영국 의과대학 간 졸업생의 MRCP, PACES 시험 수행능력 차이(BMC Medicine, 2008)

영국 의과대학 간 졸업생의 MRCP, PACES 시험 수행능력 차이(BMC Medicine, 2008)

Graduates of different UK medical schools show substantial differences in performance on MRCP(UK) Part 1, Part 2 and PACES examinations

IC McManus*1, Andrew T Elder2, Andre de Champlain3, Jane E Dacre4, Jennifer Mollon5 and Liliana Chis5

배경

Background

GMC의 Education Committee는 2006년 보고서에서 여러 영국 의과대학 졸업생간 지식/술기/행동의 차이가 유의하게 차이가 난다는 것을 평가할 정보가 부족함을 강조하였다.

The Education Committee of the General Medical Council (GMC), in its wide-ranging report of June 2006, Strategic Options for Undergraduate Education in the United Kingdom [1], highlighted the lack of information available to assess whether graduates from different UK universities vary sig- nificantly in the knowledge, skills or behaviours which are likely to be relevant to their future competence or per- formance as doctors.

더 최근의 2007년 Tooke 보고서에서는 "국가 수준의 지식 시험"이 도입되어야 한다고 주장하면서 ,"국가시험은 의과대학 내에서의 발전을 장려할 것이며, 의과대학이 새로운 교육과정을 개발할 때 안전장치 역할을 하고, 핵심 지식과 술기가 확실히 교육되고 평가되게 해줄 것이다"라고 하였다.

The more recent Tooke Report of October 2007 has also argued, more strongly, that "a national test of knowledge" should be introduced at undergraduate level in UK medical schools, saying that "A national examination would ... encourage development within medical schools, serve as a safeguard when medical schools are developing new curricula, and ensure core knowledge and skills are taught and assessed ([2], p. 126)." 

MRCP시험에 대한 설명

The Membership of the Royal Colleges of Physicians (MRCP(UK)) examination is..

• a three-stage, high-stakes, international postgraduate medical assessment, the com- pletion of which forms a critical part of career progression for aspiring physicians in the UK, and is attempted by about 30% of all UK medical graduates.

• Medical gradu- ates from UK universities and elsewhere sit the first part of the examination as early as 18 months after graduation and most complete the third and final part within a fur- ther 3 years.

• The format of the examination has been described in detail elsewhere [3-8], and details, example questions, marking schemes, etc., can be found at the examination website [9]. Briefly, the examination consists of three parts.

• Part 1 and Part 2, which are taken sequen- tially, both consist of best-of-five multiple choice exami- nations,

• with Part 1 concentrating on diagnosis, basic management and basic medical science,

• while Part 2 has longer questions involving more complex data interpreta- tion, including photographic and other visual material, and considers more in-depth issues of diagnosis and man- agement within internal medicine.

• Both examinations are blue-printed to cover the typical range of acute and chronic conditions presenting in the wide range of patients seen in general medical practice, and the diagnos- tic, therapeutic and management options which need to considered.

• The pass mark is set by Angoff-based crite- rion-referencing coupled with a Hofstee procedure.

• The third part of the examination, Part 2 Clinical (PACES), is a clinical examination, similar in some ways to an OSCE,

• in which candidates rotate around five 20-minute sta- tions, seeing a range of patients and simulated patients, typically two or more at each station, and the candidates are required to interview, examine and discuss manage- ment options.

• Two stations are devoted to communica- tion,

• with one emphasizing the taking of history and the communication of technical information and

• the other looking at more difficult communication problems such as breaking bad news or asking permission to take organs for transplantation.

• Each candidate on each case is assessed separately and independently by two trained examiners, with different examiners at each station.

• PACES can only be taken after Part 1 and Part 2 have both been passed.

방법

Methods

주 분석

Main analysis

추가 분석

Additional analysis

시험의 세 파트에 대한 설명

The formats of the Part 1, Part 2 and PACES stages of the examination were stable between 2003/2 and 2005/3.

• The Part 1 examination comprised two separate 3-hour papers each of 100 test items in a one-answer- from-five (best-of-five) format.

• The written examination of Part2 comprised two separate 3-hour papers each of 100 questions in a one-answer-from-five (best-of-five) format until the last 2003 diet when it increased to three 3-hour papers each of 90 questions.

