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Year : 2017  |  Volume : 30  |  Issue : 1  |  Page : 75-78

Comparing the academic performance of graduate-entry and undergraduate medical students at a UK medical school


Department of Medicine, St. George's University of London, Cranmer Terrace, London SW17 0RE, United Kingdom

Date of Web Publication13-Jul-2017

Correspondence Address:
James Knight
St. George's University of London, Cranmer Terrace, London SW17 0RE
United Kingdom
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/efh.EfH_157_15

  Abstract 

Background: The aim of the study was to assess whether graduate-entry (GE) medicine is a valid route to medical school in the United Kingdom. We set out to analyze the academic performance of GE students when compared with undergraduate (UG) students by assessing the representation of high achievers and students with fail grades within the two cohorts. Methods: Using the Freedom of Information Act, we requested examination result data for the academic year 2013–2014 at St. George's Medical School, London, UK. We analyzed the number of students gaining distinction (top 7.5%) and those in the first two deciles. Results: There were 389 GE and 548 UG students in the clinical years. A total of 61.3% of the first or second decile places were awarded to GEs, with 38.7% going to UGs (P < 0.0005). The proportion of GEs achieving the first or second decile was 30.1% compared to 12.8% of UGs (P < 0.01). The proportion of GEs awarded distinction was 12.3% compared to 2.9% of UGs (P < 0.02). The total number of students failing a year at the first attempt was 103. The failure rate within each group was 12.1% for GE and 10.2% for UG. Discussion: Our study found that GE students were overrepresented in the high-achieving groups when compared to UG students. GE students were significantly more likely to be placed in the first or second decile or attain a distinction award. However, GE and UG have a similar failure rate. This study shows that GE programs are a valid entry route to medical courses in the UK.

Keywords: Exam performance, graduate-entry medicine, medical education


How to cite this article:
Knight J, Stead AP, Geyton TO. Comparing the academic performance of graduate-entry and undergraduate medical students at a UK medical school. Educ Health 2017;30:75-8

How to cite this URL:
Knight J, Stead AP, Geyton TO. Comparing the academic performance of graduate-entry and undergraduate medical students at a UK medical school. Educ Health [serial online] 2017 [cited 2019 Nov 14];30:75-8. Available from: http://www.educationforhealth.net/text.asp?2017/30/1/75/210503


  Background Top


Graduate-entry (GE) medicine-accelerated courses have existed in the UK since 1999,[1] and currently, 15 universities are running graduate programs.[2] St. George's University of London (SGUL) is one of the schools that pioneered the introduction of GE programs in the UK. This followed the UK government's initiative to increase both medical school places and the proportion of GE students.[3] This, coupled with the drive to broaden access to medical schools for those from disadvantaged backgrounds and particularly those from lower socioeconomic groups, has led to an increase in GE places in recent years.[3]

The entry requirements and course structure of a 4-year GE course are evidently different from those of a traditional 5-year undergraduate (UG) course.[4],[5] Whether the newer graduate stream is a valid option for universities in the UK has limited data. Graduate students, particularly those with previous careers, are more likely to have fostered better “personal” qualities. However, empirical evidence comparing students' performance of graduate against UG courses is sparse, particularly in the UK system.

To assess whether GE medicine is a valid route to medical school, we aimed to analyze the academic performance of GE students when compared with UG students across the three clinical years at SGUL. Primarily, we will be looking at the numbers of distinctions (top 7.5%) awarded to GE and UG students as well as the relative proportion of those students who placed in the top two decile rankings as well as those who failed the year at the first attempt.


  Methods Top


Using the Freedom of Information Act, we requested data pertaining to performance statistics of both GE and UG medical students at a London Medical School. We analyzed data from clinical years 1, 2, and 3, particularly focusing on those students awarded distinctions (top 7.5%) and those in the first or second decile (top 20%). The number of students who failed examinations at the first attempt was also compared, regardless of whether they were offered a resit or discontinued from the course. Decile rankings and awards are calculated by combining results from the year-specific knowledge test and the end-of-year practical objective structured clinical examination.

