Exploring UK medical school differences: the MedDifs study of selection, teaching, student and F1 perceptions, postgraduate outcomes and fitness to practise
Authors: McManus I. C. , Harborne Andrew Christopher , Horsfall Hugo Layard , Joseph Tobin , Smith Daniel T. , Marshall-Andon Tess , Samuels Ryan , Kearsley Joshua William , Abbas Nadine , Baig Hassan , Beecham Joseph , Benons Natasha , Caird Charlie , Clark Ryan , Cope Thomas , Coultas James , Debenham Luke , Douglas Sarah , Eldridge Jack , Hughes-Gooding Thomas , Jakubowska Agnieszka , Jones Oliver , Lancaster Eve , MacMillan Calum , McAllister Ross , Merzougui Wassim , Phillips Ben , Phillips Simon , Risk Omar , Sage Adam , Sooltangos Aisha , Spencer Robert , Tajbakhsh Roxanne , Adesalu Oluseyi , Aganin Ivan , Ahmed Ammar , Aiken Katherine , Akeredolu Alimatu-Sadia , Alam Ibrahim , Ali Aamna , Anderson Richard , Ang Jia Jun , Anis Fady Sameh , Aojula Sonam , Arthur Catherine , Ashby Alena , Ashraf Ahmed , Aspinall Emma , Awad Mark , Yahaya Abdul-Muiz Azri , Badhrinarayanan Shreya , Bandyopadhyay Soham , Barnes Sam , Bassey-Duke Daisy , Boreham Charlotte , Braine Rebecca , Brandreth Joseph , Carrington Zoe , Cashin Zoe , Chatterjee Shaunak , Chawla Mehar , Chean Chung Shen , Clements Chris , Clough Richard , Coulthurst Jessica , Curry Liam , Daniels Vinnie Christine , Davies Simon , Davis Rebecca , De Waal Hanelie , Desai Nasreen , Douglas Hannah , Druce James , Ejamike Lady-Namera , Esere Meron , Eyre Alex , Fazmin Ibrahim Talal , Fitzgerald-Smith Sophia , Ford Verity , Freeston Sarah , Garnett Katherine , General Whitney , Gilbert Helen , Gowie Zein , Grafton-Clarke Ciaran , Gudka Keshni , Gumber Leher , Gupta Rishi , Harlow Chris , Harrington Amy , Heaney Adele , Ho Wing Hang Serene , Holloway Lucy , Hood Christina , Houghton Eleanor , Houshangi Saba , Howard Emma , Human Benjamin , Hunter Harriet , Hussain Ifrah , Hussain Sami , Jackson-Taylor Richard Thomas , Jacob-Ramsdale Bronwen , Janjuha Ryan , Jawad Saleh , Jelani Muzzamil , Johnston David , Jones Mike , Kalidindi Sadhana , Kalsi Savraj , Kalyanasundaram Asanish , Kane Anna , Kaur Sahaj , Al-Othman Othman Khaled , Khan Qaisar , Khullar Sajan , Kirkland Priscilla , Lawrence-Smith Hannah , Leeson Charlotte , Lenaerts Julius Elisabeth Richard , Long Kerry , Lubbock Simon , Burrell Jamie Mac Donald , Maguire Rachel , Mahendran Praveen , Majeed Saad , Malhotra Prabhjot Singh , Mandagere Vinay , Mantelakis Angelos , McGovern Sophie , Mosuro Anjola , Moxley Adam , Mustoe Sophie , Myers Sam , Nadeem Kiran , Nasseri Reza , Newman Tom , Nzewi Richard , Ogborne Rosalie , Omatseye Joyce , Paddock Sophie , Parkin James , Patel Mohit , Pawar Sohini , Pearce Stuart , Penrice Samuel , Purdy Julian , Ramjan Raisa , Randhawa Ratan , Rasul Usman , Raymond-Taggert Elliot , Razey Rebecca , Razzaghi Carmel , Reel Eimear , Revell Elliot John , Rigbye Joanna , Rotimi Oloruntobi , Said Abdelrahman , Sanders Emma , Sangal Pranoy , Grandal Nora Sangvik , Shah Aadam , Shah Rahul Atul , Shotton Oliver , Sims Daniel , Smart Katie , Smith Martha Amy , Smith Nick , Sopian Aninditya Salma , South Matthew , Speller Jessica , Syer Tom J. , Ta Ngan Hong , Tadross Daniel , Thompson Benjamin , Trevett Jess , Tyler Matthew , Ullah Roshan , Utukuri Mrudula , Vadera Shree , Van Den Tooren Harriet , Venturini Sara , Vijayakumar Aradhya , Vine Melanie , Wellbelove Zoe , Wittner Liora , Yong Geoffrey Hong Kiat , Ziyada Farris , Devine Oliver Patrick 
Published: May 2020

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 includeinstitutional 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 andfitness 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 withp < 0.05, and 201 (16.4%) reached a Tukey-adjusted criterion ofp < 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 reportedgreaterstudent satisfaction with feedback also showedlowerperformance 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.