• The PACES examina- tion comprised a five-station, structured clinical examina- tion lasting 2 hours, incorporating 10 separate clinical encounters each of which was directly observed and assessed by two different and experienced clinician exam- iners, with each candidate being assessed by 10 examiners in total.

 

문항의 역사적 변화과정

There were three diets of Part 1, Part 2 and PACES each year.

• From 1989/1 to 2002/1 the Part 1 examination consisted of a single paper containing 300 multiple true- false items.

• From 2002/2 to 2003/1 the Part 1 exam con- sisted of a similar multiple true-false paper and a separate best-of-five exam with 100 questions.

시험점수

Examination scores

배경

Background variables

의과대학

Medical schools

Compositional variables

입학전 특성

Pre-admission qualifications

교육 퀄리티에 대한 인식

Perceptions of teaching quality

병원에서의 커리어 흥미도

Career interest in hospital medicine

MRCP Part 1 응시자 비율

Proportion of graduates taking MRCP(UK) Part 1

In Cambridge, Oxford and Edinburgh, 40%, 40% and 38% of graduates, respectively, took MRCP(UK), compared with 27%, 24% and 23% of grad- uates of Liverpool, Leicester and Birmingham, respec- tively.

MRCGP 퍼포먼스

Performance at MRCGP

MRCGP (Membership of the Royal College of General Practitioners) is the principal postgraduate assessment for doctors in the UK wishing to become general practition- ers.

가디언지 분석

The Guardian analyses

통계 분석

Statistical analysis

결과

Results

주 분석

Main analysis

다수준 모델링

Multilevel modelling

 

배경 변인의 영향

Effect of background variables

시험 영역간 관계

Correlations between examination parts

의과대학 효과

Medical school effects

 

의과대학 수준에서 Part 2의 퍼포먼스는 Part 1의 퍼포먼스와 유의한 상관관계에 있었다.

At the medical school level, performance at Part 2 corre-lated significantly with performance at Part 1 (r = 0.981, p= 0.004), with the same schools as for Part 1 showing sig-nificant differences from the mean. 

PACES시험에서 Part 1과 Part 2와의 상관관계는 Part1-Part2의 상관관계보다는 조금 낮았지만 매우 유의했다. 네 개의 학교가 평균에서 상당한 차이를 보였으며, 그 중 세 개 학교는 Part 1 과 Part 2에서도 그러하였다.

In the PACES examination, the correlation with perform-ance at Part 1 and Part 2 was a little lower than that found between Part 1 and Part 2, but was also highly significant(Part 1 with PACES: r  = 0.849, p  = 0.0114; Part 2 with PACES:  r  = 0.897, p  = 0.0096). Four schools performed significantly differently from average, three of which were also significant at Part 1 and Part 2 (Oxford above average,and Dundee and Liverpool below average) and in addi-tion London also performed significantly worse than aver-age, although London graduates had been almost precisely at the average for Parts 1 and 2

 

 

Compositional variable 분석

Analysis of compositional variables

 

19개 의과대학 수준에서 분석하였으며, '입학생 수준이 높다'라고 할 때는 '의과대학의 평균적 수준'을 이야기하는 것으로 개별 학생을 의미하는 것이아니다. 개인 수준과 의과대학 수준의 상관관계는 유사할 수 있지만 반드시 그러한 것은 아니다.

In this section we analyse data at the level of the 19 med-ical schools, and whenever phrases such as 'higher pre-admission qualifications' are used it must be emphasized that this refers to 'medical schools whose candidates have higher pre-admission qualifications' and does not  mean'individual candidates with higher pre-admission qualifi-cations'. Correlations and structural models at the indi-vidual and school level may be similar but they need not be [20], and the analyses described here are specifically at the school level of analysis. 

MRCP응시 비율이 높은 의과대학에서 'pre-admission qualifications'이 높은 경향은 있지만 의과대학의 MRCP 퍼포먼스와 응시 비율과의 상관관계는 더 약했다.

Although medical schools with a higher proportion of graduates taking MRCP(UK) tended to have higher pre-admission qualifications (r  = 0.833, p = 0.001, n  = 19), there was a weaker correlation between a medical school's performance at MRCP(UK) and the proportion of its grad-uates taking the exam (r = 0.613, p = 0.005, n = 19). 

MRCP 응시 비율은 pre-admission qualifications 를 통제했을 때 outcome을 예측하지 못했으나, pre-admission qualifications 는 응시 비율을 통제한 이후에도 유의한 예측인자였다. 따라서 MRCP에 응시하는 학생 비율은 독립적으로 효과를 가지지 않는다.

