Objectives For the first time, this systematic review provides a summary of the literature exploring the relationship between performance in the UK Clinical Aptitude Test (UKCAT) and assessments in undergraduate medical and dental training. Design In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis, relevant studies were identified through systematic literature searches. Electronic searches were carried out on EBSCO, EMBASE, Educational Resources Information Centre, SCOPUS, Web of Knowledge. Studies which included the predictive validity of selection criteria including some element of the UKCAT were considered. Results 22 papers were identified for inclusion in the study. Four studies describe outcomes from dental programmes with limited results reported. 18 studies reported on relationships between the UKCAT and performance in undergraduate medical training. Of these, 15 studies reported relationships between the UKCAT cognitive tests and undergraduate medical assessments. Weak relationships (r=0.00–0.29) were observed in 14 of these studies; four studies reported some moderate relationships (r=0.30–0.49). The strongest relationships with performance in medical school were observed for the UKCAT total score and the verbal reasoning subtest. Relationships with knowledge-based assessments scores were higher than those for assessments of skills as the outcome. Relationships observed in small (single and double centre studies) were larger than those observed in multicentre studies. Conclusion The results indicate that UKCAT scores predict performance in medical school assessments. The relationship is generally weak, although noticeably stronger for both the UKCAT total score and the verbal reasoning subtest. There is some evidence that UKCAT continues to predict performance throughout medical school. We recommend more optimal approaches to future studies. This assessment of existing evidence should assist medical/dental schools in their evaluation of selection processes.

Medical schools worldwide undertake widening access (WA) initiatives (e.g. pipeline, outreach and academic enrichment programmes) to support pupils from high schools which do not traditionally send high numbers of applicants to medicine. UK literature indicates that pupils in these schools feel that their teachers are ill-equipped, cautious or even discouraging towards their aspiration and/or application to medicine. This study aimed to explore teachers' perspectives and practices to include their voice in discussions and consider how medical schools might best engage with them to facilitate WA. Interviews were conducted with high school teachers in three UK regions, working in schools targeted by WA initiatives. Data were analysed thematically using template analysis, using a largely data-driven approach. Findings showed that although medicine was largely seen as a prestigious and worthwhile career, teachers held reservations about advocating this above other choices. Teachers saw it as their role to encourage pupils to educate themselves about medicine, but to ultimately allow pupils to make their own decisions. Their attitudes were influenced by material constraints in their schools, and the perception of daunting, long and emotionally difficult admissions requirements, with low chances of success. Medical schools may wish to work with teachers to understand their hesitations and help them develop the mindset required to advocate a challenging and unfamiliar career, emphasising that this encouragement can further the shared goal of empowering and preparing pupils to feel capable of choosing medicine. Reciprocally, medical schools should ensure pupils have fair opportunities for access, should they choose to apply.

Context Literature published around a decade ago demonstrated that UK individuals from non-traditional groups may not consider, or aspire to, medicine because of sociocultural barriers and instead may perceive medicine as 'not for the likes of me'. Since this time, the UK higher education landscape has undergone significant change, with an increased emphasis on student choice and widening access (WA) initiatives. Consequently, the present study looks anew at the perceptions of medicine held by school pupils from non-traditional backgrounds to assess whether sociocultural factors remain a major barrier to medicine. Methods Focus groups were conducted with 71 high-achieving school pupils in their penultimate or final years (aged 16-18 years). Participants attended UK state-funded schools engaged with medical school WA initiatives. Transcripts were analysed thematically using a data-driven approach. Themes were then interpreted through the conceptual lens of the 'reflexive habitus', an adapted version of Bourdieu's classic concept. Results Participants did not perceive that sociocultural differences would deter them from aspiring to, or pursuing, the career of their choice. Some participants identified their 'different' background as a strength to bring to medicine. They reported that intrinsic motivators (personal interest and fulfilment) were most important in their own career choices. When asked what they believed might have motivated current medical students for the career, participants debated the role of extrinsic motivators (high status and income) versus intrinsic ones. 'Hot knowledge' (social contacts) from within medicine helped some participants reconcile any clash in perceived values and better imagine themselves in the profession. Conclusions These non-traditional school pupils from schools engaged with WA initiatives appear to have embraced the belief that medicine is for anyone with the appropriate desire and ability, regardless of background. Furthermore, some pupils reported that some aspects of their 'difference' (diversity) could help enrich the workforce and patient care.

