McManus I C, Elder Andrew T, de Champlain Andre, Dacre Jane E, Mollon Jennifer, Chis Liliana
Department of Psychology, University College London, Gower Street, London WC1E 6BT, UK.
BMC Med. 2008 Feb 14;6:5. doi: 10.1186/1741-7015-6-5.
The UK General Medical Council has emphasized the lack of evidence on whether graduates from different UK medical schools perform 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.
We perform a retrospective analysis of the performance of 5827 doctors graduating in UK medical schools taking the Part 1, Part 2 or PACES for the first time between 2003/2 and 2005/3, and 22453 candidates taking Part 1 from 1989/1 to 2005/3.
Graduates of UK medical schools performed differently in the MRCP(UK) examination between 2003/2 and 2005/3. Part 1 and 2 performance 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.
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 between medical schools in teaching focus, content and approaches. Exploration of causal mechanisms would be enhanced by results from a national medical qualifying examination.
英国医学总会强调，目前缺乏证据表明英国不同医学院的毕业生在临床职业生涯中的表现是否存在差异。在此，我们评估了参加英国皇家内科医师资格考试（MRCP(UK)）第一部分和第二部分（均为多项选择题评估）以及实践技能与沟通技能评估（PACES，一项使用真实和模拟患者进行临床检查技能评估）的英国毕业生的表现，并探讨了医学院之间存在差异的原因。
我们对2003/2至2005/3年间首次参加第一部分、第二部分或PACES考试的5827名毕业于英国医学院的医生，以及1989/1至2005/3年间参加第一部分考试的22453名考生的成绩进行了回顾性分析。
2003/2至2005/3年间，英国医学院的毕业生在MRCP(UK)考试中的表现存在差异。牛津大学、剑桥大学和纽卡斯尔大学毕业生在第一部分和第二部分的成绩显著高于平均水平，而利物浦大学、邓迪大学、贝尔法斯特女王大学和阿伯丁大学毕业生的成绩则显著低于平均水平。在PACES（临床）考试中，牛津大学毕业生的表现显著高于平均水平，而邓迪大学、利物浦大学和伦敦大学毕业生的表现则显著低于平均水平。尽管入学前资格的差异解释了约60%的医学院成绩差异，但剩余差异仍然显著，莱斯特大学、牛津大学、伯明翰大学、纽卡斯尔大学和伦敦大学的毕业生在第一部分表现优于预期，而南安普敦大学、邓迪大学、阿伯丁大学、利物浦大学和贝尔法斯特女王大学的毕业生相对于入学前资格表现不佳。2003/2至2005/3年第一部分考试中各学校的排名与1999 - 2001年、1996 - 1998年、1993 - 1995年和1989 - 1992年的成绩相关性分别为0.723、0.654、0.618和0.493。
来自英国不同医学院的考生在MRCP(UK)考试的所有三个部分中表现不同，各部分的排名顺序一致，且1989年至2005年第一部分成绩的差异保持一致。尽管入学前资格解释了部分医学院成绩差异，但其余差异似乎并非源于职业偏好或其他选拔偏差，推测是由于医学院入学时未测量的能力差异，或医学院在教学重点、内容和方法上的差异所致。全国医学资格考试的结果将有助于加强对因果机制的探索。