The proportion of graduates taking MRCP(UK) did not predict outcome after pre-admission qualifications were taken into account (β = -0.175, p = 0.559), whereas pre-admis-sion qualifications did predict outcome after taking into account the proportion of graduates taking MRCP(UK) (β= 0.928, p  = 0.006). There is therefore no independent effect of the proportion of a school's graduates taking MRCP(UK). 

모든 변인과 Part 1 퍼포먼스의 관계를 보았을 때 유일하게 pre-admission qualifications 만이 다중회귀분석에서 MRCP퍼포먼스를 예측하였다.

The relationship between all of the variables and Part 1performance was examined using multiple regression,and only pre-admission qualifications predicted perform-ance at MRCP(UK)

 

가디언지 평가 관련

Performance in relation to the Guardian assessments

Table 2에서 (두 세트의 데이터 모두에서) 가장 높은 상관관계를 보여주는 것은 '입학점수'였으며, 이는 '대학입학기준'에 기반한 것이었다. Forward-entry로 다중회귀분석을 하였을 때 entry score가 먼저 입력된 후 '대학입학기준'에 포함되는 다른 변인들은 유의한 예측을 하지 못하였다.

Table 2 shows correlations between the variables reported in the two compilations of data by the Guardian, and out-come at Part 1, Part 2 and PACES. The highest correla-tions, for both sets of data, are with the entry scores, whichare based on university admission criteria. Using a for-ward entry multiple regression, in which the entry score based on the 2003–2004 data was entered first, no other variables apart from university admission criteria were sig- nificant predictors of Part 1, Part 2 or PACES performance.

 

 

 

 

 

 

Additional analysis

 

 

 

고찰

Discussion

 

우리의 결과를 보면, 서로 다른 영국 의과대학에서 교육받은 학생들은 MRCP시험에서 서로 다른 수행능력을 보인다. Part 1을 한 번에 통과한 학생이 높은 3개 대학과 낮은 4개 대학.

Our analysis shows that candidates who have trained at different UK medical schools perform differently in the MRCP(UK) examination. In 2003–2005, 91%, 76% and 67% of students from Oxford, Cambridge and Newcastle passed Part 1 at their first attempt, compared with 32%, 38%, 37% and 41% of Liverpool, Dundee, Belfast and Aberdeen graduates, so that, for instance, twice as many Newcastle graduates pass the exam first time compared with Liverpool graduates (odds ratio = 4.3×).

의과대학 수준에서 Part 1의 퍼포먼스는 Part 2의 퍼포먼스와 거의 완벽한 상관관계를 보이나, (실기시험인) PACES와의 상관관계에서는 (여전히 높긴 하지만) 순위에 약간의 차이를 보인다.

At the medical school level, performance at Part 1 corre- lates almost perfectly with performance at Part 2 (and both are multiple-choice examinations), while perform- ance at PACES, which is a clinical examination, still corre- lates highly with Parts 1 and 2, although there are some small changes in rank order,

개인 수준에서 졸업시험의 결과가 학부의학교육과 졸업후커리어에서의 퍼포먼스를 예측한다는 것은 알려진 바 있다. 비록 'pre-admission academic qualifications'가 MRCP Part 1 수행능력과 의과대학 수준에서 유의한 상관관계에 있었지만, 이러한 관계는 Part1과 Part2와의 관계에 비하면 훨씬 낮았다 'pre-admission academic qualifications '는 따라서 전체 변인 중 62%정도를 설명하는 것이며, 38%는 학교-수준의 변이 또는 다른 알려지지 않은 것에 의한 것이라 볼 수 있다. 성별과 인종에 따른 차이가 다수준 모델에 포함되었으므로, 의과대학 수준에서 인종이나 성별에 따른 차이는 없다.

School-leaving examinations are known at the individual level to predict performance in undergraduate medical examinations and in postgraduate careers [23,24]. Although pre-admission academic qualifications correlate significantly with MRCP(UK) Part 1 performance at the medical school level (r = 0.779), that correlation is sub- stantially less than the correlation found between Part 1 and Part 2 of the examination (r = 0.992). Pre-admission qualifications therefore account for about 62% of the accountable variance, leaving about 38% of the school- level variance dependent on other, unknown, factors. It should be emphasized that because sex and ethnic origin have been entered into the multilevel model at an individ- ual level, there can be no differences at medical school level attributable to ethnicity or sex.