ObjectivesTo systematically review the available literature on physicians’ and dentists’ experiences influencing job motivation, job satisfaction, burnout, well-being and symptoms of depression as indicators of job morale in low-income and middle-income countries.DesignThe review was reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for studies evaluating outcomes of interest using qualitative methods. The framework method was used to analyse and integrate review findings.Data sourcesA primary search of electronic databases was performed by using a combination of search terms related to the following areas of interest: ‘morale’, ‘physicians and dentists’ and ‘low-income and middle-income countries’. A secondary search of the grey literature was conducted in addition to checking the reference list of included studies and review papers.ResultsTen papers representing 10 different studies and involving 581 participants across seven low-income and middle-income countries met the inclusion criteria for the review. However, none of the studies focused on dentists’ experiences was included. An analytical framework including four main categories was developed: work environment (physical and social), rewards (financial, non-financial and social respect), work content (workload, nature of work, job security/stability and safety), managerial context (staffing levels, protocols and guidelines consistency and political interference). The job morale of physicians working in low-income and middle-income countries was mainly influenced by negative experiences. Increasing salaries, offering opportunities for career and professional development, improving the physical and social working environment, implementing clear professional guidelines and protocols and tackling healthcare staff shortage may influence physicians’ job morale positively.ConclusionsThere were a limited number of studies and a great degree of heterogeneity of evidence. Further research is recommended to assist in scrutinising context-specific issues and ways of addressing them to maximise their utility.PROSPERO registration numberCRD42017082579.

Background Educating doctors is expensive and poor performance by future graduates can literally cost lives. Whilst the practice of medicine is highly evidence based, medical education is much less so. Research on medical school selection, undergraduate progression, Fitness to Practise (FtP) and postgraduate careers has been hampered across the globe by the challenges of uniting the data required. This paper describes the creation, structure and access arrangements for the first UK-wide attempt to do so. Overview A collaborative approach has created a research database commencing with all entrants to UK medical schools in 2007 and 2008 (UKMED Phase 1). Here the content is outlined, governance arrangements considered, system access explained, and the potential implications of this new resource discussed. The data currently include achievements prior to medical school entry, admissions tests, graduation point information and also all subsequent data collected by the General Medical Council, including FtP, career progression, annual National Training Survey (NTS) responses, career choice and postgraduate exam performance data. UKMED has grown since the pilot phase with additional datasets; all subsequent years of students/trainees and stronger governance processes. The inclusion of future cohorts and additional information such as admissions scores or bespoke surveys or assessments is now being piloted. Thus, for instance, new scrutiny can be applied to selection techniques and the effectiveness of educational interventions. Data are available free of charge for approved studies from suitable research groups worldwide. Conclusion It is anticipated that UKMED will continue on a rolling basis. This has the potential to radically change the volume and types of research that can be envisaged and, therefore, to improve standards, facilitate workforce planning and support the regulation of medical education and training. This paper aspires to encourage proposals to utilise this exciting resource.

This article was migrated. The article was marked as recommended. Worldwide there is a call for diversifying the healthcare workforce through widening participation (WP) necessitating a significant change in current recruitment and selection policies and practices. However this is advocated without a well understood conceptualisation of WP or consensus between stakeholders about its purposes. Employers, and patients, require a medical workforce that is both caring and competent but also accessible. This presents a significant challenge for most countries, especially in some areas of healthcare, for both common and varying reasons. For example Australia and NZ have long struggled to recruit healthcare workers to remote and rural parts of their countries, whilst currently general practice within the UK, is in crisis due to under recruitment and low morale. Higher Education institutions wish to recruit the best students but it is not clear who the "best students" are and who will progress to fulfil future workforce requirements. Globally universities are concerned by market forces and face significant financial constraints often directly competing with WP policies. Furthermore an established culture of meritocracy, schemes to "top-up" perceived deficits within certain student groups, and fears surrounding the performance of non-traditional students once at university, deter both would be students and the institutions themselves from increasing diversity.Whilst medical schools may aspire to the aims of social justice and fair opportunities such a trajectory is plagued with difficulties, such as university tariff leagues tables, and concerns with student attrition and differential attainment. However considering the aforementioned workforce issues it is timely to look afresh at what our priorities are in selecting for the future medical workforce. Better understanding the available evidence and the inherent tensions within WP would help us make the required step change that facilitates selecting a more appropriate medical workforce.