Participants included in the study were those students in clinical years 1, 2, and 3 who gained access to the course through either the traditional UG or GE route. Participants excluded from the study were those who gained access to the clinical years through transfer from biomedical sciences.

The three groups studied were students attaining a distinction, first or second decile, or fail grade, who were on the GE or UG course. Groups were compared in terms of absolute numbers within each group as well as the proportion of students represented in each group in relation to the total number of GE and UG students in each year.


  Results Top


For the academic year 2013–2014, there were a total of 389 GE and 548 UG students in their clinical years [Table 1]. Of those included in our study, graduates represented 42% (n = 389) of the cohort. Gender ratios were 47% (n = 183) males to 53% (n = 206) females on the GE course and 43% (n = 237) males and 57% (n = 311) females on the UG course.
Table 1: Number of students per clinical year in the undergraduate and graduate-entry groups combined

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The total number of students in the first or second decile across all clinical years was 185. On an average, 61.3% (n = 115) of the first or second decile places were awarded to GEs with 38.7% (n = 70) going to UGs (P< 0.0005). The proportion of GEs achieving the first or second decile was, on average, 30.1% (n = 115) compared to 12.8% (n = 70) of UGs (P< 0.01). This was calculated using the number of students from a group (GE or UG) achieving that decile compared to the groups' proportional representation in a given year (viz., clinical years 1, 2, or 3). The total number of students awarded a distinction across all the clinical years was 64. Distinctions are awarded to the students representing the top 7.5% (n = 48) of the year [Figure 1] and [Table 2]. Seventy-five percent (n = 48) of distinctions were awarded to GEs (P< 0.0005). The proportion of GEs awarded distinctions was on an average of 12.3% (n = 48) compared to 2.9% (n = 16) of UGs (P< 0.02).
Figure 1: Results showing proportions of students in each group (graduate-entry and undergraduate). Note: 1st clinical year is equivocal to 2nd graduate-entry year and 3rd undergraduate year

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Table 2: Percentage of students in the undergraduate and in the graduate-entry groups achieving distinction, first or second decile, and fail grades

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The total number of students failing a year at the first attempt across all clinical years was 103 with 47 being GEs and 56 UGs. This gives an average rate of 12.1% (n = 47) GE failure and 10.2% (n = 56) UG failure. This is not statistically significant (P< 0.5). These results were at the first attempt for that academic year and do not include students resitting examinations. The First clinical year for the academic year 2013–2014 had a very high GE failure rate of 20% (n = 29, P < 0.05) compared with an UG of 10.9% (n = 19), whereas the second and third clinical years demonstrated a GE rate of 5.8% (n = 8) and 9.3% (n = 10) compared with an UG rate of 8.1% (n = 15) and 11.8% (n = 22), respectively. Reason for this has not been found.


  Discussion Top


This study has shown a similar relative failure rate between the GE and UG students on the SGUL medicine course. However, there was a clear difference in the performance of students at the top of the cohort. In particular, a significantly greater proportion of GE students were ranked in the first or second decile and held an even stronger proportion of distinction awards. Of all the distinctions awarded, 75% went to GE students. This is more significant when viewed as a proportion as the cohort is made up of 42% GE and 58% UG students. Thus, the proportion of GE students achieving a distinction is 12% as opposed to the expected 7.5%. The proportion of UG students achieving a distinction is 3% while the expected is 7.5%.

We also see a similar pattern in the top two deciles of the year rankings. The top two deciles represent the top 20% of the cohort, and thus it would be expected that 20% of GE and 20% of UG students are distributed in the first or second decile. However, we have found that 30% of GE students achieve the first or second decile compared with 12.8% of UGs. Thus, nearly, two-thirds of the top two deciles are occupied by GE students.

Explaining a reason for the higher proportion of GE students in the high-achieving groups of the cohort is multifactorial. One reason could be an increased maturity of the GE students, particularly in regards to study methods and workload management. It could be presumed that a previous degree would produce these skills. However, by the first clinical year, the UG students had spent at least 2 years at medical school in preclinical training plus a significant number of UG students also intercalate, adding a further year of study. Therefore, although GE students have 3 years of previous study and 1 year of preclinical education, most UGs have 2–3-year preclinical education.