이러한 결과는 크게 selection effect, training effect, career preference의 세 가지로 설명될 수 있다.

There are at least three broad types of explanation for the differences we have found: differences in those entering the schools (selection effects); differences in education or training at the school (training effects); or differences owing to students from different schools preferring differ- ent postgraduate careers (career preference effects).

개인 수준에서 A-레벨 결과가 MRCP Part 1의 퍼포먼스와 상관관계가 있었고, 의과대학마다 'pre-admission academic qualifications'에 명확한 차이가 있었다. 우리의 compositional variable 분석은 의과대학 간 차이의 절반 이상은 어떤 학생이 입학하느냐에 따라 달려있다는 것을 보여주며, 가디언지 자료를 분석한 것도 이를 지지한다.

At the individual level it is known that A- level results correlate with performance in MRCP(UK) Part 1 [24] and there are also clear differences in the aver- age pre-admission qualifications of applicants receiving offers at different medical schools (see Figure 2). Our analysis of compositional variables leaves little doubt that one-half or more of the variance between schools can be explained by differences in intake, and that is supported by the correlations found with the data reported in the Guardian tables,

특히, MRCP의 퍼포먼스는 'pre-admission academic qualifications'로만 예측한것에 비해서 일부 의대에서는 1SD만큼 높거나 1SD만큼 낮았다. 그러나 London의 under-performance는 어떤 것으로도 잘 설명되지 않는다.

In particular, MRCP(UK) performance is about one SD higher than predicted from pre-admission qualifications alone for Leicester, Oxford, Birmingham, Newcastle-upon-Tyne and London, and about one SD lower than expected for Southampton, Dundee, Aber- deen, Liverpool and Belfast. Neither differences in pre-admission qualifications can explain the relative under- performance of London graduates at PACES, compared with Part 1 and Part 2

커리어 선호도가 MRCP 수행능력에 영향을 주었을 수 있는데, 왜냐하면 서로 다른 전공에 대한 자기-선택의 형태로 나타날 수 있기 때문이다. 예컨대 Park house보고에 따르면, 1974년과 1983년 사이에 hospital medicine이 특별히 유행했던 대학과 유행하지 않았던 대학이 있다.

Career preference effects would occur if the differential performance of graduates on MRCP(UK) reflects a form of self-selection into different specialities (and Park house reported, for instance, that amongst those qualifying between 1974 and 1983 that hospital medicine was par-ticularly popular for Oxford, London and Wales gradu-ates, and particularly unpopular for Aberdeen, Dundee and Leicester graduates [25])

그러나 만약 그러한 유행이 영향을 주었다면, 한 학교에서 더 학문적으로 능력이 있는 학생이 특정 과를 선호하고, 그렇지 않은 학생은 다른 과를 선택하여 퍼포먼스의 상관관계와 시험 응시 비율이 유의미하지 않아야 할 것이다.

 If popularity also equated to status and kudos, then it might be that the most academ-ically gifted students at one school might prefer to go into one particular speciality, whereas at another school they might prefer a different speciality. However, the correlation of performance and the proportion taking the exam was non-significant after pre-admission qualifications are taken into account. 

의과대학마다 그들이 얼마만큼의 '가치'를 더하느냐에 차이가 있을 것이며 이는 중등교육에서 잘 알려진 사실이다.

Institutions can differ in the amount of 'value' that theyadd, an effect well known in secondary education [26]. 

만약 커리어 선호와 'pre-admission qualifications'가 모든 차이를 설명하지 못한다면, 논리적인 결론은 의과대학 내에서의 training의 퀄리티 차이이다.

 If career preferences and pre-admission qualifications cannot explain all of the differences between medical schools,then a reasonable conclusion is that that medical schools also differ in the quality of their training in general medi-cine. 

그러나 가디언지의 자료에서 교육과 관련한 그 어떤 척도도 MRCP퍼포먼스와 관련이 있지 않았다.

However, it is of interest that none of the teaching-related measures in the Guardian compilations correlate with MRCP(UK) performance.

MRCP시험은 커리어의 초반에 치르게 된다. 우리 연구에서 의과대학의 교육이 퍼포먼스에 미치는 영향을 보여주는 근거는 recency of graduation이 모든 세 파트에서 퍼포먼스의 예측인자였다는 것이다. 의과대학 간 차이를 보여주는 계수는 Part 1에서 가장 컸고 PACES에서 가장 작았는데, 이는 시간이 흐름에 따라서 학부교육의 효과가 희석됨을 보여준다.