IntroductionMedical admissions must balance two potentially competing missions: to select those who will be successful medical students and clinicians and to increase the diversity of the medical school population and workforce. Many countries address this dilemma by reducing the heavy reliance on prior educational attainment, complementing this with other selection tools. However, evidence to what extent this shift in practice has actually widened access is conflicting.AimTo examine if changes in medical school selection processes significantly impact on the composition of the student population.Design and settingObservational study of medical students from 18 UK 5-year medical programmes who took the UK Clinical Aptitude Test from 2007 to 2014; detailed analysis on four schools.Primary outcomeProportion of admissions to medical school for four target groups (lower socioeconomic classes, non-selective schooling, non-white and male).Data analysisInterrupted time-series framework with segmented regression was used to identify the impact of changes in selection practices in relation to invitation to interview to medical school. Four case study medical schools were used looking at admissions within for the four target groups.ResultsThere were no obvious changes in the overall proportion of admissions from each target group over the 8-year period, averaging at 3.3% lower socioeconomic group, 51.5% non-selective school, 30.5% non-white and 43.8% male. Each case study school changed their selection practice in decision making for invite to interview during 2007–2014. Yet, this within-school variation made little difference locally, and changes in admission practices did not lead to any discernible change in the demography of those accepted into medical school.ConclusionAlthough our case schools changed their selection procedures, these changes did not lead to any observable differences in their student populations. Increasing the diversity of medical students, and hence the medical profession, may require different, perhaps more radical, approaches to selection.

ProblemSituational judgment tests (SJTs) can be used to assess the nonacademic attributes necessary for medical and dental trainees to become successful practitioners. Evidence for SJTs' predictive validity, however, relates predominantly to selection in postgraduate settings or using video-based SJTs at the undergraduate level; it may not be directly transferable to text-based SJTs in undergraduate medical and dental school selection. This preliminary study aimed to address these gaps by assessing the validity of the UK Clinical Aptitude Test (UKCAT) text-based SJT.ApproachStudy participants were 218 first-year medical and dental students from four UK undergraduate schools who completed the first UKCAT text-based SJT in 2013. Outcome measures were educational supervisor ratings of in-role performance in problem-based learning tutorial sessions-mean rating across the three domains measured by the SJT (integrity, perspective taking, and team involvement) and an overall judgment of performance-collected in 2015.OutcomesThere were significant correlations between SJT scores and both mean supervisor ratings (uncorrected r = 0.24, P < .001; corrected r = 0.34) and overall judgments (uncorrected r(s) = 0.16, P < .05; corrected r(s) = 0.20). SJT scores predicted 6% of variance in mean supervisor ratings across the three nonacademic domains.Next StepsThe results provide evidence that a well-designed text-based SJT can be appropriately integrated, and add value to, the selection process for undergraduate medical and dental school. More evidence is needed regarding the longitudinal predictive validity of SJTs throughout medical and dental training pathways, with appropriate outcome criteria.

CONTEXT:In the UK, applications to medicine from those in lower socio-economic groups remain low despite significant investments of time, interest and resources in widening access (WA) to medicine. This suggests that medical schools' core messages about WA may be working to embed or further reinforce marginalisation, rather than to combat this. Our objective was to investigate how the value of WA is communicated by UK medical schools through their websites, and how this may create expectations regarding who is 'suitable' for medicine.METHODS:We conducted a critical discourse analysis of the webpages of UK medical schools in relation to WA. Our conceptual framework was underpinned by a Foucauldian understanding of discourse. Analysis followed an adapted version of Hyatt's analytical framework. This involved contextualising the data by identifying drivers, levers and warrants for WA, before undertaking a systematic investigation of linguistic features to reveal the discourses in use, and their assumptions.RESULTS:Discourses of 'social mobility for the individual' justified WA as an initiative to support individuals with academic ability and commitment to medicine, but who were disadvantaged by their background in the application process. This meritocratic discourse communicated the benefits of WA as flowing one way, with medical schools providing opportunities to applicants. Conversely, discourses justifying WA as an initiative to benefit patient care were marginalised and largely excluded. Alternative strengths typically attributed to students from lower socio-economic groups were not mentioned, which implies that these were not valued.CONCLUSIONS:Current discourses of WA on UK medical school websites do not present non-traditional applicants as bringing gains to medicine through their diversity. This may work as a barrier to attracting larger numbers of diverse applicants. Medical schools should reflect upon their website discourses, critically evaluate current approaches to encouraging applications from those in lower socio-economic groups, and consider avenues for positive change.