Differing entry criteria may be a reason for GE higher achievement. GE students need a previous degree while UG students need four A levels at grades AAAb.[4],[5] GE students sit the GAMSAT [6] entry examination while UGs sit the UKCAT.[7] GAMSAT is shown to clearly differentiate between high-scoring candidates.[8] This may also be demonstrated here in our study, as at the lower end of achievement, namely students who fail, there was a similar representation of GE and UG students.

Finally, another consideration is the variety of students entering GE medicine compared with the UG route. UG students need A level including Chemistry and Biology. This is a traditional academic requirement for medicine courses in the UK.[4] GE medicine, however, requires a previous degree in any subject.[5] This allows for more students from an arts, humanities, or social science background to gain entry. Aldous et al.[8] showed that medical students with strong humanities and science backgrounds outperform those students with strong science background alone.[2],[9]

GE programs in Australia [3] assist students from disadvantaged backgrounds in gaining a place on a medicine course. With the vast variation in available careers and specialties for a medicine graduate, it is important that medical schools do not produce a homogenized cohort of graduates.[10] Elliott and Epstein have argued that GE medical programs provide an important alternative, but not a replacement for UG-entry medical schools due, in part, to their potential to produce a variety, in character, of medical practitioners.[10]


  Conclusion Top


At SGUL, for the academic year 2013–2014, GE medicine students were overrepresented in the high-achieving groups for the three clinical years when compared to UG students. Graduate students were significantly more likely to be placed in the first or second decile or attain a distinction award. However, GE and UG have a similar failure rate.

Graduate courses produce medical students from more varied backgrounds, including the arts, humanities, and social sciences. It is important that medical schools continue to promote entry to their courses from wider social demographics. Our study has shown that GE programs constitute a valid way of doing this.

Finally, it is vital to analyze the outcomes of entrants to medical school to assist in the selection of the best candidates for medical courses.[9] This study shows that the GE route is a good mode of selection for prospective medical students.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Medical Careers. Graduate Entry Programme. Available from: http://www.medicalcareers.nhs.uk/considering_medicine/graduate_entry_programme.aspx. [Last accessed on 2014 Oct 02].  Back to cited text no. 1
    
2.
Medical Schools Council. Graduate Entry. Available from: http://www.medschools.ac.uk/Students/Courses/Pages/Graduate.aspx. [Last accessed on 2014 Oct 02].  Back to cited text no. 2
    
3.
Powis D, Hamilton J, Gordon J. Are graduate entry programmes the answer to recruiting and selecting tomorrow's doctors? Med Educ 2004;38:1147-53.  Back to cited text no. 3
    
4.
St. George's University of London. Undergraduate Courses MBBS4. Available from: http://www.sgul.ac.uk/courses/courses/undergraduate/mbbs4. [Last accessed on 2014 Oct 02].  Back to cited text no. 4
    
5.
St. George's University of London. Medicine MBBS. Available from: http://www.sgul.ac.uk/courses/undergraduate/mbbs5. [Last accessed on 2014 Oct 02].  Back to cited text no. 5
    
6.
ACER. About GAMSAT. Available from: http://www.gamsat.acer.edu.au/about-gamsat. [Last accessed on 2014 Oct 02].  Back to cited text no. 6
    
7.
UK Clinical Aptitude Test. What is the UKCAT? Available from: http://www.ukcat.ac.uk/about-the-test. [Last accessed on 2014 Oct 02].  Back to cited text no. 7
    
8.
Aldous CJ, Leeder SR, Price J, Sefton AE, Teubner JK. A selection test for Australian graduate-entry medical schools. Med J Aust 1997;166:247-50.  Back to cited text no. 8
    
9.
Rolfe IE, Pearson S, Powis DA, Smith AJ. Time for a review of admission to medical school? Lancet 1995;346:1329-33.  Back to cited text no. 9
    
10.
Elliott SL, Epstein J. Selecting the future doctors: The role of graduate medical programmes. Intern Med J 2005;35:174-7.  Back to cited text no. 10
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2]


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