The MRCP(UK) examinations are typically taken early in the career, The impact of university teaching on perform-ance is supported by our finding that recency of gradua-tion is a predictor of performance in all three parts of the examination. The coefficient of variation for medical school differences was largest for Part 1 and smallest for PACES, suggesting that postgraduate education dilutes the effects of undergraduate training as time passes.

의과대학 학생이 교육이 '매우 흥미롭다'라고 응답할수록 MRCP에서 더 잘했다는 사실은 흥미롭다. 그러나 이러한 효과는 'pre-admission qualifications'에 부차적인 것으로, 'pre-admission qualifications'이 높은 학교의 학생들이 의학 수업이 더 흥미롭다고 응답했다.

It is interesting that when a university's students are more likely to report that the teaching of medicine is 'very interesting', then graduates subsequently perform better at MRCP(UK). However, that effect does seem to be secondary to pre-admission qualifications, with students from schools with higher pre-admission qualifications also reporting the teaching of medicine to be more inter- esting.

모든 의과대학에 있어서 또 다른 교란변수는 교육과정의 지속적 변화이다. 그러나 우리의 Part 1에 대한 추가적 분석은 1989년에까지 거슬러 올라가며, 이러한 결과가 지속적long-standing이며, GMC의 TD에 의해서 시작된 의학교육의 변화에 의해서 설명되는 부분은 아주 미미함을 보여준다. 

An additional confounding issue for all schools of medi- cine is the constant change in curricula. However, our additional analysis of Part1 data going back to those tak- ing the exam in 1989 (who would have entered medical school in about 1982) shows that the broad pattern of results we have found is long-standing, and therefore could only partly be explained by the changes in medical education initiated by the GMC in Tomorrow's Doctors in 1993 [27].

개별 의과대학에 대한 더 자세한 분석으로부터 1989년과 2005년 사이에 의과대학간 퍼포먼스의 변이가 매우 적었음을 확인할 수 있다. PBL이 도입된 의과대학이라도 효과가 큰 곳과 그렇지 않은 곳이 있었다. 많은 성과의 향상이 있었음에도 London의 재조직화는 많은 비판을 받았다. 옥스포드와 캠브리지는 1990년대 후반에 급격한 퍼포먼스의 향상을 보여주었으며 웨일즈도 마찬가지였다. 다른 학교들은 약간의 변동이 있었으나, 전반적으로는 일관된 인상을 주었으며, 교육과정 등의 변화가 상대적인 퍼포먼스에 별로 영향을 주지 않는 것으로 보인다.

A detailed examination of individual medical schools (see Figures S11a-11e in additional file 1) shows that for many schools there has been little variation in rel- ative performance between 1989 and 2005. Problem- based learning, introduced in Glasgow, Liverpool and Manchester, has had little obvious impact in the latter two schools, although performance did increase in Glasgow. Despite many, much criticised reorganizations in London, performance overall has improved. Oxford and Cam- bridge both showed sudden increases in performance in the late 1990s, as did Wales. Other schools showed fluctu- ations, but the overwhelming impression is of constancy rather than change, suggesting that curricular and other changes have had little impact on relative performance of schools.

MRCP는 지필시험과 실기시험으로 나뉘는데, 시험이 의사에게 요구되는 모든 지식/술기/태도를 평가할 수는 없다. 물론 내과적 진단과 관리를 포괄적으로 다루며 PACES는 광범위한 실제적 술기를 평가한다.

The MRCP(UK) consists of both written and clinical examinations, and detailed analyses of its rationale and behaviour have been presented elsewhere [3-8]. Of course, the examination does not assess the entire range of knowledge, skills and attitudes necessary to be a success- ful physician, although it does cover diagnosis and man- agement within internal medicine comprehensively, and the PACES examination assesses a wide range of practical skills,

그러나 MRCP는 모든 필요한 역량을 평가할 수 없으며, 평가되지 않는 어떤 역량은 의과대학마다 다른 순위를 보일 수도 있다.

However, MRCP(UK) cannot assess all of the necessary competencies and it is possible that some of those not assessed are also inculcated better by some med- ical schools than others, and this possibility must await further evidence from other sources.