This article was migrated. The article was not marked as recommended. Aim: This study aimed to identify whether an intercalated BSc (iBSc) in Medical Education offers long-term career benefits beyond that of traditional iBScs by exploring candidates' retrospective perceptions. Method: A small-scale study was conducted with doctors who had completed an iBSc at Barts and the London SMD. A mixed methods approach was adopted using a questionnaire (21), and semi-structured interviews (4) to further explore respondent's perceptions. Results: All iBScs highlight similar curriculum outcomes in terms of research skill development and offer additional points at foundation- and specialty training applications. Medical Education respondents reported additional parallel benefits such as teaching alongside research activity, with a greater numbers of outputs e.g. presentations, publications. Understanding educational theory, developing teaching skills and portfolio creation were identified by the Medical Education group as particularly valuable to career progression. Additionally, Medical Educational iBSc candidates felt the course would offer ubiquitous value in the core medical curriculum, with those completing traditional 'lab based' iBScs feeling that no aspect of their intercalation had such generic value, and should remain a separate, optional educational intervention. Conclusion: Considering the increasing emphasis on education and teaching in medicine, this study suggests Medical Education offers greater benefit to candidates in the long-term. It follows that incorporation of this in the core medical curriculum would offer value to all candidates.

Medical EducationVolume 51, Issue 6 p. 670-670 Letter to the Editor Response to Adam et al. regarding selection methods Fiona Patterson, Corresponding Author Fiona Patterson f.patterson@workpsychologygroup.com Work Psychology Group, Derby, UK & University of Cambridge, Cambridge, UKCorrespondence: Fiona Patterson, Work Psychology Group, 27 Brunel Parkway, Pride Park, Derby, UK; Tel: +44(0)1332 295687; Email: f.patterson@workpsychologygroup.comSearch for more papers by this authorAlec Knight, Alec Knight Institute of Psychiatry, Psychology & Neuroscience, King's College London, UKSearch for more papers by this authorJon Dowell, Jon Dowell School of Medicine, University of Dundee, UKSearch for more papers by this authorSandra Nicholson, Sandra Nicholson Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UKSearch for more papers by this authorFran Cousans, Fran Cousans Work Psychology Group, Derby, UK & Occupational Psychology, University of Leicester, UKSearch for more papers by this authorJennifer Cleland, Jennifer Cleland Institute of Education for Medical and Dental Sciences, University of Aberdeen, Aberdeen, UKSearch for more papers by this author Fiona Patterson, Corresponding Author Fiona Patterson f.patterson@workpsychologygroup.com Work Psychology Group, Derby, UK & University of Cambridge, Cambridge, UKCorrespondence: Fiona Patterson, Work Psychology Group, 27 Brunel Parkway, Pride Park, Derby, UK; Tel: +44(0)1332 295687; Email: f.patterson@workpsychologygroup.comSearch for more papers by this authorAlec Knight, Alec Knight Institute of Psychiatry, Psychology & Neuroscience, King's College London, UKSearch for more papers by this authorJon Dowell, Jon Dowell School of Medicine, University of Dundee, UKSearch for more papers by this authorSandra Nicholson, Sandra Nicholson Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UKSearch for more papers by this authorFran Cousans, Fran Cousans Work Psychology Group, Derby, UK & Occupational Psychology, University of Leicester, UKSearch for more papers by this authorJennifer Cleland, Jennifer Cleland Institute of Education for Medical and Dental Sciences, University of Aberdeen, Aberdeen, UKSearch for more papers by this author First published: 27 February 2017 https://doi.org/10.1111/medu.13251Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume51, Issue6June 2017Pages 670-670 RelatedInformation

In the UK widening access (WA) activities and policies aim to increase the representation from lower socio-economic groups into Higher Education. Whilst linked to a political rhetoric of inclusive education such initiatives have however failed to significantly increase the number of such students entering medicine. This is compounded by a discourse that portrays WA applicants and students as lacking the essential skills or attributes to be successful in medical education. Much of the research in this area to date has been weak and it is critical to better understand how WA applicants and students negotiate medical admissions and education to inform change. To address this gap we amalgamated a larger dataset from three qualitative studies of student experiences of WA to medicine (48 participants in total). Inductively analysing the findings using social capital as a theoretical lens we created and clustered codes into categories, informed by the concepts of "weak ties" and "bridging and linking capital", terms used by previous workers in this field, to better understand student journeys in medical education. Successful applicants from lower socio-economic groups recognise and mobilise weak ties to create linking capital. However once in medical school these students seem less aware of the need for, or how to create, capital effectively. We argue WA activities should support increasing the social capital of under-represented applicants and students, and future selection policy needs to take into account the varying social capital of students, so as to not overtly disadvantage some social groups.

