Mike Jones, Sadhana Kalidindi, Savraj Kalsi, Asanish Kalyanasundaram, Anna Kane, Sahaj Kaur, Othman Khaled Al-Othman, Qaisar Khan, Sajan Khullar, Priscilla Kirkland, Hannah Lawrence-Smith, Charlotte Leeson, Julius Elisabeth Richard Lenaerts, Kerry Long, Simon Lubbock, Jamie Mac Donald Burrell, Rachel Maguire, Praveen Mahendran, Saad Majeed, Prabhjot Singh Malhotra, Vinay Mandagere, Angelos Mantelakis, Sophie McGovern, Anjola Mosuro, Adam Moxley, Sophie Mustoe, Sam Myers, Kiran Nadeem, Reza Nasseri, Tom Newman, Richard Nzewi, Rosalie Ogborne, Joyce Omatseye, Sophie Paddock, James Parkin, Mohit Patel, Sohini Pawar, Stuart Pearce, Samuel Penrice, Julian Purdy, Raisa Ramjan, Ratan Randhawa, Usman Rasul, Elliot Raymond-Taggert, Rebecca Razey, Carmel Razzaghi, Eimear Reel, Elliot John Revell, Joanna Rigbye, Oloruntobi Rotimi, Abdelrahman Said, Emma Sanders, Pranoy Sangal, Nora Sangvik Grandal, Aadam Shah, Rahul Atul Shah, Oliver Shotton, Daniel Sims, Katie Smart, Martha Amy Smith, Nick Smith, Aninditya Salma Sopian, Matthew South, Jessica Speller, Tom J. Syer, Ngan Hong Ta, Daniel Tadross, Benjamin Thompson, Jess Trevett, Matthew Tyler, Roshan Ullah, Mrudula Utukuri, Shree Vadera, Harriet Van Den Tooren, Sara Venturini, Aradhya Vijayakumar, Melanie Vine, Zoe Wellbelove, Liora Wittner, Geoffrey Hong Kiat Yong, Farris Ziyada, Oliver Patrick Devine

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Abstract

BACKGROUND: Medical schools differ, particularly in their teaching, but it is unclear whether such differences matter, although influential claims are often made. The Medical School Differences (MedDifs) study brings together a wide range of measures of UK medical schools, including postgraduate performance, fitness to practise issues, specialty choice, preparedness, satisfaction, teaching styles, entry criteria and institutional factors. METHOD: Aggregated data were collected for 50 measures across 29 UK medical schools. Data include institutional history (e.g. rate of production of hospital and GP specialists in the past), curricular influences (e.g. PBL schools, spend per student, staff-student ratio), selection measures (e.g. entry grades), teaching and assessment (e.g. traditional vs PBL, specialty teaching, self-regulated learning), student satisfaction, Foundation selection scores, Foundation satisfaction, postgraduate examination performance and fitness to practise (postgraduate progression, GMC sanctions). Six specialties (General Practice, Psychiatry, Anaesthetics, Obstetrics and Gynaecology, Internal Medicine, Surgery) were examined in more detail. RESULTS: Medical school differences are stable across time (median alpha = 0.835). The 50 measures were highly correlated, 395 (32.2%) of 1225 correlations being significant with p < 0.05, and 201 (16.4%) reached a Tukey-adjusted criterion of p < 0.0025. Problem-based learning (PBL) schools differ on many measures, including lower performance on postgraduate assessments. While these are in part explained by lower entry grades, a surprising finding is that schools such as PBL schools which reported greater student satisfaction with feedback also showed lower performance at postgraduate examinations. More medical school teaching of psychiatry, surgery and anaesthetics did not result in more specialist trainees. Schools that taught more general practice did have more graduates entering GP training, but those graduates performed less well in MRCGP examinations, the negative correlation resulting from numbers of GP trainees and exam outcomes being affected both by non-traditional teaching and by greater historical production of GPs. Postgraduate exam outcomes were also higher in schools with more self-regulated learning, but lower in larger medical schools. A path model for 29 measures found a complex causal nexus, most measures causing or being caused by other measures. Postgraduate exam performance was influenced by earlier attainment, at entry to Foundation and entry to medical school (the so-called academic backbone), and by self-regulated learning. Foundation measures of satisfaction, including preparedness, had no subsequent influence on outcomes. Fitness to practise issues were more frequent in schools producing more male graduates and more GPs. CONCLUSIONS: Medical schools differ in large numbers of ways that are causally interconnected. Differences between schools in postgraduate examination performance, training problems and GMC sanctions have important implications for the quality of patient care and patient safety.

Original languageEnglish
Article number136
JournalBMC Medicine
Volume18
Issue number1
DOIs
Publication statusPublished - 14 May 2020

Keywords

  • Fitness to practise
  • GMC sanctions
  • Institutional histories
  • Medical school differences
  • National Student Survey
  • National Training Study
  • Postgraduate qualifications
  • Preparedness
  • Problem-based learning
  • Teaching styles

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