 

 

결론

Conclusion

 

Tooke 보고서

The Tooke Report of October 2007 [2] stated that British medical education urgently needed,

" ... answers to some fundamental questions. How does an individual student from one institution compare with another from a different institution? Where should that student be ranked nationally? Are there any predictors for later careers choices and are these evident in undergraduate training? Which medical schools' students are best prepared for the Foundation Years and, crucially, what makes the difference?" ([2], p. 127)

 

GMC 보고서에서도 국가시험의 필요성을 강조했지만 의과대학 간 차이를 보여주는 증거가 불충분하다고 했다. 그러나 근거가 부족하다는 것이 근거가 없다는 것은 아니며, 의과대학마다 상당한 차이가 있다고 믿을 만한 이유는 충분하다. 미국에서도 의과대학마다 malpractice claims을 받을 가능성이 모두 다르다.

The earlier GMC report of June 2006, Strategic Options for Undergraduate Medical Education [1], had also included a discussion on the potential need to introduce a national medical assessment to ensure that all UK medical gradu- ates have attained an agreed minimum standard of com- petence. However, the report also highlighted the very limited evidence that existed to support the contention that significant differences in ability existed between grad- uates of different UK universities. However, an absence of evidence is not evidence of absence, and there are many reasons to believe that schools might differ [28]; a study in the US, for instance, found that graduates of different medical schools differed in their likelihood of malpractice claims [29]. We believe that our data provide a prima facie case that differences in performance exist between UK medical schools, and thus support the case for the routine collection and audit of performance data of UK medical graduates at all postgraduate examinations, as well as the introduction of a national licensing examination.

 

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BMC Med. 2008 Feb 14;6:5. doi: 10.1186/1741-7015-6-5.

Graduates of different UK medical schools show substantial differences in performance on MRCP(UK) Part 1,Part 2 and PACES examinations.

McManus IC1, Elder AT, de Champlain A, Dacre JE, Mollon J, Chis L.

Author information

• 1Department of Psychology, University College London, Gower Street, London WC1E 6BT, UK. i.mcmanus@ucl.ac.uk

Abstract

BACKGROUND:

The UK General Medical Council has emphasized the lack of evidence on whether graduates from different UK medical schoolsperform differently in their clinical careers. Here we assess the performance of UK graduates who have taken MRCP(UK) Part 1 and Part 2, which are multiple-choice assessments, and PACES, an assessment using real and simulated patients of clinical examination skills and communication skills, and we explore the reasons for the differences between medical schools.

METHOD:

We perform a retrospective analysis of the performance of 5827 doctors graduating in UK medical schools taking the Part 1, Part 2 orPACES for the first time between 2003/2 and 2005/3, and 22453 candidates taking Part 1 from 1989/1 to 2005/3.

RESULTS:

Graduates of UK medical schools performed differently in the MRCP(UK) examination between 2003/2 and 2005/3. Part 1 and 2performance of Oxford, Cambridge and Newcastle-upon-Tyne graduates was significantly better than average, and the performance of Liverpool, Dundee, Belfast and Aberdeen graduates was significantly worse than average. In the PACES (clinical) examination, Oxford graduates performed significantly above average, and Dundee, Liverpool and London graduates significantly below average. About 60% of medical school variance was explained by differences in pre-admission qualifications, although the remaining variance was still significant, with graduates from Leicester, Oxford, Birmingham, Newcastle-upon-Tyne and London overperforming at Part 1, and graduates from Southampton, Dundee, Aberdeen, Liverpool and Belfast underperforming relative to pre-admission qualifications. The ranking of schools at Part 1 in 2003/2 to 2005/3 correlated 0.723, 0.654, 0.618 and 0.493 with performance in 1999-2001, 1996-1998, 1993-1995 and 1989-1992, respectively.

CONCLUSION:

Candidates from different UK medical schools perform differently in all three parts of the MRCP(UK) examination, with the ordering consistent across the parts of the exam and with the differences in Part 1 performance being consistent from 1989 to 2005. Although pre-admission qualifications explained some of the medical school variance, the remaining differences do not seem to result from career preference or other selection biases, and are presumed to result from unmeasured differences in ability at entry to the medical school or to differences betweenmedical schools in teaching focus, content and approaches. Exploration of causal mechanisms would be enhanced by results from a nationalmedical qualifying examination.

PMID:

 

18275598

 

PMCID:

 

PMC2265293

 

DOI:

 

10.1186/1741-7015-6-5

[PubMed - indexed for MEDLINE] 

Free PMC Article