BACKGROUND:Despite concerns about recruitment to UK general practice, there has been no concerted educational intervention to address them.AIM:To better understand how medical students' perceptions of their experiences of their undergraduate curriculum may affect choosing general practice as a career.DESIGN AND SETTING:Qualitative study comprising focus groups of a total of 58 students from a range of medical schools across the UK.METHOD:A range of UK medical schools students were invited by email to participate in focus groups and return a questionnaire detailing their current career choice to facilitate sampling students with varied career preferences. Students late in their studies were sampled as they were likely to be considering future careers. Focus group discussions were audiotaped, transcribed, and anonymised for both school and participant, then thematically analysed. Perceived differences in medical school culture, curriculum philosophy, design, and intent were explored.RESULTS:Six focus groups (58 students) were convened. Some student participants' career aspirations were strongly shaped by family and home, but clinical placements remained important in confirming or refuting these choices. High-quality general practice attachments are a powerful attractor to general practice and, when they reflect authentic clinical practice, promote general practice careers. GP tutors can be powerful, positive role models. Students' comments revealed conflicting understandings about general practice.CONCLUSION:Attracting rather than coercing students to general practice is likely to be more effective at changing their career choices. Early, high-quality, ongoing and, authentic clinical exposure promotes general practice and combats negative stereotyping. It is recommended that increasing opportunities to help students understand what it means to be a 'good GP' and how this can be achieved are created.

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: http://www.ukcat.ac.uk), 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.

CONTEXT Widening access promotes student diversity and the appropriate representation of all demographic groups. This study aims to examine diversity-related benefits of the use of situational judgement tests (SJTs) in the UK Clinical Aptitude Test (UKCAT) in terms of three demographic variables: (i) socioeconomic status (SES); (ii) ethnicity, and (iii) gender.METHODS Outcomes in medical and dental school applicant cohorts for the years 2012 (n = 15 581) and 2013 (n = 15 454) were studied. Applicants' scores on cognitive tests and an SJT were linked to SES (parents' occupational status), ethnicity (White versus Black and other minority ethnic candidates), and gender.RESULTS Firstly, the effect size for SES was lower for the SJT (d = 0.13-0.20 in favour of the higher SES group) than it was for the cognitive tests (d = 0.38-0.35). Secondly, effect sizes for ethnicity of the SJT and cognitive tests were similar (d = similar to 0.50 in favour of White candidates). Thirdly, males outperformed females on cognitive tests, whereas the reverse was true for SJTs. When equal weight was given to the SJT and the cognitive tests in the admission decision and when the selection ratio was stringent, simulated scenarios showed that using an SJT in addition to cognitive tests might enable admissions boards to select more students from lower SES backgrounds and more female students.CONCLUSIONS The SJT has the potential to appropriately complement cognitive tests in the selection of doctors and dentists. It may also put candidates of lower SES backgrounds at less of a disadvantage and may potentially diversify the student intake. However, use of the SJT applied in this study did not diminish the role of ethnicity. Future research should examine these findings with other SJTs and other tests internationally and scrutinise the causes underlying the role of ethnicity.

Context Selection methods used by medical schools should reliably identify whether candidates are likely to be successful in medical training and ultimately become competent clinicians. However, there is little consensus regarding methods that reliably evaluate non-academic attributes, and longitudinal studies examining predictors of success after qualification are insufficient. This systematic review synthesises the extant research evidence on the relative strengths of various selection methods. We offer a research agenda and identify key considerations to inform policy and practice in the next 50 years. Methods A formalised literature search was conducted for studies published between 1997 and 2015. A total of 194 articles met the inclusion criteria and were appraised in relation to: (i) selection method used; (ii) research question(s) addressed, and (iii) type of study design. Results Eight selection methods were identified: (i) aptitude tests; (ii) academic records; (iii) personal statements; (iv) references; (v) situational judgement tests (SJTs); (vi) personality and emotional intelligence assessments; (vii) interviews and multiple mini-interviews (MMIs), and (viii) selection centres (SCs). The evidence relating to each method was reviewed against four evaluation criteria: effectiveness (reliability and validity); procedural issues; acceptability, and cost-effectiveness. Conclusions Evidence shows clearly that academic records, MMIs, aptitude tests, SJTs and SCs are more effective selection methods and are generally fairer than traditional interviews, references and personal statements. However, achievement in different selection methods may differentially predict performance at the various stages of medical education and clinical practice. Research into selection has been over-reliant on cross-sectional study designs and has tended to focus on reliability estimates rather than validity as an indicator of quality. A comprehensive framework of outcome criteria should be developed to allow researchers to interpret empirical evidence and compare selection methods fairly. This review highlights gaps in evidence for the combination of selection tools that is most effective and the weighting to be given to each tool.